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Freene N, Carroll SJ, Flynn A, Bowen S, Holley R, Rodway K, Niyonsenga T, Davey R. Activity counseling early postelective percutaneous coronary intervention (ACE-PCI): Mixed-methods pilot randomized controlled trial. Health Sci Rep 2024; 7:e1963. [PMID: 38505683 PMCID: PMC10948586 DOI: 10.1002/hsr2.1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Background Physical activity (PA) levels of people with coronary heart disease are low in the first 30 days after percutaneous coronary intervention (PCI), increasing the risk of recurrent cardiac events. Following PCI, PA counseling delivered by a physiotherapist before discharge may increase the PA levels of patients. Preliminary work is required to determine the effects of the counseling session compared to usual care. Objectives To investigate the feasibility and potential efficacy of a brief physiotherapist-led PA counseling session immediately after an elective PCI compared to usual care for improved PA early post-PCI. Methods Using concealed allocation and blinded assessments, eligible participants (n = 30) were randomized to a physiotherapist-led PA counseling session (30 min) or usual care (nurse-led PA advice < 5 min). The primary outcome was daily minutes of moderate-to-vigorous PA (accelerometry; 3 weeks). Secondary outcomes included cardiac rehabilitation intention, anxiety and depression levels (Hospital Anxiety and Depression Scale), and quality-of-life (MacNew questionnaire). Recruitment, retention, and attrition were assessed for feasibility. Semistructured interviews were conducted with 13 participants to determine intervention acceptability, and barriers and enablers to PA. Results Between and within-group comparisons were not significant in intention-to-treat analyses. All feasibility criteria were met except for retention and attrition of participants. At 3 weeks, only 25% of participants were planning to attend cardiac rehabilitation, with no between-group differences. Increased PA at 3 weeks was associated with participants that were younger, without other chronic disease,s and more active immediately following discharge. Interviews revealed personal, environmental, and program-based themes for barriers and enablers to PA. Conclusions A physiotherapist-led PA counseling session may not improve PA levels early post-elective PCI compared to very brief PA advice delivered by nurses. A larger multicentre randomized controlled trial is feasible with minor modifications to participant follow-up. Further research is required.
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Affiliation(s)
- Nicole Freene
- Department of PhysiotherapyUniversity of CanberraBruceAustralian Capital TerritoryAustralia
- Health Research InstituteUniversity of CanberraBruceAustralian Capital TerritoryAustralia
| | - Suzanne J. Carroll
- Health Research InstituteUniversity of CanberraBruceAustralian Capital TerritoryAustralia
| | - Allyson Flynn
- Department of PhysiotherapyUniversity of CanberraBruceAustralian Capital TerritoryAustralia
| | - Sarah Bowen
- National Capital Private HospitalGarranAustralian Capital TerritoryAustralia
| | - Roslyn Holley
- National Capital Private HospitalGarranAustralian Capital TerritoryAustralia
| | - Kerry Rodway
- National Capital Private HospitalGarranAustralian Capital TerritoryAustralia
| | - Theo Niyonsenga
- Health Research InstituteUniversity of CanberraBruceAustralian Capital TerritoryAustralia
| | - Rachel Davey
- Health Research InstituteUniversity of CanberraBruceAustralian Capital TerritoryAustralia
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Bacon R, Hopkins S, Georgousopoulou E, Nahon I, Hilly C, Millar C, Flynn A, Smillie L, Chapman S, Brown N. While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study. Front Med (Lausanne) 2023; 10:1151980. [PMID: 37256090 PMCID: PMC10226666 DOI: 10.3389/fmed.2023.1151980] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Student clinical placements are a mandatory requirement within most accredited health programs. During the COVID-19 pandemic, many health settings that had traditionally provided placements cancelled their offerings. Telehealth services however, increased and emerged as an alternative placement setting. Aim To compare the learning experiences for allied health students provided by telehealth and face-to-face accredited health placements. Methods Health students, from a university clinic between March to December 2020, delivering both face-to-face and telehealth consultations, were invited to complete a telephone survey with 3 demographic questions; and 10-items comparing their telehealth and face-to-face learning experiences. Pearson's chi-squared/Fisher's exact test was used to examine the association between each item and consultation setting. Qualitative survey data was thematically analysed using a descriptive approach. Results 49 students from 2 universities and 5 disciplines completed the survey. Students rated their face-to-face experiences significantly higher than their telehealth experiences across all items (all p-values <0.01). Across 9 items students reported positive learning experiences in both settings. Students had greater opportunities to work in a multidisciplinary team in a face-to-face setting. Four themes were generated: (1) placements can vary in quality regardless of setting; (2) telehealth can provide valuable learning experiences and support competency development; (3) enablers for telehealth placements and (4) barriers for telehealth placements. Conclusion While telehealth can support student learning and competency development, in this study students preferred face-to-face experiences. To optimise telehealth placements consideration needs to be given to barriers and enablers such as technological issues and university curricula preparation.
