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Scheurle A, Kunisch E, Boccaccini AR, Walker T, Renkawitz T, Westhauser F. Boric acid and Molybdenum trioxide synergistically stimulate osteogenic differentiation of human bone marrow-derived mesenchymal stromal cells. J Trace Elem Med Biol 2024; 83:127405. [PMID: 38325181 DOI: 10.1016/j.jtemb.2024.127405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Metals and their metal ions have been shown to exhibit certain biological functions that make them attractive for use in biomaterials, for example in bone tissue engineering (BTE) applications. Recent data shows that Molybdenum (Mo) is a potent inducer of osteogenic differentiation in human bone marrow-derived mesenchymal stromal cells (BMSCs). On the other hand, while boron (B) has been shown to enhance vascularization in BTE applications, its impact on osteogenic differentiation is volatile: while improved osteogenic differentiation has been described, other data show that B might slow down osteogenic differentiation or reduce the calcification of the extracellular matrix (ECM) when applied in higher doses. Still, the combination of pro-osteogenic Mo and pro-angiogenic B is certainly attractive in the context of biomaterials intended for the use in BTE. METHODS Therefore, the combined effect of molybdenum trioxide and boric acid at different ratios was investigated in this study to evaluate the effects on the viability, proliferation, osteogenic differentiation, ECM production and maturation of BMSCs. RESULTS Mo ions proved to be stronger osteoinductive compared to B, in fact, while some osteogenic differentiation markers were downregulated in the presence of B, the presence of Mo provided compensation. The combined application of B and Mo indicated a combination of individual effects, partially even enhancing the expected combined performance of the single stimulations. CONCLUSIONS The combination of B and Mo might be beneficial for BTE applications since the limited osteogenic properties of B can be compensated by Mo. Furthermore, since B is known to be pro-angiogenic, the combination of both substances may synergistically lead to improved vascularization and bone regeneration. Future studies should assess the angiogenic performance of this combination in greater detail.
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Affiliation(s)
- A Scheurle
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - E Kunisch
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - A R Boccaccini
- Institute of Biomaterials, University of Erlangen-Nuremberg, Erlangen, Germany
| | - T Walker
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - T Renkawitz
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - F Westhauser
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany.
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Forbes VE, Chamberlin MD, Dusabejambo V, Walker T, Bensen SP, Haynes N, Nunes K, Saint-Joy V, Makrauer FL. Education and Training Models for Remote Learning. Hematol Oncol Clin North Am 2024; 38:185-197. [PMID: 37635048 DOI: 10.1016/j.hoc.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Our international partnerships have fostered longstanding collaborative relationships leading to the development of unique, locally-designed, and sustainable training programs that serve as models for global health education and cooperation.
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Affiliation(s)
- Victoria E Forbes
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - Mary D Chamberlin
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive Lebanon, NH 03756, USA
| | - Vincent Dusabejambo
- University of Rwanda College of Medicine and Health Sciences, KG 11 Avenue, Kigali, Rwanda
| | - Tim Walker
- Calvary Mater Newcastle, 20 Edith Street, Waratah NSW 2298, Australia
| | - Steve P Bensen
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive Lebanon, NH 03756, USA
| | - Norrisa Haynes
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Kathryn Nunes
- Sidney Kimmel Medical College, 1025 Walnut Street, #100, Philadelphia, PA 19107, USA
| | - Veauthyelau Saint-Joy
- Centre Hospitalier de la Basse-Terre, 97100 Avenue, Gaston Feuillard, Basse-Terre 97109, Guadeloupe, France
| | - Frederick L Makrauer
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Walker T, Buckingham SA, Poole R, Elliott LR, Menneer T, Tu G, Morrissey K. Telephone-Based Training Intervention for Using Digital Communication Technologies for Social Housing Residents During the COVID-19 Pandemic: Mixed Methods Feasibility and Acceptability Evaluation. JMIR Form Res 2024; 8:e45506. [PMID: 38277209 PMCID: PMC10858426 DOI: 10.2196/45506] [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: 01/04/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND In an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion. OBJECTIVE This study aims to evaluate the feasibility and acceptability of a telephone-based training intervention designed to empower people to confidently use digital communication technologies (ie, video calls and web-based messaging). METHODS Conducted in collaboration with a UK social housing association, the intervention was facilitated by a unitary authority's Digital Inclusion Team during the COVID-19 pandemic. A mixed methods approach was used, encompassing quantitative and qualitative data collection on demand, reach, implementation, and potential outcomes. Demographic and qualitative data on the reasons for undertaking or not undertaking the training were collected via telephone interviews during the recruitment process. Digital competency and well-being data were collected via a self-reported survey before and after the intervention. RESULTS Among the 4485 residents who were offered training, 67 (1.49%) expressed interest, of whom 12 (18%) of the 67 completed the training. The findings indicate a demand for basic digital training among social housing residents. The key findings revolve around the substantial dropout rate among those who were interested in undertaking the training. Barriers were strongly influenced by socioeconomic and health circumstances, reflecting the sociodigital inequalities commonly found in this group. For the training participants, the intervention was acceptable and achieved its goals, demonstrating the potential of tailored, persistent training efforts in overcoming barriers. There were no changes in self-reported well-being or digital competency outcomes (but this was limited by the small sample size). CONCLUSIONS Sociodigital inequalities impact the reach, implementation, and acceptability of telephone-based digital training for social housing residents. Barriers to reaching and training digitally excluded groups can be overcome through the use of trusted intermediaries, personalized recruitment approaches, the minimization of administrative barriers, and tailored and agile training programs. Recognizing the resource-intensive nature of such initiatives, this study calls for enhanced recognition of intermediary efforts in national digital inclusion policies.
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Affiliation(s)
- Tim Walker
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Sarah Ann Buckingham
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Ria Poole
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Lewis Roland Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Tamaryn Menneer
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Gengyang Tu
- International Business School Suzhou, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Karyn Morrissey
- Department of Technology, Management and Economics, Technical University of Denmark, Lyngby, Denmark
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Buckingham S, Tu G, Elliott L, Poole R, Walker T, Bland E, Morrissey K. Digital competence and psychological wellbeing in a social housing community: a repeated survey study. BMC Public Health 2023; 23:2002. [PMID: 37833698 PMCID: PMC10576269 DOI: 10.1186/s12889-023-16875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Little is known about whether digital competence is related to psychological wellbeing, with most previous research focusing on students and elderly people. There is also limited evidence on seasonal changes in psychological wellbeing, particularly in specific groups. Social housing residents are an underserved and under-researched population. The objectives of this study were to explore associations between digital competence (assessed by general technology self-efficacy) and psychological wellbeing (assessed by mental wellbeing and life satisfaction), and to explore seasonal effects, in social housing residents. METHODS A repeated survey design was used. The Happiness Pulse questionnaire with a bespoke digital module was sent via post or e-mail at four timepoints between July 2021 and July 2022 to 167 social housing residents in West Cornwall, England. There were 110 respondents in total; thirty completed all four questionnaires and 59 completed an autumn/winter and summer questionnaire. Data were analysed using descriptive and inferential methods including regression, repeated measures analysis of variance and panel analysis. RESULTS Significant positive associations were found between digital self-efficacy and mental wellbeing, and between digital self-efficacy and life satisfaction. However, there were no significant seasonal changes in psychological wellbeing. CONCLUSIONS The findings extend the existing literature beyond student and elderly populations and suggest that improving digital competence is a potential pathway to improving psychological wellbeing. Surveys with larger samples and qualitative studies are needed to elucidate the mechanisms involved.
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Affiliation(s)
- Sarah Buckingham
- European Centre for Environment and Human Health, Medical School, University of Exeter, Truro, UK
| | - Gengyang Tu
- International Business School Suzhou, Xi'an Jiaotong-Liverpool University, 111 Ren'ai Rd, Suzhou, 215123, Jiangsu, China
| | - Lewis Elliott
- European Centre for Environment and Human Health, Medical School, University of Exeter, Truro, UK
| | - Ria Poole
- European Centre for Environment and Human Health, Medical School, University of Exeter, Truro, UK
| | - Tim Walker
- Centre for Geography and Environmental Science, University of Exeter, Penryn, UK
| | - Emma Bland
- European Centre for Environment and Human Health, Medical School, University of Exeter, Truro, UK.
| | - Karyn Morrissey
- Sustainability, Society and Economics Division, Department of Technology, Management and Economics, Technical University of Denmark, Lyngby, Denmark
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Westhauser F, Doll J, Bangert Y, Walker T, Reiner T, Renkawitz T. [Treatment of unicompartmental osteoarthritis of the knee]. Orthopadie (Heidelb) 2023:10.1007/s00132-023-04391-5. [PMID: 37318534 DOI: 10.1007/s00132-023-04391-5] [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] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/16/2023]
Abstract
Osteoarthritis of the knee is one of the most important degenerative joint diseases in the clinical routine. The treatment of knee osteoarthritis is not only based on the stage, symptoms and duration of the joint disease, but also depends on the existing arthrosis pattern. In the case of unicompartmental arthrosis, damage typical for osteoarthritis is limited to just one joint compartment. Both the conservative and the surgical treatment of unicompartmental osteoarthritis of the knee have to respect the individual characteristics of the respective forms of osteoarthritis. In the context of this manuscript, the genesis, the diagnostics and the guideline-based stage-adapted conservative and operative treatment of unicompartmental osteoarthritis of the knee are addressed.