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Affiliation(s)
- Rachel Bacon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sian Hopkins
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | | | - Irmina Nahon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Catherine Hilly
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - CaraJane Millar
- College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Allyson Flynn
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Linda Smillie
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sarah Chapman
- Allied Health Clinical Education Unit, Canberra Health Services, Garran, ACT, Australia
| | - Nicholas Brown
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Flynn A, Preston E, Dennis S, Canning CG, Allen NE. Utilising telehealth to support exercise and physical activity in people with Parkinson disease: a program evaluation using mixed methods. BMC Health Serv Res 2023; 23:224. [PMID: 36882780 PMCID: PMC9991450 DOI: 10.1186/s12913-023-09194-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Physical activity and exercise play a key role in managing Parkinson disease. This study aimed to: 1) determine if physiotherapy supported by telehealth helped people with Parkinson disease (PwP) to adhere to a home-based exercise program and maintain their physical activity; and 2) understand their experiences of using telehealth during the COVID-19 pandemic. METHODS A mixed methods program evaluation involving a retrospective file audit from a student-run physiotherapy clinic and semi-structured interviews exploring participants' experiences of telehealth. Ninety-six people with mild to moderate disease received home-based telehealth physiotherapy for 21 weeks. The primary outcome was adherence to the prescribed exercise program. Secondary outcomes were measures of physical activity. Interviews were conducted with 13 clients and seven students and analysed thematically. RESULTS Adherence to the prescribed exercise program was high. The mean (SD) proportion of prescribed sessions completed was 108% (46%). On average clients spent 29 (12) minutes per session, and 101 (55) minutes per week exercising. Physical activity levels were maintained, with clients taking 11,226 (4,832) steps per day on entry to telehealth, and 11,305 (4,390) steps per day on exit from telehealth. The semi-structured interviews identified important features of a telehealth service required to support exercise; a flexible approach of clients and therapists, empowerment, feedback, a therapeutic relationship, and mode of delivery. CONCLUSIONS PwP were able to continue exercising at home and maintain their physical activity when physiotherapy was provided via telehealth. The flexible approach of both the client and the service was imperative.
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Affiliation(s)
- Allyson Flynn
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia.
| | - Elisabeth Preston
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,South Western Sydney Local Health District, Liverpool, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Colleen G Canning
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Natalie E Allen
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Salmon R, Preston E, Mahendran N, Ada L, Flynn A. People with mild Parkinson's disease have impaired force production in upper limb muscles: A cross-sectional study. Physiother Res Int 2023; 28:e1976. [PMID: 36266769 PMCID: PMC10078520 DOI: 10.1002/pri.1976] [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: 09/09/2021] [Revised: 03/30/2022] [Accepted: 10/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND There has been little examination of force production of the upper limb in people with Parkinson's disease (PD), despite its impact on activities of daily living and clear evidence that force production is significantly reduced in lower limb muscle groups. The aim of this study was to determine the force production of the major muscle groups of the upper limb in people with PD during the "on" phase after medication, compared with aged-matched neurologically-normal controls. METHOD A cross-sectional study was carried out. PARTICIPANTS Thirty people with mild PD (Hoehn Yahr mean 1.1) and 24 age-matched neurologically-normal controls. OUTCOME MEASURES Maximum isometric force production of the shoulder flexors, extensors, abductors, adductors, internal rotators and external rotators, elbow flexors and extensors, wrist flexors and extensors and hand grip using dynamometry. RESULTS There was a significant impairment in force production in all upper limb muscle groups, compared with control participants, except in the wrist flexors. On average the deficit in force production was 22%, despite people with PD having mild disease, being physically active and being measured during the "on" phase of medication. The most severely affected muscle groups were the upper limb extensors. CONCLUSION People with PD have a significant deficit in force production of the upper limb muscle groups compared with age-matched neurologically normal controls. CLINICAL IMPLICATIONS Regular assessment of strength of the upper limb should be considered by clinicians and strengthening interventions could be implemented if a deficit is identified.
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Affiliation(s)
- Renee Salmon
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | | | - Louise Ada
- Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Allyson Flynn
- Faculty of Health, University of Canberra, Canberra, Australia
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5
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Freene N, Wallett H, Flynn A, Preston E, Cowans S, Lueck C, Niyonsenga T, Mohanty I, Davey R. Cardiovascular Rehabilitation for transient ischaemic Attack and Mild Stroke: the CRAMS effectiveness-implementation hybrid study protocol. BMC Health Serv Res 2022; 22:1391. [PMID: 36419153 PMCID: PMC9682670 DOI: 10.1186/s12913-022-08797-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Internationally, stroke and cardiac rehabilitation clinicians agree that current cardiac rehabilitation models are a suitable secondary prevention program for people following a transient ischaemic attack (TIA) or mild stroke. There is strong evidence for exercise-based cardiac rehabilitation in people with heart disease, however, the evidence for cardiac rehabilitation post-TIA or stroke is limited. Here we will explore the effectiveness and implementation of an integrated (TIA, mild stroke, heart disease) traditional exercise-based cardiovascular rehabilitation (CVR) program for people with TIA or mild stroke over 6-months. METHODS This type 1 effectiveness-implementation hybrid study will use a 2-arm single-centre assessor-blind randomised controlled trial design, recruiting 140 participants. Adults who have had a TIA or mild stroke in the last 12-months will be recruited by health professionals from hospital and primary healthcare services. Participants will be assessed and randomly allocated (1:1) to the 6-week CVR program or the usual care 6-month wait-list control group. Distance completed in the 6-min walk test will be the primary effectiveness outcome, with outcomes collected at baseline, 6-weeks (complete CVR) and 6-months in both groups. Other effectiveness outcome measures include unplanned cardiovascular disease-related emergency department and hospital admissions, daily minutes of accelerometer moderate-to-vigorous physical activity, body mass index, waist circumference, blood pressure, quality of life, anxiety and depression. Implementation outcomes will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, including a cost-effectiveness analysis. Semi-structured interviews will be conducted with participants and CVR program health professionals, investigating the acceptability, value, and impact of the CVR program. Qualitative analyses will be guided by the Consolidated Framework for Implementation Research. DISCUSSION Few studies have assessed the effectiveness of cardiac rehabilitation for people with TIA and mild stroke, and no studies appear to have investigated the cost-effectiveness or implementation determinants of such programs. If successful, the CVR program will improve health outcomes and quality of life of people who have had a TIA or mild stroke, guiding future research, policy, and clinical practice, reducing the risk of repeat heart attacks and strokes for this population. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621001586808 , Registered 19 November 2021.
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Affiliation(s)
- Nicole Freene
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia ,grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
| | - Hannah Wallett
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia
| | - Allyson Flynn
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia
| | - Elisabeth Preston
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia
| | - Shahla Cowans
- Neurology, Canberra Health Services, Garran, ACT Australia
| | | | - Theophile Niyonsenga
- grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
| | - Itismita Mohanty
- grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
| | - Rachel Davey
- grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
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Stephenson C, Flynn A, Overs A, Strickland K. Support needs of people with younger onset Parkinson's disease: An interpretative phenomenological analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hendriksen JD, Flynn A, Maarup SB, Poulsen HS, Lassen U, Weischenfeldt J. P06.01.A Deconvolution of immunotherapy-treated glioblastoma identifies cellular heterogeneity and plasticity at the single-cell level. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Glioblastoma is the most aggressive cancer originating in the brain with an average survival of 15 months. One of the characteristics of glioblastoma is the high level of intra-tumour heterogeneity (ITH), but the composition and complexity at the single-cell level is poorly understood. Here, we aimed to assess the effects and consequences of immune checkpoint inhibitor (ICI) on the cellular and molecular heterogeneity of glioblastoma tumours using at the single cell level.
Material and Methods
In collaboration with the phase I trials unit at Rigshospitalet, we performed paired molecular analysis of glioma cells from primary and relapse surgery after ICI treatment. Samples were analysed using single-cell RNA sequencing (scRNA-seq) as well as bulk RNA sequencing and whole exome DNA sequencing.
Results
In an effort to trace cellular lineages we developed and refined methods to a identify copy number changes using scRNA-seq. To this end, we identified clonal and subclonal tumour cell populations in each sample. We found high levels of ITH prior to treatment, both with respect to the glioblastoma subtype enrichment and the cell type-specific gene expression. Using expression-based cell-type classification, we found defined recurrent cell-type populations present at both surgery time points. The immune checkpoint treatment had consequences on the cellular phenotypes and proportions of tumour cells, suggesting a level of plasticity in the neoplastic cells. Moreover, we identified examples of clonal dynamics and sweeps following ICI treatment, pointing to potential treatment response and resistance in these population.
Conclusion
In summary, we pursued single cell-focused analysis of ICI treated glioblastoma patients to study the cellular and molecular heterogeneity within and between glioblastoma patients, which pointed to recurrent patterns of cellular responses following ICI treatment.