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Affiliation(s)
- F Westhauser
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - J Doll
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Y Bangert
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Walker
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Reiner
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
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Bruhaug G, Rinderknecht HG, E Y, Wei MS, Brannon RB, Guy D, Peck RG, Landis N, Brent G, Fairbanks R, McAtee C, Walker T, Buczek T, Krieger M, Romanofsky MH, Milhem C, Francis KG, Zhang XC, Collins GW, Rygg JR. Development of a hardened THz energy meter for use on the kilojoule-scale, short-pulse OMEGA EP laser. Rev Sci Instrum 2022; 93:123502. [PMID: 36586943 DOI: 10.1063/5.0099328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
A highly adaptable and robust terahertz (THz) energy meter is designed and implemented to detect energetic THz pulses from high-intensity (>1018 W/cm2) laser-plasma interactions on the OMEGA EP. THz radiation from the laser driven target is detected by a shielded pyrometer. A second identical pyrometer is used for background subtraction. The detector can be configured to detect THz pulses in the 1 mm to 30 μm (0.3- to 10-THz) range and pulse energies from joules to microjoules via changes in filtration, aperture size, and position. Additional polarization selective filtration can also be used to determine the THz pulse polarization. The design incorporates significant radiation and electromagnetic pulse shielding to survive and operate within the OMEGA EP radiation environment. We describe the design, operational principle, calibration, and testing of the THz energy meter. The pyrometers were calibrated using a benchtop laser and show linear sensitivity to up to 1000 nJ of absorbed energy. The initial results from four OMEGA EP THz experiments detected up to ∼15μJ at the detector, which can correspond to hundreds of mJ depending on THz emission and reflection models.
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Affiliation(s)
- G Bruhaug
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - H G Rinderknecht
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - Y E
- The Institute of Optics, University of Rochester, Rochester, New York 14627, USA
| | - M S Wei
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - R B Brannon
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - D Guy
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - R G Peck
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - N Landis
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - G Brent
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - R Fairbanks
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - C McAtee
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - T Walker
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - T Buczek
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - M Krieger
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - M H Romanofsky
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - C Milhem
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - K G Francis
- The Institute of Optics, University of Rochester, Rochester, New York 14627, USA
| | - X C Zhang
- The Institute of Optics, University of Rochester, Rochester, New York 14627, USA
| | - G W Collins
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J R Rygg
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
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Kliewer M, Walker T, Bagley AR. Toward Ergonomic Design in Ultrasound Scanning: Strategies to Mitigate Injurious Forces. Ultrasound Q 2022; 38:65-71. [PMID: 35239630 DOI: 10.1097/ruq.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sonographers experience stress-related musculoskeletal injuries at alarming rates. The magnitude of the problem has resulted in substantial economic and human costs. Early efforts, such as the transposition of office ergonomic models to the ultrasound suite, have been only marginally successful because of the vast difference between clerical and sonography work demands. In addition, although the issue has attracted the attention of professional sonographer societies, equipment manufacturers, and governmental agencies, such as the OSHA (Occupational Safety and Health), the causative mechanisms by which sonographers are injured remain inadequately addressed. A definitive ergonomic solution has been elusive.With the help of occupational therapists and biomechanical engineers, we have developed a number of possible ergonomic modifications of ultrasound equipment. We explain the rationale behind these approaches to transducer design and assess the strengths and deficiencies of each.
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Affiliation(s)
- Mark Kliewer
- Department of Radiology, University of Wisconsin School of Medicine, Madison, WI
| | - Tim Walker
- Department of Radiology, University of Wisconsin School of Medicine, Madison, WI
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Buckingham SA, Walker T, Morrissey K. The feasibility and acceptability of digital technology for health and wellbeing in social housing residents in Cornwall: A qualitative scoping study. Digit Health 2022; 8:20552076221074124. [PMID: 35096410 PMCID: PMC8793427 DOI: 10.1177/20552076221074124] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this study was to explore the feasibility and acceptability of digital technology for improving health and wellbeing in social housing residents living in a deprived area in Cornwall, England. Methods Qualitative scoping study with focus groups and telephone interviews (23 participants in total). Focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Levels of use and experience with digital technology were diverse in this group, ranging from ‘willing and unable’ to ‘expert’ on a self-perceived scale. Overall, participants had positive perceptions of technology and were keen to try new technologies. Five categories of factors influencing technology use were identified: functional, physical / health, psychological and attitudinal, technology-associated barriers, and privacy, safety and security. Preferred types of digital technology were wearable activity monitors (e.g. Fitbit®), virtual assistants (e.g. Amazon Alexa) and social messaging (e.g. WhatsApp). There was a strong consensus that technology should be easy to use and should have a clear purpose. There was a need to improve awareness, knowledge and confidence in technology use and participants desired further training and support. Conclusions There is a need and desire to use digital technology to improve health, wellbeing and social connectedness in social housing residents in Cornwall. The findings will be used to inform a digital training and support programme for the participants of the Smartline project. This study also serves as a template for future research that seeks to scope the feasibility and acceptability of different digital interventions in similar populations.
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Affiliation(s)
- Sarah Ann Buckingham
- European Centre for Environment and Human Health, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK
| | - Tim Walker
- Centre for Geography and Environmental Science, University of Exeter, Penryn, UK
| | - Karyn Morrissey
- Sustainability Division, Department of Technology, Management and Economics, Technical University of Denmark
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Kaputu-Kalala-Malu C, Musalu EM, Walker T, Ntumba-Tshitenge O, Ahuka-Mundeke S. PTSD, depression and anxiety in Ebola virus disease survivors in Beni town, Democratic Republic of the Congo. BMC Psychiatry 2021; 21:342. [PMID: 34238249 PMCID: PMC8265146 DOI: 10.1186/s12888-021-03343-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/08/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Ebola Virus Disease (EVD) is a deadly and feared infectious disease, which can be responsible of debilitating physical and psychological sequelae in survivors including depression and anxiety disorders. Unfortunately, there are scarce data on survivor sequelae in Democratic Republic of the Congo. So this study assessed PTSD, depression and anxiety symptoms among EVD survivors enrolled in the follow-up program of the psychosocial care team of Beni town's general hospital. METHODS A cross-sectional study used consecutive sampling to recruit 144 Ebola virus disease survivors who came for follow up from October 23 to November 13; 2019. Basic socio-demographic data, presence of headache and short-term memory function were assessed. The Post-traumatic Checklist Scale and Hospital Anxiety and Depression Scale were used to assess psychological burden among participants. Descriptive statistics were used to summarized data and Pearson's or likelihood chi-square were used to test association between psychiatric disorders and associated factors. RESULTS The prevalence of PTSD, depression and anxiety was 24.3, 24.3 and 33.3% respectively. Being male (OR = 0.42, 95% CI: 0.16, 0.95, p = 0.049), suffering from persistent headache (OR = 2.62, 95% CI: 1.12, 6.14, p = 0.014), losing a loved one because of EVD (OR: 2.60, 95% CI: 1.11, 6.15, p = 0. 015) and being young - 18-24 years - (OR: 0. 261, 95% CI: 0. 08, 0.82, p = 0,026) were statistically associated with PTSD diagnosis. Having short-term memory impairment and suffering from persistent headache were statistically associated with depression and anxiety diagnoses (OR = 2.44, 95% CI: 1.03, 5.82, p = 0.026); (OR = 2.24, 95% CI: 1.04, 4.85, p = 0.025); (OR = 2.62, 95% CI: 1.12, 6.14, p = 0.014); (OR = 2.31, 95% CI: 1.06, 5.01, p = 0.020). CONCLUSION The prevalence of PTSD, depression and anxiety is high among EVD survivors. Development of specialized psychiatric services to sustain psychiatric and psychological health amongst survivors in the cultural context of the Eastern part of the DRC should be considered by the teams fighting against EVD in the DRC.
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Affiliation(s)
- Célestin Kaputu-Kalala-Malu
- Department of Neurology, Centre Neuropsychopathologique (CNPP), Kinshasa University Teaching Hospital, Kinshasa, Democratic Republic of Congo.
| | - Eric Mafuta Musalu
- grid.9783.50000 0000 9927 0991School of Public Health, Kinshasa University teaching Hospital, Kinshasa, Democratic Republic of Congo
| | - Tim Walker
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales Australia
| | - Olga Ntumba-Tshitenge
- grid.9783.50000 0000 9927 0991Institut National de Récherche Biomédicale, Kinshasa, Democratic Republic of Congo & Microbiology service, Kinshasa University Teaching Hospital, Kinshasa, Democratic Republic of Congo
| | - Steve Ahuka-Mundeke
- grid.9783.50000 0000 9927 0991Institut National de Récherche Biomédicale, Kinshasa, Democratic Republic of Congo & Microbiology service, Kinshasa University Teaching Hospital, Kinshasa, Democratic Republic of Congo
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Di Capua J, Reid N, Som A, An T, Lopez D, So A, Di C, Walker T. Abstract No. 162 The effect of preprocedural renal failure on outcomes following infrainguinal endovascular arterial interventions. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Williams AJ, Menneer T, Sidana M, Walker T, Maguire K, Mueller M, Paterson C, Leyshon M, Leyshon C, Seymour E, Howard Z, Bland E, Morrissey K, Taylor TJ. Fostering Engagement With Health and Housing Innovation: Development of Participant Personas in a Social Housing Cohort. JMIR Public Health Surveill 2021; 7:e25037. [PMID: 33591284 PMCID: PMC7925145 DOI: 10.2196/25037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Personas, based on customer or population data, are widely used to inform design decisions in the commercial sector. The variety of methods available means that personas can be produced from projects of different types and scale. OBJECTIVE This study aims to experiment with the use of personas that bring together data from a survey, household air measurements and electricity usage sensors, and an interview within a research and innovation project, with the aim of supporting eHealth and eWell-being product, process, and service development through broadening the engagement with and understanding of the data about the local community. METHODS The project participants were social housing residents (adults only) living in central Cornwall, a rural unitary authority in the United Kingdom. A total of 329 households were recruited between September 2017 and November 2018, with 235 (71.4%) providing complete baseline survey data on demographics, socioeconomic position, household composition, home environment, technology ownership, pet ownership, smoking, social cohesion, volunteering, caring, mental well-being, physical and mental health-related quality of life, and activity. K-prototype cluster analysis was used to identify 8 clusters among the baseline survey responses. The sensor and interview data were subsequently analyzed by cluster and the insights from all 3 data sources were brought together to produce the personas, known as the Smartline Archetypes. RESULTS The Smartline Archetypes proved to be an engaging way of presenting data, accessible to a broader group of stakeholders than those who accessed the raw anonymized data, thereby providing a vehicle for greater research engagement, innovation, and impact. CONCLUSIONS Through the adoption of a tool widely used in practice, research projects could generate greater policy and practical impact, while also becoming more transparent and open to the public.