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Affiliation(s)
- J D Hendriksen
- University of Copenhagen , Copenhagen , Denmark
- Rigshospitalet , Copenhagen , Denmark
| | - A Flynn
- University of Melbourne , Melbourne , Australia
| | | | | | - U Lassen
- Rigshospitalet , Copenhagen , Denmark
| | - J Weischenfeldt
- University of Copenhagen , Copenhagen , Denmark
- Rigshospitalet , Copenhagen , Denmark
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Tosh C, Kavanagh K, Flynn A, White S, Catalao R, Wilson C. The physical-mental health interface during pregnancy planning. Eur Psychiatry 2022. [PMCID: PMC9566705 DOI: 10.1192/j.eurpsy.2022.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
The physical and mental health of women prior to conception can have a significant impact on pregnancy and child outcomes. Given the rising burden of non-communicable diseases, the aim of this analysis was to explore the relationship between mental health, physical health and health behaviour in women planning a pregnancy.
Objectives
To investigate the association between indices of physical and mental health in a large population of women in the UK planning a pregnancy.
Methods
Responses to a preconception health digital education tool provided data on the physical and mental health and health behaviour of 131,182 women planning pregnancy. Logistic regression was used to explore associations between mental health and physical health variables. Multiple imputation by chained equations was implemented to handle missing data.
Results
There was evidence for an association between physical and mental health conditions (OR 2.22; 95% CI 2.14, 2.3). There was also an association between having a mental disorder and physical inactivity (OR 1.14; 95% CI 1.11, 1.18), substance misuse (OR 2.4; 95% CI 2.25, 2.55) and less folic acid use (OR 0.89; 95% CI 0.86,0.92).
Conclusions
There is a need for greater integration of physical and mental healthcare for women in the preconception period, which could support women, including those who wish to conceive, to optimise their health during this time.
Disclosure
No significant relationships.
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Flynn A, Dennis S, Preston E, Canning CG, Allen NE. Exercising with Parkinson's: The good, the bad and the need for support to keep exercising. A qualitative study. Clin Rehabil 2022; 36:1332-1341. [PMID: 35549564 DOI: 10.1177/02692155221100884] [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: 11/17/2022]
Abstract
OBJECTIVES To explore the experiences of people with Parkinson's disease exercising and to determine if the location (home versus centre) or exercising in a group impacted on their experience. DESIGN A qualitative study. PARTICIPANTS Community-dwelling people with mild to moderate Parkinson's disease who had undertaken a 10-week exercise intervention. METHOD Semi-structured interviews were conducted with 17 participants; nine participants had completed 10-weeks of predominately home-based exercise and eight participants had predominately centre-based excercise. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis. RESULTS Four key themes emerged. Two themes: 'targeted exercise is important when you have Parkinson's disease' and 'support helps me to gain the most from the exercise', were related to exercising with Parkinson's disease and were not specific to location. Two themes encompassed the perceptions when exercising at a centre in a group compared to exercising at home: 'the good and the bad of exercising in a group' and 'exercising at home, can I do it?' CONCLUSION Experiences of people with Parkinson's disease when exercising were primarily influenced by the prescription of specific exercise and the support provided. There was no clear preference for the location of exercise but maintaining the motivation to exercise at home was challenging.
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Affiliation(s)
- Allyson Flynn
- Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Discipline of Physiotherapy, Faculty of Health, 2234University of Canberra, Canberra Australia
| | - Sarah Dennis
- Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,1511South Western Sydney Local Health District, Liverpool, Australia.,550242Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Elisabeth Preston
- Discipline of Physiotherapy, Faculty of Health, 2234University of Canberra, Canberra Australia
| | - Colleen G Canning
- Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Natalie E Allen
- Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Abstract
Student-led clinics provide a unique opportunity for interprofessional education as part of the education of future allied health professionals. A rapid review was conducted to determine the benefits to allied health students participating in interprofessional education in student-led clinics. Studies were included if they took place within a student-led clinic, reported on outcomes for students and where the clinic involved interprofessional education for students from either two or more allied health professions, or one allied health and one nursing student. Results were analyzed using a descriptive qualitative approach. Five themes were identified: (a) understanding of own role and scope of practice; (b) understanding of the role and scope of practice of other professions; (c) individual benefits to the students; (d) impact on patient-centered care; and (c) understanding of how to work in an interprofessional team. These benefits indicate that student-led clinics are a suitable setting for the delivery of interprofessional education to allied health students. More research is needed that considers the long-term impact on these student outcomes following students' entry into the healthcare profession, as well as on the impact of specific components of the interprofessional education models on student outcomes.
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Affiliation(s)
- Sian Hopkins
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, Australia
| | - Rachel Bacon
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, Australia
| | - Allyson Flynn
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
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Flynn A, Preston E, Dennis S, Canning CG, Allen NE. Home-based exercise monitored with telehealth is feasible and acceptable compared to centre-based exercise in Parkinson's disease: A randomised pilot study. Clin Rehabil 2020; 35:728-739. [PMID: 33272025 DOI: 10.1177/0269215520976265] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the feasibility and acceptability of a home-based exercise program monitored using telehealth for people with Parkinson's disease. DESIGN Pilot randomised control trial. SETTING University physiotherapy clinic, participants' homes. PARTICIPANTS Forty people with mild to moderate Parkinson's disease, mean age 72 (6.9). INTERVENTION In Block 1 (5 weeks) all participants completed predominantly centre-based exercise plus a self-management program. Participants were then randomised to continue the centre-based exercise (n = 20) or to a home-based program with telehealth (n = 20) for Block 2 (5 weeks). The exercises targeted balance and gait. OUTCOMES The primary outcomes were the feasibility and acceptability of the intervention. Secondary outcomes were balance, gait speed and freezing of gait. RESULTS Adherence was high in Block 1 (93%), and Block 2 (centre-based group = 93%, home-based group = 84%). In Block 2, the physiotherapist spent 6.4 hours providing telehealth to the home-based group (mean 10 (4) minutes per participant) and 32.5 hours delivering the centre-based exercise classes (98 minutes per participant). Participants reported that exercise was helpful, they could follow the home program and they would recommend exercising at home or in a group. However, exercising at home was less satisfying and there was a mixed response to the acceptability of the self-management program. There was no difference between groups in any of the secondary outcome measures (preferred walking speed mean difference -0.04 (95% CI: -0.12 to 0.05). CONCLUSION Home-based exercise monitored using telehealth for people with Parkinson's disease is feasible and acceptable.
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Affiliation(s)
- Allyson Flynn
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Discipline of Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Elisabeth Preston
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sarah Dennis
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,South Western Sydney Local Health District, Liverpool, NSW, Australia.,Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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Flynn A, Allen NE, Dennis S, Canning CG, Preston E. Home-based prescribed exercise improves balance-related activities in people with Parkinson's disease and has benefits similar to centre-based exercise: a systematic review. J Physiother 2019; 65:189-199. [PMID: 31521554 DOI: 10.1016/j.jphys.2019.08.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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] [Received: 07/25/2019] [Accepted: 08/13/2019] [Indexed: 12/27/2022] Open
Abstract
QUESTIONS In people with Parkinson's disease, does home-based prescribed exercise improve balance-related activities and quality of life compared with no intervention? Are the effects of home-based exercise similar to those of equivalent centre-based exercise? DESIGN Systematic review and meta-analysis of randomised and quasi-randomised controlled trials. PARTICIPANTS Adults diagnosed with idiopathic Parkinson's disease. INTERVENTION Predominantly home-based prescribed exercise (defined as a minimum of two-thirds of the exercise being completed at home). The intervention had to primarily involve physical practice of exercises targeting gait and/or standing balance compared with either control (ie, usual care only, a sham intervention or no physiotherapy) or equivalent predominantly centre-based exercise. OUTCOME MEASURES The primary outcome was balance-related activities and the secondary outcomes were gait speed, Berg Balance Scale, Functional Reach test, and quality of life. RESULTS Sixteen trials met the inclusion criteria and all contributed to the meta-analyses. Twelve trials compared home-based prescribed exercise with control, and four trials compared home-based prescribed exercise with equivalent centre-based exercise. Home-based prescribed exercise improved balance-related activities (SMD 0.21, 95% CI 0.10 to 0.32) and gait speed (SMD 0.30, 95% CI 0.12 to 0.49), but not quality of life (SMD 0.11, 95% CI -0.01 to 0.23) compared with control. Home-based and centre-based exercise had similar effects on balance-related activities (SMD -0.04, 95% CI -0.36 to 0.27) and quality of life (SMD -0.08, 95% CI -0.41 to 0.24). CONCLUSION Home-based prescribed exercise improves balance-related activities and gait speed in people with Parkinson's disease, and these improvements are similar to improvements with equivalent centre-based exercise. REGISTRATION PROSPERO CRD 42018107331.
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Affiliation(s)
- Allyson Flynn
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia; Discipline of Physiotherapy, Faculty of Health, University of Canberra, Australia.