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Affiliation(s)
- Andrew James Williams
- School of Medicine, University of St Andrews, St Andrews, Fife, United Kingdom
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
| | - Tamaryn Menneer
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
- Environment and Sustainability Institute, University of Exeter, Penryn, Cornwall, United Kingdom
| | - Mansi Sidana
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - Tim Walker
- Centre for Geography and Environmental Science, University of Exeter, Penryn, Cornwall, United Kingdom
| | - Kath Maguire
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
| | - Markus Mueller
- Environment and Sustainability Institute, University of Exeter, Penryn, Cornwall, United Kingdom
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - Cheryl Paterson
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
| | - Michael Leyshon
- Centre for Geography and Environmental Science, University of Exeter, Penryn, Cornwall, United Kingdom
| | - Catherine Leyshon
- Centre for Geography and Environmental Science, University of Exeter, Penryn, Cornwall, United Kingdom
| | - Emma Seymour
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
| | - Zoë Howard
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
| | - Emma Bland
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
| | - Karyn Morrissey
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
| | - Timothy J Taylor
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, United Kingdom
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Patel S, Shannon D, Eldridge W, El-Ters N, Hanford J, Walker T, Scheer A, Jones E, Linwood K, Aragon N, Dunscombe L, Gerbes J, Srinivasan N, Vachharajani A. Understanding umbilical venous catheter insertion practices through a prospective multicenter observational study. J Matern Fetal Neonatal Med 2021; 35:5043-5048. [PMID: 33530795 DOI: 10.1080/14767058.2021.1874908] [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
OBJECTIVE To understand practices of umbilical venous catheter (UVC) insertion in tertiary level neonatal intensive care units (NICU) and investigate the outcomes of subsequent attempts following a failed initial attempt. STUDY DESIGN Prospective, multi-center observational study of UVC insertions at tertiary level NICUs between March 2019 and January 2020. RESULTS Of the 101 UVCs inserted at 4 centers, seventy-two (71%) were central at the first attempt and 50% were central at subsequent attempts. Patients with at least 1 failed attempt at insertion were less likely to have a centrally placed UVC (p = .009). Manipulations were less likely to be required when UVC was centrally placed during the first attempt. Maneuvers such as posterior liver mobilization used during insertion were likely to be associated with successful central placement of UVC (p = .0243). The time to complete the procedure was significantly less when the UVC was central at the first attempt (34.2 ± 20.2 vs 46.9 ± 33.8) (p = .0292). Gestational age, birth weight, and age of the baby at the insertion of the UVC, experience of the provider, and type of catheter were comparable among groups. The Shukla formula was most commonly used by providers to measure the depth of UVC placement. CONCLUSION Repetitive attempts and manipulations were less likely to be beneficial in the successful central placement of UVC in neonates. Additionally, repetitive attempts at insertion prolonged the overall duration of the procedure.
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Affiliation(s)
- S Patel
- Department of Pediatrics, University of Illinois at Chicago, Oak Park, IL, USA
| | - D Shannon
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - W Eldridge
- Department of Pediatrics, Saint Joseph Women's Hospital, Tampa, FL, USA
| | - N El-Ters
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - J Hanford
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - T Walker
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - A Scheer
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - E Jones
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - K Linwood
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - N Aragon
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - L Dunscombe
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - J Gerbes
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - N Srinivasan
- Department of Pediatrics, University of Illinois at Chicago, Oak Park, IL, USA
| | - A Vachharajani
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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14
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Hossenbaccus L, Steacy L, Walker T, Malone C, Ellis A. A072 HOUSE DUST MITE ENVIRONMENTAL EXPOSURE UNIT: CLINICAL VALIDATION OF A MODEL FOR PERENNIAL ALLERGIC RHINITIS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Szeszulski J, Walker T, Robertson M, Cuccaro P, Fernandez ME. School Staff's Perspectives on the Adoption of Elementary-School Physical Activity Approaches: A Qualitative Study. Am J Health Educ 2020; 51:395-405. [PMID: 33763162 DOI: 10.1080/19325037.2020.1822241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background There is a need to understand how schools adopt physical activity approaches (curricula, programs and practices), but few studies report on this process. Purpose To obtain elementary school staff's perspectives regarding how their schools are currently adopting physical activity approaches. Methods We recruited 15 participants from four job types in an urban Texas school district to participate in semi-structured interviews. We coded and analyzed interviews using directed content analysis and iterative categorization. Results We identified four themes pertaining to how the district, schools, and teachers contribute to the adoption of approaches. Themes included: (1) Staff identify new approaches through numerous channels; (2) Adoption occurs at multiple organizational levels; (3) District staff fulfilled a supporting role in the adoption process; and (4) School staff's perceptions of approach characteristics influence adoption. Discussion We found that schools adopt physical activity approaches at both the district- and school-level. Additionally, multiple stakeholders played a role in the adoption process and those roles varied across approaches. Translation to Health Education Practice Time, money, space, staff, competing priorities, limited information, the school's mission, and the benefits an approach provides to children are factors that researches and practitioners should consider when starting a new physical activity approach.
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Affiliation(s)
- Jacob Szeszulski
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030.,The University of Texas Health Science Center at Houston School of Public Health, Austin Campus, Michael Susan Dell Center for Healthy Living, 1616 Guadalupe St Suite 6.300, Austin, TX, USA 78701
| | - Tim Walker
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030
| | - Michael Robertson
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030.,MD Anderson Cancer Center, Cancer Prevention Building, Center for Energy Balance, Department of Behavioral Science, Unit 1330, 1155 Pressler St, Houston, TX USA 77030
| | - Paula Cuccaro
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030
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16
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Connolly EA, Walker T, Van der Westhuizen A. Impending infliximab access crisis: a case of steroid-refractory, relapsing immunotherapy-induced colitis responsive to infliximab. Intern Med J 2020; 50:767-768. [PMID: 32537919 DOI: 10.1111/imj.14854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth A Connolly
- Medical Oncology Department, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Tim Walker
- Medical Oncology Department, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Gastroenterology Department, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andre Van der Westhuizen
- Medical Oncology Department, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Gastroenterology Department, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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17
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Abstract
IntroductionThe number of novel psychoactive substances (NPS) available is increasing. Synthetic cannabinoids (SC) are one of many NPS sold. SC aim to emulate the effects of natural cannabis by acting on cannabinoid receptors. Despite much research into pharmacology, there is limited data on the user experience of SC.AimIt is useful for psychiatrists, to understand what experiences people have whilst on illicit substances. The aim of this qualitative study is to gain an initial understanding of what characterizes the experiences of those who use SC.MethodFourty anonymously written online reports were collected from the “Erowid experience vaults” and analysed using the Empirical Phenomenological Psychological Method.ResultsThe analysis yielded 488 meaning units (MU). These were grouped into 36 categories revealing 5 broad themes: (1) physical affects; (2) sensory distortions and distortions of perception; (3) emotional and psychological effects; (4) re-dosing, addiction and comedown effects; (5) similarities to other substances.ConclusionSynthetic cannabinoids have a mixed effect on users with a myriad of experiences reported. Some experienced positive results from their usage such as euphoria and relaxation, however these were counter balanced by those who experienced some serious negative emotional and physical side effects such as anxiety, paranoia, palpitations and convulsions. SC appear to often emulate that of their natural counterpart, yet there is an unpredictability to them which can end with serious consequences. Online forum content gives us a strong base understanding of users experiences of SC. Further research is required to elucidate a more nuanced understanding.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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18
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Zdora MC, Zanette I, Walker T, Phillips NW, Smith R, Deyhle H, Ahmed S, Thibault P. X-ray phase imaging with the unified modulated pattern analysis of near-field speckles at a laboratory source. Appl Opt 2020; 59:2270-2275. [PMID: 32225757 DOI: 10.1364/ao.384531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
X-ray phase-contrast techniques are powerful methods for discerning features with similar densities, which are normally indistinguishable with conventional absorption contrast. While these techniques are well-established tools at large-scale synchrotron facilities, efforts have increasingly focused on implementations at laboratory sources for widespread use. X-ray speckle-based imaging is one of the phase-contrast techniques with high potential for translation to conventional x-ray systems. It yields phase-contrast, transmission, and dark-field images with high sensitivity using a relatively simple and cost-effective setup tolerant to divergent and polychromatic beams. Recently, we have introduced the unified modulated pattern analysis (UMPA) [Phys. Rev. Lett.118, 203903 (2017)PRLTAO0031-900710.1103/PhysRevLett.118.203903], which further simplifies the translation of x-ray speckle-based imaging to low-brilliance sources. Here, we present the proof-of-principle implementation of UMPA speckle-based imaging at a microfocus liquid-metal-jet x-ray laboratory source.