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia
| | - Sarah Dennis
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia; South Western Sydney Local Health District, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia
| | - Elisabeth Preston
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Australia
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Eccles C, Webb J, Flynn A, McWillianm A, Sanneh A, Van Herk M, Choudhury A, Aznar M. EP-2212 Piloting an educational framework for the enhanced role of RTTs in MRI-guided adaptive radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32632-5] [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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14
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Li D, Waite DW, Gunawardana DN, McCarthy B, Anderson D, Flynn A, George S. DNA barcoding and real-time PCR detection of Bactrocera xanthodes (Tephritidae: Diptera) complex. Bull Entomol Res 2019; 109:102-110. [PMID: 29729674 DOI: 10.1017/s0007485318000251] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Immature fruit fly stages of the family Tephritidae are commonly intercepted on breadfruit from Pacific countries at the New Zealand border but are unable to be identified to the species level using morphological characters. Subsequent molecular identification showed that they belong to Bactrocera xanthodes, which is part of a species complex that includes Bactrocera paraxanthodes, Bactrocera neoxanthodes and an undescribed species. To establish a more reliable molecular identification system for B. xanthodes, a reference database of DNA barcode sequences for the 5'-fragment of COI gene region was constructed for B. xanthodes from Fiji, Samoa and Tonga. To better understand the species complex, B. neoxanthodes from Vanuatu and B. paraxanthodes from New Caledonia were also barcoded. Using the results of this analysis, real-time TaqMan polymerase chain reaction (PCR) assays for the detection of B. xanthodes complex and for the three individual species of the complex were developed and validated. The assay showed high specificity for the target species, with no cross-reaction observed for closely related organisms. Each of the real-time PCR assays is sensitive, detecting the target sequences at concentrations as low as ten copies µl-1 and can be used as either singleplex or multiplex formats. This real-time PCR assay for B. xanthodes has been successfully applied at the borders in New Zealand, leading to the rapid identification of intercepted Tephritidae eggs and larvae. The developed assays will be useful biosecurity tools for rapid detection of species in the B. xanthodes complex worldwide.
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Affiliation(s)
- D Li
- Plant Health and Environment Laboratory,Ministry for Primary Industries,P.O. Box 2095,Auckland 1140,New Zealand
| | - D W Waite
- Plant Health and Environment Laboratory,Ministry for Primary Industries,P.O. Box 2095,Auckland 1140,New Zealand
| | - D N Gunawardana
- Plant Health and Environment Laboratory,Ministry for Primary Industries,P.O. Box 2095,Auckland 1140,New Zealand
| | - B McCarthy
- Plant Health and Environment Laboratory,Ministry for Primary Industries,PO Box 14018,Christchurch 8544,New Zealand
| | - D Anderson
- Plant Health and Environment Laboratory,Ministry for Primary Industries,PO Box 14018,Christchurch 8544,New Zealand
| | - A Flynn
- Plant Health and Environment Laboratory,Ministry for Primary Industries,P.O. Box 2095,Auckland 1140,New Zealand
| | - S George
- Plant Health and Environment Laboratory,Ministry for Primary Industries,P.O. Box 2095,Auckland 1140,New Zealand
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Flynn A, Kilmartin D, Phelan S, McMenamin M, Kelly J, Laing ME. Delayed immunological reaction to Integra™ skin graft. Clin Exp Dermatol 2019; 44:714-716. [PMID: 30675916 DOI: 10.1111/ced.13855] [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] [Accepted: 08/22/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A Flynn
- Department of Dermatology, Galway University Hospital, Galway, Ireland
| | - D Kilmartin
- Department of Pathology, Galway University Hospital, Galway, Ireland
| | - S Phelan
- Department of Pathology, Galway University Hospital, Galway, Ireland
| | - M McMenamin
- Department of Pathology, St James's Hospital, Dublin, Ireland
| | - J Kelly
- Department of Plastics, Galway University Hospital, Galway, Ireland
| | - M E Laing
- Department of Dermatology, Galway University Hospital, Galway, Ireland
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Ryan KE, Lane DA, Flynn A, Shepperd J, Ireland HA, Curtis JR. Dose Finding Study of a Low Molecular Weight Heparin, Innohep, in Haemodialysis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA pilot investigation was performed with Innohep, a low molecular weight (LMWH) preparation (peak maximum molecular mass 3,000-6,000), to determine possible dose regimens for patients undergoing regular maintenance haemodialysis for chronic renal failure. Results from this study suggested that suppression of macroscopic clot formation and fibrinopeptide A (FPA), a marker of fibrin formation, could be achieved following bolus injections rather than bolus injections and an infusion. On the basis of these preliminary findings, a randomised crossover study was performed in eight patients undergoing regular maintenance haemodialysis for 5-7 h to determine the effective antithrombotic dose of this LMWH. Single i.v. bolus doses of 1,250 AFXa u, 2,500 AFXa u and 5,000 AFXa u (n = 7-8) were compared to an UFH regime of 5,000 iu + 1,500 iu/h. Excessive clot formation in the dialyser bubble trap, necessitating additional UFH to enable completion of a prolonged (up to 7 h) dialysis, was observed in all patients on the 1,250 AFXa u dose (mean duration of dialysis prior to UFH, 3 h) but in a single patient only receiving the other LMWH doses. A dose-related response in the AFXa activity, measured by chromogenic substrate (CS) assay was seen in the three LMWH groups, with levels declining significantly (p <0.05) from 1-7 h. This contrasted with the constant levels maintained during dialysis with UFH. FPA levels were significantly elevated after 2 h following the 1,250 AFXa u bolus and after 4 h following the 2,500 AFXa u bolus. There was no significant difference in FPA levels between the 5,000 AFXa u bolus and UFH. β-thromboglobulin (pTG) levels rose significantly towards the end of dialysis in all LMWH groups and, at 5 h, were significantly increased following the 5,000 AFXa u and 2,500 AFXa u doses when compared to the UFH regime. AFXa levels correlated negatively with FPA levels (r = -0.62; p <0.01). In conclusion, for administration of Innohep, a bolus dose of 2,500 AFXa u would appear to be sufficient for dialyses of short duration (up to 4 h), whilst a 5,000 AFXa u bolus is as effective as UFH for a 6 h dialysis. AFXa activity measured by CS assay is related to inhibition of fibrin formation and can be used for monitoring purposes.