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19
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Di Capua J, Di Capua C, Grenier R, Lopez D, Walker T. 3:54 PM Abstract No. 314 The effect of age as a postoperative risk factor following lower extremity endovascular arterial interventions. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Browne F, Bettles S, Clift S, Walker T. Connecting patients, practitioners, and regulators in supporting positive experiences and processes of shared decision making: A progress report. J Eval Clin Pract 2019; 25:1030-1040. [PMID: 31597223 PMCID: PMC6900193 DOI: 10.1111/jep.13279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/27/2022]
Abstract
This paper describes a novel approach to explore how regulators, working with patients and practitioners, may contribute to supporting person-centred care and processes of shared decision making in implementing professional standards and reducing harms. Osteopathic patients report high levels of patient care. However, areas of consultations less likely to be rated as high included "fully understanding your concerns," "helping you to take control," and "making a plan of action with you," suggestive of a paternalistic approach to care and a barrier to the effective implementation of standards. This programme explored how to support patients and practitioners to make more explicit what is important to support consultations with better communication in accordance with standards. A series of workshops took place involving approximately 80 participants, which explored and identified practitioner and patient values; these were themed to develop a common framework and tested using case studies. Aspects of what enables or presents a barrier to a positive consultation were further explored with real patient narratives, and a range of resources were subsequently developed, which may support patients and practitioners to make explicit what is important to them in a consultation. A series of approaches and tools were then developed for piloting including patient curriculum vitae; patient goal planner; patient animation to support preparation for an appointment; infographic: a patient poster or leaflet; practitioner reflective tool; and an audio recording to increase awareness and understanding of values-based practice. In conclusion, a range of approaches may help to support patients and practitioners to make explicit what is important to them in a consultation. The next phase of our programme will use a range of methods including cluster sampling, pre-testing and post-testing with the Consultation and Relational Empathy (CARE) measure tool, and interviews and focus groups with users and practitioners to demonstrate impact.
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Affiliation(s)
- Fiona Browne
- Professional Standards DepartmentGeneral Osteopathic CouncilLondonUK
| | - Steven Bettles
- Professional Standards DepartmentGeneral Osteopathic CouncilLondonUK
| | - Stacey Clift
- Professional Standards DepartmentGeneral Osteopathic CouncilLondonUK
| | - Tim Walker
- Professional Standards DepartmentGeneral Osteopathic CouncilLondonUK
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21
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Schröeder SE, Pedrana A, Scott N, Wilson D, Kuschel C, Aufegger L, Atun R, Baptista‐Leite R, Butsashvili M, El‐Sayed M, Getahun A, Hamid S, Hammad R, ‘t Hoen E, Hutchinson SJ, Lazarus JV, Lesi O, Li W, Binti Mohamed R, Olafsson S, Peck R, Sohn AH, Sonderup M, Spearman CW, Swan T, Thursz M, Walker T, Hellard M, Howell J. Innovative strategies for the elimination of viral hepatitis at a national level: A country case series. Liver Int 2019; 39:1818-1836. [PMID: 31433902 PMCID: PMC6790606 DOI: 10.1111/liv.14222] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022]
Abstract
Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.
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Affiliation(s)
- Sophia E. Schröeder
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Alisa Pedrana
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | | | - David Wilson
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | | | - Lisa Aufegger
- Centre for Health PolicyImperial College LondonLondonUK
| | - Rifat Atun
- Harvard T H Chan School of Public HealthHarvard UniversityBostonMAUSA
| | - Ricardo Baptista‐Leite
- Universidade Catolica PortuguesaLisbonPortugal,Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | | | - Manal El‐Sayed
- Department of Pediatrics and Clinical Research CenterAin Shams UniversityCairoEgypt
| | - Aneley Getahun
- School of Public Health and Primary CareFiji National UniversitySuvaFiji
| | | | | | - Ellen ‘t Hoen
- Global Health UnitUniversity Medical CentreGroningenthe Netherlands,Medicines Law & PolicyAmsterdamthe Netherlands
| | - Sharon J. Hutchinson
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK,Health Protection ScotlandMeridian CourtGlasgowUK
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal)Hospital ClinicUniversity of BarcelonaBarcelonaSpain
| | | | | | | | - Sigurdur Olafsson
- Gastroenterology and HepatologyLandspitali University HospitalReykjavikIceland
| | | | | | - Mark Sonderup
- Division of HepatologyDepartment of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Catherine W. Spearman
- Division of HepatologyDepartment of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | - Mark Thursz
- Department of HepatologyImperial College LondonLondonUK
| | - Tim Walker
- Department of Gastroenterology and General MedicineCalvary MaterNewcastleNSWAustralia,School of Medicine and Public HealthUniversity of NewcastleNewcastleNSWAustralia
| | - Margaret Hellard
- Burnet InstituteMelbourneVICAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia,Hepatitis ServicesDepartment of Infectious DiseasesThe Alfred HospitalMelbourneVICAustralia,Doherty Institute and Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
| | - Jessica Howell
- Burnet InstituteMelbourneVICAustralia,Department of GastroenterologySt Vincent's HospitalMelbourneVICAustralia,Department of MedicineUniversity of MelbourneMelbourneVICAustralia
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22
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Mawer D, Byrne F, Drake S, Brown C, Prescott A, Warne B, Bousfield R, Skittrall JP, Ramsay I, Somasunderam D, Bevan M, Coslett J, Rao J, Stanley P, Kennedy A, Dobson R, Long S, Obisanya T, Esmailji T, Petridou C, Saeed K, Brechany K, Davis-Blue K, O'Horan H, Wake B, Martin J, Featherstone J, Hall C, Allen J, Johnson G, Hornigold C, Amir N, Henderson K, McClements C, Liew I, Deshpande A, Vink E, Trigg D, Guilfoyle J, Scarborough M, Scarborough C, Wong THN, Walker T, Fawcett N, Morris G, Tomlin K, Grix C, O'Cofaigh E, McCaffrey D, Cooper M, Corbett K, French K, Harper S, Hayward C, Reid M, Whatley V, Winfield J, Hoque S, Kelly L, King I, Bradley A, McCullagh B, Hibberd C, Merron M, McCabe C, Horridge S, Taylor J, Koo S, Elsanousi F, Saunders R, Lim F, Bond A, Stone S, Milligan ID, Mack DJF, Nagar A, West RM, Wilcox MH, Kirby A, Sandoe JAT. Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. J Hosp Infect 2019; 103:200-209. [PMID: 31077777 DOI: 10.1016/j.jhin.2019.05.001] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.
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Affiliation(s)
- D Mawer
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
| | - F Byrne
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - S Drake
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - C Brown
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - A Prescott
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - B Warne
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - R Bousfield
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - J P Skittrall
- Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK
| | - I Ramsay
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - D Somasunderam
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - M Bevan
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Coslett
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Rao
- Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK
| | - P Stanley
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - A Kennedy
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - R Dobson
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - S Long
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Obisanya
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Esmailji
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - C Petridou
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Brechany
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Davis-Blue
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - H O'Horan
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - B Wake
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - J Martin
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - J Featherstone
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - C Hall
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - J Allen
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - G Johnson
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - C Hornigold
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - N Amir
- Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - K Henderson
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - C McClements
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - I Liew
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - A Deshpande
- Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - E Vink
- Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - D Trigg
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Guilfoyle
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M Scarborough
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - C Scarborough
- Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK
| | - T H N Wong
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - T Walker
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - N Fawcett
- Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - G Morris
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - K Tomlin
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - C Grix
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - E O'Cofaigh
- Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK
| | - D McCaffrey
- Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW, UK
| | - M Cooper
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K Corbett
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K French
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Harper
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - C Hayward
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - M Reid
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - V Whatley
- Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - J Winfield
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Hoque
- Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - L Kelly
- Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - I King
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - A Bradley
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - B McCullagh
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C Hibberd
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - M Merron
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C McCabe
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - S Horridge
- Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - J Taylor
- Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - S Koo
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Elsanousi
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - R Saunders
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Lim
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - A Bond
- Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK
| | - S Stone
- Royal Free Campus, University College Medical School, London, NW3 2QG, UK
| | - I D Milligan
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - D J F Mack
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - A Nagar
- Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - M H Wilcox
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - A Kirby
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| | - J A T Sandoe
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
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Robertson F, Mutabazi Z, Kyamanywa P, Ntakiyiruta G, Musafiri S, Walker T, Kayibanda E, Mukabatsinda C, Scott J, Costas-Chavarri A. Laparoscopy in Rwanda: A National Assessment of Utilization, Demands, and Perceived Challenges. World J Surg 2019; 43:339-345. [PMID: 30232568 DOI: 10.1007/s00268-018-4797-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Laparoscopy has proven to be feasible and effective at reducing surgical morbidity and mortality in low resource settings. In Rwanda, the demand for and perceived challenges to laparoscopy use remain unclear. METHODS A mixed-methods study was performed at the four Rwandan national referral teaching hospitals. Retrospective logbook reviews (July 2014-June 2015) assessed procedure volume and staff involvement. Web-based surveys and semi-structured interviews investigated barriers to laparoscopy expansion. RESULTS During the study period, 209 laparoscopic procedures were completed: 57 (27.3%) general surgery cases; 152 (72.7%) ob/gyn cases. The majority (58.9%, 125/209) occurred at the private hospital, which performed 82.6% of cholecystectomies laparoscopically (38/46). The three public hospitals, respectively, performed 25% (7/28), 15% (12/80), and 0% (denominator indeterminate) of cholecystectomies laparoscopically. Notably, the two hospitals with the highest laparoscopy volume relied on a single surgeon for more than 85% of cases. The four ob/gyn departments performed between 4 and 87 laparoscopic cases (mostly diagnostic). Survey respondents at all sites listed a dearth of trainers as the most significant barrier to performing laparoscopy (65.7%; 23/35). Other obstacles included limited access to training equipment and courses. Equipment and material costs, equipment functionality, and material supply were perceived as lesser barriers. Twenty-two interviews revealed widespread interest in laparoscopy, insufficient laparoscopy exposure, and a need for trainers. CONCLUSION While many studies identify cost as the most prohibitive barrier to laparoscopy utilization in low resource settings, logbook review and workforce perception indicate that a paucity of trainers is currently the greatest obstacle in Rwanda.