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Affiliation(s)
- K E Ryan
- The Departments of Haematology and Medicine, Charing Cross and Westminster Medical School, London, UK
| | - D A Lane
- The Departments of Haematology and Medicine, Charing Cross and Westminster Medical School, London, UK
| | - A Flynn
- The Departments of Haematology and Medicine, Charing Cross and Westminster Medical School, London, UK
| | - J Shepperd
- The Departments of Haematology and Medicine, Charing Cross and Westminster Medical School, London, UK
| | - H A Ireland
- The Departments of Haematology and Medicine, Charing Cross and Westminster Medical School, London, UK
| | - J R Curtis
- The Departments of Haematology and Medicine, Charing Cross and Westminster Medical School, London, UK
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Ryan KE, Lane DA, Flynn A, Ireland H, Boisclair M, Shepperd J, Curtis JR. Antithrombotic Properties of Dermatan Sulphate (MF 701) in Haemodialysis for Chronic Renal Failure. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe therapeutic potential of the glycosaminoglycan (GAG), dermatan sulphate (DS), as an antithrombotic agent in humans has yet to be established. We have performed dose ranging studies of DS to determine its effectiveness as an antithrombotic agent in patients (n = 6–8) undergoing haemodialysis for chronic renal failure. In an initial study, Study 1, i.v. bolus doses of 2–4 mg/kg and 5–6 mg/kg DS were given to patients dialysing with polyacrylonitrile hollow fibre (PAN HF) membranes. In a second crossover study, Study 2, performed using cuprophane hollow fibre (CHF) membranes, i. v. bolus doses of 3 mg/kg and 6 mg/kg DS were compared to a standard unfractionated heparin (UFH) regime that has been shown previously to inhibit fibrin formation. Further infusion studies, Study 3 and Study 4 evaluated the antithrombotic efficacy of an i. v. DS bolus of 3 mg/kg plus an i. v. infusion of DS 0.6 mg kg-1 h-1 and a DS bolus of 5 mg/ kg plus an infusion of 1 mg kg-1 h-1 over 5 h, respectively. These studies were compared to standard UFH regimes in a randomised crossover design. Plasma levels of fibrinopeptide A (FPA) and thrombin-antithrombin (TAT) were used as markers of fibrin formation and thrombin generation during dialysis using both membranes.The changes in DS concentration following administration of the different doses were similar in Studies 1 and 2. However, the effectiveness of DS as an anticoagulant appeared to depend markedly on the different dialyser types used in the two studies. In Study 1, 13/14 dialyses required additional UFH to complete a normal ~6 h session and DS was unable to prevent thrombin and fibrin formation, as determined by measurement of plasma FPA and TAT. However, some dose related effects were observed in the levels of these markers. Furthermore, DS levels correlated with those of FPA and TAT. In Study 2, increasing doses of DS (3 mg/kg and 6 mg/kg), allowed longer dialysis sessions (mean 4.57 h c.f. 5.25 h), approaching that obtained with UFH regime (5.86 h). FPA and TAT generation were incompletely suppressed by both doses of DS; FPA rose significantly compared to that observed with the UFH regime, while TAT did not. While no significant differences in the activation markers were observed between the two DS doses, DS levels, taken as a whole, showed significant negative correlations with those of FPA and TAT Little effect on the KCCT was seen.In Study 3, 3/6 patients required additional UFH (mean dialysis duration with DS 4.33 h c. f. 5.67 h with UFH). Mean DS levels were maintained between 35–40 µg/ml. Mean plasma FPA levels were maintained at constant levels throughout dialysis following DS administration but were higher than those observed following the UFH regime. In Study 4 mean DS levels were
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Affiliation(s)
- K E Ryan
- The Departments of Haematology and Medicine, Charing Cross and Westminster Hospital and Medical School, Hammersmith, London, UK
| | - D A Lane
- The Departments of Haematology and Medicine, Charing Cross and Westminster Hospital and Medical School, Hammersmith, London, UK
| | - A Flynn
- The Departments of Haematology and Medicine, Charing Cross and Westminster Hospital and Medical School, Hammersmith, London, UK
| | - H Ireland
- The Departments of Haematology and Medicine, Charing Cross and Westminster Hospital and Medical School, Hammersmith, London, UK
| | - M Boisclair
- The Departments of Haematology and Medicine, Charing Cross and Westminster Hospital and Medical School, Hammersmith, London, UK
| | - J Shepperd