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Affiliation(s)
- Faith Robertson
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Zeta Mutabazi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Kampala, Uganda
| | | | - Sanctus Musafiri
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Centre Hospitalier Universitaire de Butare, Butare, Rwanda
| | - Tim Walker
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | | | | | - John Scott
- Brigham and Women's Hospital, Boston, MA, USA
| | - Ainhoa Costas-Chavarri
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Rwanda Military Hospital, Kigali, Rwanda.,Boston Children's Hospital, Boston, MA, USA
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24
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Stewart P, Stewart J, Walker T, Gullapudi VRL, Selby NM, Taal MW. SP541MEASURING PRESSURE WAVES IN DIALYSIS LINES TO DERIVE CONTINUOUS ARTERIAL BLOOD PRESSURE: PILOT WORK IN AN IN VITRO AND IN SILICO MODEL. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - T Walker
- University of Derby, Derby, United Kingdom
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25
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Stewart P, Stewart J, Walker T, Gullapudi VRL, Taal MW, Selby NM. FP630DEVELOPMENT OF AN IN VITRO SIMULATION MODEL TO INVESTIGATE HAEMODYNAMIC RESPONSES DURING HAEMODIALYSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - T Walker
- University of Derby, Derby, United Kingdom
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26
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Gullapudi VRL, Stewart J, Stewart P, Walker T, Eldehni TE, Taal MW, Selby NM. FP638FREQUENCY ANALYSIS REVEALS UNIQUE HAEMODYNAMIC RESPONSES TO HAEMODIALYSIS: BASELINE RESULTS FROM THE ITREND STUDY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - T Walker
- University of Derby, Derby, United Kingdom
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27
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Walker T, Kelly R, Frezzini C, Cereceda-Monteoliva N, Clark R, Cobb A, Ayliffe P. The rose trellis mucoperiosteal scoring technique improves flap stretch for alveolar cleft and oro antral fistula repair. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Walker T, Frezzini C, Wu E, Haria N, Sahjir G, Cobb A. Cleft LIP & palate and photosharing social media platforms (instagram). Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Walker T, Clark R, Deacon S, Revington P. Factors affecting success in the management of the alveolar cleft - a review of 304 tibial bone grafts in a single institution. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Walker T, Stapleton P, Gibbons S. Identification of novel antimicrobial-producing bacteria from an ancient water source by Oxford Nanopore Whole Genome Sequencing and Natural Product Chemistry. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0214] [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: 11/18/2022] Open
Affiliation(s)
- Tim Walker
- University College London, London, United Kingdom
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31
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Walker T, Rutkowski L, Innmann M, Panzram B, Herre J, Gotterbarm T, Aldinger PR, Merle C. Unicondylar knee arthroplasty using cobalt-chromium implants in patients with self-reported cutaneous metal hypersensitivity. Bone Joint J 2019; 101-B:227-232. [DOI: 10.1302/0301-620x.101b2.bjj-2018-0778.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/15/2022]
Abstract
Aims The treatment of patients with allergies to metal in total joint arthroplasty is an ongoing debate. Possibilities include the use of hypoallergenic prostheses, as well as the use of standard cobalt-chromium (CoCr) alloy. This non-designer study was performed to evaluate the clinical outcome and survival rates of unicondylar knee arthroplasty (UKA) using a standard CoCr alloy in patients reporting signs of a hypersensitivity to metal. Patients and Methods A consecutive series of patients suitable for UKA were screened for symptoms of metal hypersensitivity by use of a questionnaire. A total of 82 patients out of 1737 patients suitable for medial UKA reporting cutaneous metal hypersensitivity to cobalt, chromium, or nickel were included into this study and prospectively evaluated to determine the functional outcome, possible signs of hypersensitivity, and short-term survivorship at a minimum follow-up of 1.5 years. Results At a mean follow-up of three years (1.5 to 5.7), no local or systemic symptoms of hypersensitivity to metal were observed. One patient underwent revision surgery to a bicondylar prosthesis due to a tibial periprosthetic fracture resulting in a survival rate of 98.8% (95% confidence interval (CI) 91.7 to 99.8; number at risk, 28) at three years with the endpoint of revision for any reason and a survival rate of 97.6% (95% CI 90.6 to 99.3; number at risk, 29) for the endpoint of all reoperations. Clinical outcome was good to excellent with a mean Oxford Knee Score of 42.5 (sd 2.5; 37 to 48). Conclusion This study is the first demonstrating clinical results and survival analysis of UKA using a CoCr alloy in patients with a history of metal hypersensitivity. Functional outcome and survivorship are on a high-level equivalent to those reported for UKA in patients without a history of metal hypersensitivity. No serious local or systemic symptoms of metal hypersensitivity could be detected, and no revision surgery was performed due to an adverse reaction to metal ions.
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Affiliation(s)
- T. Walker
- Center for Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - L. Rutkowski
- Department of Orthopaedic Surgery, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany
| | - M. Innmann
- Center for Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - B. Panzram
- Center for Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - J. Herre
- Department of Orthopaedic Surgery, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany
| | - T. Gotterbarm
- Head of Center for Orthopaedic and Trauma Surgery, University of Linz, Linz, Austria
| | - P. R. Aldinger
- Head of Department of Orthopaedic Surgery, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany
| | - C. Merle
- Center for Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
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32
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Jamil K, Walker T, Onikul E, Munns CF, Little DG. A comparison of subtraction MRI with the standard contrast-enhanced imaging in Perthes' disease. J Child Orthop 2019; 13:82-88. [PMID: 30838080 PMCID: PMC6376440 DOI: 10.1302/1863-2548.13.180136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/19/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Perthes' disease (PD) results from loss of blood supply to the hip and can progress to femoral head deformity. MRI in the early course of the disease can provide data on the initial extent of infarct. Vascularity of the femoral head is assessed by gadolinium-enhanced MRI (contrast MRI), which may be improved by the digital subtraction technique (subtraction MRI). We hypothesized that gadolinium-enhanced MRI without subtraction was comparable with subtraction MRI in depicting the femoral head perfusion. METHODS In all, 34 patients (34 hips) with unilateral PD had gadolinium-enhanced MRI as part of a prospectively randomized study. Nine patients had three MRIs, 15 had two and ten had a single MRI. Measurement of perfusion of the femoral head (MRI perfusion index) was obtained using digital image analysis on all the MRIs, including both before and after subtraction. A paired sample t-test was performed to compare the measurements. RESULTS The mean age of the patients was 8.9 years (sd 1.6). At the time of diagnosis, the subtraction MRI did not elicit a statistically significant difference in MRI perfusion index measurements when compared with the contrast MRI (p = 0.19). The same findings were found when including all patients at various stages of the disease (p = 0.30). Qualitatively, although some subtraction MRI images showed superior delineation of epiphysis, there are no significant differences throughout the whole series. CONCLUSION Although the current literature supports the increasing role of the subtraction MRI for PD management, our study proposed that the contrast MRI without subtraction technique appears adequate in assessing femoral head perfusion. LEVEL OF EVIDENCE Level I - Diagnostic study.
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Affiliation(s)
- K. Jamil
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Orthopaedic Research and Biotechnology, The Children’s Hospital at Westmead, Westmead NSW, Australia
- Medical Faculty, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - T. Walker
- Discipline of Medical Imaging, The Children’s Hospital at Westmead, Sydney, Australia
| | - E. Onikul
- Discipline of Medical Imaging, The Children’s Hospital at Westmead, Sydney, Australia
| | - C. F. Munns
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead NSW, Australia
| | - D. G. Little
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Orthopaedic Research and Biotechnology, The Children’s Hospital at Westmead, Westmead NSW, Australia
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33
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Miyazaki K, Sekiya T, Fu D, Bowman KW, Kulawik SS, Sudo K, Walker T, Kanaya Y, Takigawa M, Ogochi K, Eskes H, Boersma KF, Thompson AM, Gaubert B, Barre J, Emmons LK. Balance of Emission and Dynamical Controls on Ozone During the Korea-United States Air Quality Campaign From Multiconstituent Satellite Data Assimilation. J Geophys Res Atmos 2019; 124:387-413. [PMID: 31007989 PMCID: PMC6472638 DOI: 10.1029/2018jd028912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 05/05/2023]
Abstract
Global multiconstituent concentration and emission fields obtained from the assimilation of the satellite retrievals of ozone, CO, NO2, HNO3, and SO2 from the Ozone Monitoring Instrument (OMI), Global Ozone Monitoring Experiment 2, Measurements of Pollution in the Troposphere, Microwave Limb Sounder, and Atmospheric Infrared Sounder (AIRS)/OMI are used to understand the processes controlling air pollution during the Korea-United States Air Quality (KORUS-AQ) campaign. Estimated emissions in South Korea were 0.42 Tg N for NO x and 1.1 Tg CO for CO, which were 40% and 83% higher, respectively, than the a priori bottom-up inventories, and increased mean ozone concentration by up to 7.5 ± 1.6 ppbv. The observed boundary layer ozone exceeded 90 ppbv over Seoul under stagnant phases, whereas it was approximately 60 ppbv during dynamical conditions given equivalent emissions. Chemical reanalysis showed that mean ozone concentration was persistently higher over Seoul (75.10 ± 7.6 ppbv) than the broader KORUS-AQ domain (70.5 ± 9.2 ppbv) at 700 hPa. Large bias reductions (>75%) in the free tropospheric OH show that multiple-species assimilation is critical for balanced tropospheric chemistry analysis and emissions. The assimilation performance was dependent on the particular phase. While the evaluation of data assimilation fields shows an improved agreement with aircraft measurements in ozone (to less than 5 ppbv biases), CO, NO2, SO2, PAN, and OH profiles, lower tropospheric ozone analysis error was largest at stagnant conditions, whereas the model errors were mostly removed by data assimilation under dynamic weather conditions. Assimilation of new AIRS/OMI ozone profiles allowed for additional error reductions, especially under dynamic weather conditions. Our results show the important balance of dynamics and emissions both on pollution and the chemical assimilation system performance.
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Affiliation(s)
- K. Miyazaki
- Japan Agency for Marine‐Earth Science and TechnologyYokohamaJapan
| | - T. Sekiya
- Japan Agency for Marine‐Earth Science and TechnologyYokohamaJapan
| | - D. Fu
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - K. W. Bowman
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - S. S. Kulawik
- Bay Area Environmental Research InstituteSonomaCAUSA
| | - K. Sudo
- Japan Agency for Marine‐Earth Science and TechnologyYokohamaJapan
- Graduate School of Environmental StudiesNagoya UniversityNagoyaJapan
| | - T. Walker
- Department of Civil and Environmental EngineeringCarleton UniversityOttawaOntarioCanada
| | - Y. Kanaya
- Japan Agency for Marine‐Earth Science and TechnologyYokohamaJapan
| | - M. Takigawa
- Japan Agency for Marine‐Earth Science and TechnologyYokohamaJapan
| | - K. Ogochi
- Japan Agency for Marine‐Earth Science and TechnologyYokohamaJapan
| | - H. Eskes
- Royal Netherlands Meteorological Institute (KNMI)De BiltNetherlands
| | - K. F. Boersma
- Royal Netherlands Meteorological Institute (KNMI)De BiltNetherlands
- Meteorological and Air Quality DepartmentWageningen UniversityWageningenNetherlands
| | | | - B. Gaubert
- Atmospheric Chemistry Observations and& Modeling (ACOM) LaboratoryNational Center for Atmospheric ResearchBoulderCOUSA
| | - J. Barre
- European Centre for Medium‐Range Weather ForecastsReadingUK
| | - L. K. Emmons
- Atmospheric Chemistry Observations and& Modeling (ACOM) LaboratoryNational Center for Atmospheric ResearchBoulderCOUSA
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34
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Goodsall TM, Walker T. Iron absorption from oral iron supplements given on consecutive versus alternate days in iron-depleted women. BMJ Evid Based Med 2018; 23:228-229. [PMID: 29941655 DOI: 10.1136/bmjebm-2018-111013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Thomas M Goodsall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Tim Walker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Medicine, Calvary Mater Newcastle, Waratah, New South Wales, Australia
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Kabakambira JD, Hategeka C, Page C, Ntirenganya C, Dusabejambo V, Ndoli J, Ngabonziza F, Hale D, Bayingana C, Walker T. Efficacy of Helicobacter pylori eradication regimens in Rwanda: a randomized controlled trial. BMC Gastroenterol 2018; 18:134. [PMID: 30165823 PMCID: PMC6117961 DOI: 10.1186/s12876-018-0863-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Successful H. pylori treatment requires the knowledge of local antimicrobial resistance. Data on the efficacy of H. pylori eradication regimens available in sub-Saharan Africa are scant, hence the optimal treatment is unknown. Our goals were to determine the efficacy of available regimens in Rwanda as well as evaluate the effect of treatment on health-related quality of life (HRQoL) in patients undergoing esophagogastroduodenoscopy. METHODS This is a randomized controlled trial conducted from November 2015 to October 2016 at a tertiary hospital in Rwanda. Enrollees were 299 patients (35% male, age 42 ± 16 years (mean ± SD)) who had a positive modified rapid urease test on endoscopic biopsies. After a fecal antigen test (FAT) and HRQoL assessment by the Short Form Nepean Dyspepsia Index (SF-NDI) questionnaire, patients were randomized 1:1:1:1 to either a triple therapy combining omeprazole, amoxicillin and one of clarithromycin/ciprofloxacin/metronidazole or a quadruple therapy combining omeprazole, amoxicillin, ciprofloxacin and doxycycline. All therapies were given for a duration of 10 days. The outcome measures were the persistence of positive FAT (treatment failure) 4 to 6 weeks after treatment and change in HRQoL scores. RESULTS The treatment success rate was 80% in the total population and 78% in patients with a history of prior triple therapy. Significant improvement in HRQoL in the total group (HRQoL mean scores before and after treatment respectively: 76 ± 11 and 32 ± 11, p < 0.001) and the group with functional dyspepsia (HRQoL mean scores before and after treatment respectively: 73 ± 11 and 30 ± 9, P < 0.001) was observed across all treatment groups. Using clarithromycin based triple therapy (standard of care) as a reference, the group treated with metronidazole had worse HRQoL (p = 0.012) and had a trend towards worse treatment outcome (p = 0.086) compared to the ciprofloxacin based combination therapies. CONCLUSION Clarithromycin and ciprofloxacin based combination therapies are effective and safe to use alternatively for H. pylori eradication and improve HRQoL. Among the regimens studied, metronidazole based triple therapy is likely to be clinically inferior. TRIAL REGISTRATION The clinical trial was retrospectively registered ( PACTR201804003257400 ) with the Pan African Clinical Trial Registry database, on April 6th, 2018 in South Africa.
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Affiliation(s)
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC Canada
| | - Cameron Page
- Department of Medicine, University Hospital of Brooklyn, New York, USA
| | | | | | - Jules Ndoli
- Butare University Teaching Hospital (CHUB), Huye, Rwanda
| | | | - DeVon Hale
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | | | - Tim Walker
- Butare University Teaching Hospital (CHUB), Huye, Rwanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Patzelt J, Ulrich M, Magunia HF, Sauter R, Droppa M, Jorbenadze R, Becker AS, Walker T, Von Bardeleben RS, Grasshoff C, Rosenberger P, Gawaz M, Seizer P, Langer HF. P2575Comparison of deep sedation with general anesthesia in patients undergoing percutaneous mitral valve repair (PMVR). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2575] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Patzelt
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - M Ulrich
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - H F Magunia
- university hospital, department of anaesthesiology and intensive care medicine, Tuebingen, Germany
| | - R Sauter
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - M Droppa
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - R Jorbenadze
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - A S Becker
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - T Walker
- university hospital, department of cardiovascular surgery, Tuebingen, Germany
| | - R S Von Bardeleben
- University Hospital, Johannes Gutenberg-University, Cardiology, Mainz, Germany
| | - C Grasshoff
- university hospital, department of anaesthesiology and intensive care medicine, Tuebingen, Germany
| | - P Rosenberger
- university hospital, department of anaesthesiology and intensive care medicine, Tuebingen, Germany
| | - M Gawaz
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - P Seizer
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
| | - H F Langer
- university hospital, department of cardiology and cardiovascular medicine, Tuebingen, Germany
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Wyllie DH, Davidson JA, Grace Smith E, Rathod P, Crook DW, Peto TEA, Robinson E, Walker T, Campbell C. A Quantitative Evaluation of MIRU-VNTR Typing Against Whole-Genome Sequencing for Identifying Mycobacterium tuberculosis Transmission: A Prospective Observational Cohort Study. EBioMedicine 2018; 34:122-130. [PMID: 30077721 PMCID: PMC6116353 DOI: 10.1016/j.ebiom.2018.07.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 06/15/2018] [Revised: 07/13/2018] [Accepted: 07/15/2018] [Indexed: 12/24/2022] Open
Abstract
Background Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) typing is widely used in high-income countries to determine Mycobacterium tuberculosis relatedness. Whole-genome sequencing (WGS) is known to deliver greater specificity, but no quantitative prospective comparison has yet been undertaken. Methods We studied isolates from the English Midlands, sampled consecutively between 1 January 2012 and 31 December 2015. In addition to routinely performed MIRU-VNTR typing, DNA was extracted from liquid cultures and sequenced using Illumina technology. Demographic and epidemiological data for the relevant patients were extracted from the Enhanced Tuberculosis Surveillance system run by Public Health England. Closely related samples, defined using a threshold of five single nucleotide variants (SNVs), were compared to samples with identical MIRU-VNTR profiles, to samples from individuals with shared epidemiological risk factors, and to those with both characteristics. Findings 1999 patients were identified for whom at least one M. tuberculosis isolate had been MIRU-VNTR typed and sequenced. Comparing epidemiological risk factors with close genetic relatedness, only co-residence had a positive predictive value of over 5%. Excluding co-resident individuals, 18.6% of patients with identical MIRU-VNTR profiles were within 5 SNVs. Where patients also shared social risk factors and ethnic group, this rose to 48%. Only 8% of MIRU-VNTR linked pairs in lineage 1 were within 5 SNV, compared to 31% in lineage 4. Interpretation In the setting studied, this molecular epidemiological study shows MIRU-VNTR typing and epidemiological risk factors are poorly predictive of close genomic relatedness, assessed by SNV. MIRU-VNTR performance varies markedly by lineage. Funding Public Health England, Health Innovation Challenge Fund, NIHR Health Protection Research Unit Oxford, NIHR Oxford Biomedical Research Centre. M. tuberculosis relatedness was measured by MIRU-VNTR typing and single nucleotide variants (SNV). In consecutive isolates in England, only 20% of samples with identical MIRU-VNTR profiles were within 5 SNVs. MIRU-VNTR is more predictive of close relatedness in lineage 4 (Euro-American) lineages than in other lineages.
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Affiliation(s)
- David H Wyllie
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; Public Health England Academic Collaborating Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; The National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, UK.
| | - Jennifer A Davidson
- Tuberculosis Section, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - E Grace Smith
- Public Health England National Regional Mycobacteriology Laboratory North and Midlands, Heartlands Hospital, Birmingham BS9 5SS
| | - Priti Rathod
- Public Health England National Regional Mycobacteriology Laboratory North and Midlands, Heartlands Hospital, Birmingham BS9 5SS
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; The National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, UK
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; The National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, UK
| | - Esther Robinson
- Public Health England National Regional Mycobacteriology Laboratory North and Midlands, Heartlands Hospital, Birmingham BS9 5SS
| | - Tim Walker
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Colin Campbell
- Tuberculosis Section, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Walker T, Dusabejambo V, Ho JJ, Karigire C, Richards B, Sofair AN. An International Collaboration for the Training of Medical Chief Residents in Rwanda. Ann Glob Health 2018; 83:339-346. [PMID: 28619410 DOI: 10.1016/j.aogh.2016.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The year-long position of chief medical resident is a time-honored tradition in the United States that serves to provide the trainee with an opportunity to gain further skills as a clinician, leader, teacher, liaison, and administrator. However, in most training programs in the developing world, this role does not exist. OBJECTIVES We sought to develop a collaborative program to train the first medical chief residents for the University of Rwanda and to assess the impact of the new chief residency on residency training, using questionnaires and qualitative interviews with Rwandan faculty, chief residents, and residents. METHODS The educational context and the process leading up to the appointment of Rwandan chief residents, including selection, job description, and necessary training (in the United States and Rwanda), are described. One year after implementation, we used a parallel, mixed methods approach to evaluate the new chief medical resident program through resident surveys as well as semistructured interviews with key informants, including site chief residents, chief residents, and faculty. We also observed chief residents and site chief residents at work and convened focus groups with postgraduate residents to yield additional qualitative information. RESULTS Rwandan faculty and residents generally felt that the new position had improved the educational and administrative structure of the teaching program while providing a training ground for future academicians. CONCLUSIONS A collaborative training program between developing and developed world academic institutions provides an efficient model for the development of a new chief residency program in the developing world.
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Affiliation(s)
- Tim Walker
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Vincent Dusabejambo
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Janet J Ho
- Department of Internal Medicine Yale University School of Medicine, New Haven, CT
| | - Claudine Karigire
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Bradley Richards
- Department of Internal Medicine Yale University School of Medicine, New Haven, CT
| | - Andre N Sofair
- Department of Internal Medicine Yale University School of Medicine, New Haven, CT.
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Brugman VA, Kristan M, Gibbins MP, Angrisano F, Sala KA, Dessens JT, Blagborough AM, Walker T. Detection of malaria sporozoites expelled during mosquito sugar feeding. Sci Rep 2018; 8:7545. [PMID: 29765136 PMCID: PMC5954146 DOI: 10.1038/s41598-018-26010-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Malaria is a severe disease of global importance transmitted by mosquitoes of the genus Anopheles. The ability to rapidly detect the presence of infectious mosquitoes able to transmit malaria is of vital importance for surveillance, control and elimination efforts. Current methods principally rely on large-scale mosquito collections followed by labour-intensive salivary gland dissections or enzyme-linked immunosorbent (ELISA) methods to detect sporozoites. Using forced salivation, we demonstrate here that Anopheles mosquitoes infected with Plasmodium expel sporozoites during sugar feeding. Expelled sporozoites can be detected on two sugar-soaked substrates, cotton wool and Whatman FTA cards, and sporozoite DNA is detectable using real-time PCR. These results demonstrate a simple and rapid methodology for detecting the presence of infectious mosquitoes with sporozoites and highlight potential laboratory applications for investigating mosquito-malaria interactions. Our results indicate that FTA cards could be used as a simple, effective and economical tool in enhancing field surveillance activities for malaria.
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Affiliation(s)
- V A Brugman
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Evolution Biotechnologies, Colworth Science Park, Sharnbrook, Bedford, MK44 1LZ, UK.
| | - M Kristan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - M P Gibbins
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - F Angrisano
- Department of Life Sciences, Sir Alexander Fleming Building, Imperial College London, Imperial College Road, South Kensington, London, SW7 2AZ, UK
| | - K A Sala
- Department of Life Sciences, Sir Alexander Fleming Building, Imperial College London, Imperial College Road, South Kensington, London, SW7 2AZ, UK
| | - J T Dessens
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A M Blagborough
- Department of Life Sciences, Sir Alexander Fleming Building, Imperial College London, Imperial College Road, South Kensington, London, SW7 2AZ, UK
| | - T Walker
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Walker T, Zahn N, Bruckner T, Streit MR, Mohr G, Aldinger PR, Clarius M, Gotterbarm T. Mid-term results of lateral unicondylar mobile bearing knee arthroplasty: a multicentre study of 363 cases. Bone Joint J 2018; 100-B:42-49. [PMID: 29305449 DOI: 10.1302/0301-620x.100b1.bjj-2017-0600.r1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 12/12/2022]
Abstract
AIMS The aim of this independent multicentre study was to assess the mid-term results of mobile bearing unicondylar knee arthroplasty (UKA) for isolated lateral osteoarthritis of the knee joint. PATIENTS AND METHODS We retrospectively evaluated 363 consecutive, lateral UKAs (346 patients) performed using the Oxford domed lateral prosthesis undertaken in three high-volume knee arthroplasty centres between 2006 and 2014. Mean age of the patients at surgery was 65 years (36 to 88) with a mean final follow-up of 37 months (12 to 93) RESULTS: A total of 36 (10.5%) patients underwent revision surgery, giving a survival rate of 90.1% at three years (95% confidence intervals (CI) 86.1 to 93.1; number at risk: 155) and 85.0% at five years (95% CI 77.9 to 89.9; number at risk: 43). Dislocation of the mobile bearing occurred in 18 patients (5.6%) at three years (95% CI 1.0 to 16.4; number at risk: 154) and in 20 patients (8.5%) at five years (95% CI 1.0 to 27.0; number at risk: 42). There were no significant differences in the dislocation rate between the participating centres or the surgeons. We were not able to identify an effect of each surgeon's learning curve on the dislocation rate of the mobile bearing. The clinical outcome in patients without revision surgery at final follow-up was good to excellent, with a mean Oxford knee score of 40.3 (95% CI 39.4 to 41.2), a mean Tegner activity score of 3.2 (95% CI 3.1 to 3.3) and a mean University of California, Los Angeles score of 5.7 (95% CI 5.5 to 5.9). CONCLUSION Our data, which consists of a high number of patients treated with mobile bearing UKA in the lateral compartment, indicates a high revision rate of 15% at five years with dislocation of the mobile bearing being the main reason for implant failure. Despite the good functional and clinical results and the high patient satisfaction in our study group, we therefore discontinued using mobile-bearing lateral UKA in favour of a fixed-bearing component. Cite this article: Bone Joint J 2018;100-B:42-9.
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Affiliation(s)
- T Walker
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - N Zahn
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - T Bruckner
- University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - M R Streit
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - G Mohr
- Vulpius Clinic, Vulpiusstrasse 29, 74906 Bad Rappenau, Germany
| | - P R Aldinger
- Diakonie Clinic Paulinenhilfe, Rosenbergstrasse 38, 70176 Stuttgart, Germany
| | - M Clarius
- Vulpius Clinic, Vulpiusstrasse 29, 74906 Bad Rappenau, Germany
| | - T Gotterbarm
- University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
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Walker T, Stoppelkamp S, Weber M, Segan S, Sollazzo F, Lescan M, Steger V, Wendel HP, Schlensak C. Establishing an Alveolar in Vitro Model to Test Potential Pathogenic Aerosols. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T. Walker
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - S. Stoppelkamp
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - M. Weber
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - S. Segan
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - F. Sollazzo
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - M. Lescan
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - V. Steger
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - H.-P. Wendel
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - C. Schlensak
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
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She RC, Romney MG, Jang W, Walker T, Karichu JK, Richter SS. Performance of the BacT/Alert Virtuo Microbial Detection System for the culture of sterile body fluids: prospective multicentre study. Clin Microbiol Infect 2017; 24:992-996. [PMID: 29274462 DOI: 10.1016/j.cmi.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Continuous monitoring blood culture systems are commonly used for sterile body fluid cultures. In this multicentre study, we evaluated the performance of the new-generation BacT/Alert Virtuo system compared to the BacT/Alert 3D and conventional culture for the recovery of microorganisms from sterile body fluids. METHODS Peritoneal, cerebrospinal, pericardial, pleural and synovial fluids from adult patients submitted for culture were collected from three different centres. Specimens were inoculated into two bottles of the same bottle type (SA, SN, FA Plus or FN Plus) in equal volumes for simultaneous incubation in the Virtuo and 3D instruments. Each specimen was also Gram stained and seeded to solid media. RESULTS A total of 811 specimens were inoculated to 1257 bottle pairs. The Virtuo and 3D showed equivalent recovery of clinically significant microorganisms (127/155, 81.9%, vs. 126/155, 81.3%, respectively). Solid media cultures recovered fewer pathogens than either continuous monitoring system (95/155, 61.3%, p <0.001), including significantly fewer Enterobacteriaceae and enterococci. The Virtuo was significantly faster than the 3D in median time to detection of isolates from the same specimen (12.5 (range, 2.8-101.5) hours vs. 15.5 (range, 4.3-78.5) hours, p <0.001). Direct specimen Gram stain detected the eventual pathogen in 30 (26.1%) of 115 significant positive specimens. CONCLUSIONS The BacT/Alert Virtuo system was equivalent to the 3D system in organism recovery from sterile body fluid culture but showed faster detection of growth as a result of design enhancements.
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Affiliation(s)
- R C She
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - M G Romney
- St Paul's Hospital, Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Jang
- St Paul's Hospital, Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Walker
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - J K Karichu
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - S S Richter
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Walker T, Canales M, Noimark S, Page K, Parkin I, Faull J, Bhatti M, Ciric L. A Light-Activated Antimicrobial Surface Is Active Against Bacterial, Viral and Fungal Organisms. Sci Rep 2017; 7:15298. [PMID: 29127333 PMCID: PMC5681661 DOI: 10.1038/s41598-017-15565-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 05/11/2016] [Accepted: 10/26/2017] [Indexed: 11/09/2022] Open
Abstract
Evidence has shown that environmental surfaces play an important role in the transmission of nosocomial pathogens. Deploying antimicrobial surfaces in hospital wards could reduce the role environmental surfaces play as reservoirs for pathogens. Herein we show a significant reduction in viable counts of Staphylococcus epidermidis, Saccharomyces cerevisiae, and MS2 Bacteriophage after light treatment of a medical grade silicone incorporating crystal violet, methylene blue and 2 nm gold nanoparticles. Furthermore, a migration assay demonstrated that in the presence of light, growth of the fungus-like organism Pythium ultimum and the filamentous fungus Botrytis cinerea was inhibited. Atomic Force Microscopy showed significant alterations to the surface of S. epidermidis, and electron microscopy showed cellular aggregates connected by discrete surface linkages. We have therefore demonstrated that the embedded surface has a broad antimicrobial activity under white light and that the surface treatment causes bacterial envelope damage and cell aggregation.
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Affiliation(s)
- Tim Walker
- Healthy Infrastructure Research Group, Department of Civil, Environmental & Geomatic Engineering, University College London, London, UK
| | - Melisa Canales
- Healthy Infrastructure Research Group, Department of Civil, Environmental & Geomatic Engineering, University College London, London, UK
| | - Sacha Noimark
- Materials Chemistry Centre, Department of Chemistry, University College London, London, UK
| | - Kristopher Page
- Materials Chemistry Centre, Department of Chemistry, University College London, London, UK
| | - Ivan Parkin
- Materials Chemistry Centre, Department of Chemistry, University College London, London, UK
| | - Jane Faull
- Department of Biological Sciences, Birkbeck College, London, UK
| | - Manni Bhatti
- Healthy Infrastructure Research Group, Department of Civil, Environmental & Geomatic Engineering, University College London, London, UK
| | - Lena Ciric
- Healthy Infrastructure Research Group, Department of Civil, Environmental & Geomatic Engineering, University College London, London, UK.
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Walker T, Edge D, Shaw J, Wilson H, McNair L, Mitchell H, Gutridge K, Senior J, Sutton M, Meacock R, Abel K. Contemporary women's secure psychiatric services in the United Kingdom: A qualitative analysis of staff views. J Psychiatr Ment Health Nurs 2017; 24:660-670. [PMID: 28783204 DOI: 10.1111/jpm.12416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. ABSTRACT Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported.
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Affiliation(s)
- T Walker
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - D Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - H Wilson
- Lancashire Care NHS Foundation Trust, Preston, UK
| | - L McNair
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - H Mitchell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Gutridge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Senior
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - M Sutton
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - R Meacock
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Abel
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Lescan M, Veseli K, Oikonomou A, Walker T, Lausberg H, Blumenstock G, Bamberg F, Schlensak C, Krüger T. Aortic Elongation and Stanford B Dissection: The Tübingen Aortic Pathoanatomy (TAIPAN) Project. Eur J Vasc Endovasc Surg 2017; 54:164-169. [PMID: 28663040 DOI: 10.1016/j.ejvs.2017.05.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 02/15/2017] [Accepted: 05/28/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE/BACKGROUND Aortic elongation has not yet been considered as a potential risk factor for Stanford type B dissection (TBD). The role of both aortic elongation and dilatation in patients with TBD was evaluated. METHODS The aortic morphology of a healthy control group (n = 236) and patients with TBD (n = 96) was retrospectively examined using three dimensional computed tomography imaging. Curved multiplanar reformats were used to examine aortic diameters at defined landmarks and aortic segment lengths. RESULTS Diameters at all landmarks were significantly larger in the TBD group. The greatest diameter difference (56%) was measured in dissected descending aortas (p < .001). The segment with the most considerable difference between the study groups with regard to elongation was the non-dissected aortic arch of patients with TBD (36%; p < .001). Elongation in the aortic arch was accompanied by a diameter increase of 21% (p < .001). In receiver-operating curve analysis, the area under the curve was .85 for the diameter and .86 for the length of the aortic arch. CONCLUSIONS In addition to dilatation, aortic arch elongation is associated with the development of TBD. The diameter and length of the non-dissected aortic arch may be predictive for TBD and may possibly be used for risk assessment in the future. This study provides the basis for further prospective evaluation of these parameters.
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Affiliation(s)
- M Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany.
| | - K Veseli
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - A Oikonomou
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - T Walker
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - H Lausberg
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - G Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - F Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Centre Tübingen, Tübingen, Germany
| | - C Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - T Krüger
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
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Elmi A, Walker T, Ganguli S, Kalva S. The Clinical and Technical Effectiveness of Endovascular Embolization in Patients with Nonvariceal Gastrointestinal Bleeding. J Clin Interv Radiol ISVIR 2017. [DOI: 10.1055/s-0037-1603564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background and Aim Endovascular embolization is a well-established option in the management of acute gastrointestinal bleeding (GIB) after failed therapeutic endoscopy; however, questions remain concerning the outcomes and the various predictors of clinical and technical success of this therapy. The authors aimed to assess the effectiveness of endovascular embolization in patients with nonvariceal GIB.
Method Clinical records of 88 patients (mean age: 67.8 years) who underwent endovascular embolization for GIB were reviewed. Patient demographics, history, angiographic findings, treatment, and outcomes were recorded. The technical success of embolization, and the 24-hour and 30-day rebleeding and mortality rates were calculated. Multivariate analysis was performed to assess the factors associated with 24-hour and 30-day rebleeding.
Results Angiography demonstrated signs of bleeding in 63 (71.6%) patients and all underwent selective embolization of the abnormal artery. Empiric embolization was performed in 25 patients. Embolization was performed with coils (n = 45), Gelfoam (n = 12), microparticles (n = 14), glue (n = 2), or a combination of these (n = 15). The technical success rate was 96.6%. The 24-hour and 30-day rebleeding occurred in 13 (14.7%) and 16 (18.2%) patients, respectively. The 24-hour and 30-day mortality rates were 9.1 and 11.3%, respectively. Ischemic complications following embolization were seen in three patients, of which two required surgery. Based on the multivariate analysis, the need for continued transfusion after embolization and prior GIB were independent variables associated with 24-hour and 30-day rebleeding, respectively.
Conclusions Endovascular embolization has a high technical and clinical success in patients presenting with nonvariceal GIB.
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Affiliation(s)
- Azadeh Elmi
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - T. Walker
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Suvranu Ganguli
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Sanjeeva Kalva
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Schibilsky D, Klumm P, Nemeth A, Krüger T, Häberle H, Henn P, Wendel H, Walker T, Schlensak C. Out-of-Center ECLS Implantation: Extended Experience of an Interdisciplinary Team Approach. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- D. Schibilsky
- Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - P. Klumm
- Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - A. Nemeth
- Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - T. Krüger
- Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - H. Häberle
- Anesthesiology and Intensive Care Medicine, University Medical Center Tuebingen, Tuebingen, Germany
| | - P. Henn
- Anesthesiology and Intensive Care Medicine, University Medical Center Tuebingen, Tuebingen, Germany
| | - H.P. Wendel
- Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - T. Walker
- Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
| | - C. Schlensak
- Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany
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49
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Nemeth A, König O, Zengerle D, Nolte A, Avci-Adali M, Walker T, Wendel H, Schlensak C. RNA Eluting Surfaces for the Modulation of Gene Expression as a Novel Stent Concept. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Nemeth
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
| | - O. König
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
| | - D. Zengerle
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
| | - A. Nolte
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
| | - M. Avci-Adali
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
| | - T. Walker
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
| | - H.P. Wendel
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
| | - C. Schlensak
- University Medical Center Tübingen, Department of Thoracic and Cardiovascular Surgery, Tübingen, Germany
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50
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Schibilsky D, Benk C, Berchtold-Herz M, Krüger T, Nemeth A, Walker T, Häberle H, Rosenberger P, Wendel H, Trummer G, Siepe M, Beyersdorf F, Schlensak C. Left-Ventricular-Assist-Device Weaning Protocol Including Exercise and Invasive Hemodynamics - Multi-Institutional Experience. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- D. Schibilsky
- University Medical Center Tuebingen, Thoracic and Cardiovascular Surgery, Tuebingen, Germany
| | - C. Benk
- University Medical Center Freiburg, Cardiovascular Surgery, Freiburg, Germany
| | - M. Berchtold-Herz
- University Medical Center Freiburg, Cardiovascular Surgery, Freiburg, Germany
| | - T. Krüger
- University Medical Center Tuebingen, Thoracic and Cardiovascular Surgery, Tuebingen, Germany
| | - A. Nemeth
- University Medical Center Tuebingen, Thoracic and Cardiovascular Surgery, Tuebingen, Germany
| | - T. Walker
- University Medical Center Tuebingen, Thoracic and Cardiovascular Surgery, Tuebingen, Germany
| | - H. Häberle
- University Medical Center Tuebingen, Anesthesiology and Intensive Care Medicine, Tuebingen, Germany
| | - P. Rosenberger
- University Medical Center Tuebingen, Anesthesiology and Intensive Care Medicine, Tuebingen, Germany
| | - H.P. Wendel
- University Medical Center Tuebingen, Thoracic and Cardiovascular Surgery, Tuebingen, Germany
| | - G. Trummer
- University Medical Center Freiburg, Cardiovascular Surgery, Freiburg, Germany
| | - M. Siepe
- University Medical Center Freiburg, Cardiovascular Surgery, Freiburg, Germany
| | - F. Beyersdorf
- University Medical Center Freiburg, Cardiovascular Surgery, Freiburg, Germany
| | - C. Schlensak
- University Medical Center Tuebingen, Thoracic and Cardiovascular Surgery, Tuebingen, Germany
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