- The Departments of Haematology and Medicine, Charing Cross and Westminster Hospital and Medical School, Hammersmith, London, UK
| | - J R Curtis
- The Departments of Haematology and Medicine, Charing Cross and Westminster Hospital and Medical School, Hammersmith, London, UK
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Flynn A, Ni Raghallaigh S, Impey K, Connolly M, Tobin AM. Patients with psoriasis are frequently using sunbeds. Clin Exp Dermatol 2018; 43:466-467. [DOI: 10.1111/ced.13390] [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] [Accepted: 06/02/2017] [Indexed: 11/26/2022]
Affiliation(s)
- A. Flynn
- Dermatology Department; Adelaide and Meath Hospital; Tallaght Dublin 24 Ireland
| | - S. Ni Raghallaigh
- Dermatology Department; Adelaide and Meath Hospital; Tallaght Dublin 24 Ireland
| | - K. Impey
- Dermatology Department; Adelaide and Meath Hospital; Tallaght Dublin 24 Ireland
| | - M. Connolly
- Dermatology Department; Adelaide and Meath Hospital; Tallaght Dublin 24 Ireland
| | - A. M. Tobin
- Dermatology Department; Adelaide and Meath Hospital; Tallaght Dublin 24 Ireland
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19
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Ireland H, Lane DA, Flynn A, Pegrum AC, Curtis JR. Low Molecular Weight Heparin in Haemodialysis for Chronic Renal Failure: Dose Finding Study of CY222. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
SummaryA dose finding study of the very low molecular weight heparin CY222 (MW 2500) in patients (n = 8) with chronic renal failure undergoing dialysis has been carried out to (i) establish an effective dose and (ii) determine the relationship between ex vivo anti-factor Xa levels in plasma and the anticoagulant effect (in vivo suppression of FPA levels). Doses of CY222 were compared to a dose (5000 iu bolus + 1500 iu/hr) of unfractionated heparin (UFH) that has been shown to suppress FPA levels during prolonged (>5 hr) dialysis (Ireland et ah, J Lab Clin Med 103, 643, 1984). CY222 given iv in increasing doses produced a dose related increase in anti-factor Xa levels (measured as Institute Choay u/ml, with CY222 itself as standard) and suppression of FPA levels. When given in its highest dose, 20,000 Institute Choay u bolus + 1500 Institute Choay u/hr, there was little effect upon KCCT, FPA levels were statistically indistinguishable from those of the UFH regime (indicating comparable anticoagulant effect), but anti-factor Xa levels (expressed in Institute Choay u/ ml) were 2-3 times those of UFH (expressed in iu/ml). All samples were also assayed for anti-factor Xa level against the proposed low MW Heparin Standard. Plasma levels of CY222 were then found to be 2.78 times lower, so that the anti-factor Xa levels of CY222 required to produce comparable anticoagulant effect were then indistinguishable from those of UFH. Clinically, doses of CY222 exceeding 10,000 Institute Choay u bolus were effective, although increasing amounts of fibrin were visible in the drip chamber of the dialyser circuit with decreasing dose. These results indicate that CY222 is an effective anticoagulant for haemodialysis that can be monitored by its anti-factor Xa level in plasma (in conjunction with the appropriate standard). For prolonged dialysis a dose of 20,000 Institute Choay u bolus + 1500 Institute Choay u/hr is effective at suppressing fibrin formation, while the maintenance infusion may be unnecessary for short frequent dialyses.
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Affiliation(s)
- H Ireland
- The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
| | - D A Lane
- The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
| | - A Flynn
- The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
| | - A C Pegrum
- The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
| | - J R Curtis
- The Departments of Haematology and Medicine, Charing Cross and Westminister Hospital and Medical School, London, UK
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20
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Flynn A. Media: Home exercise programs made effortless using the PhysioTherapy eXercises patient app. J Physiother 2018; 64:134-135. [PMID: 29567381 DOI: 10.1016/j.jphys.2018.01.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Allyson Flynn
- University of Canberra, Australia; University of Sydney, Australia
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21
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Chetrit M, Roujol S, Timmins L, Levine R, Weyman A, Flynn A, Shahian D, Picard M, Afilalo J. ECHOCARDIOGRAPHIC MID-VENTRICULAR LINEAR DIMENSIONS ARE MORE ACCURATE THAN TRADITIONAL BASAL-LEVEL LINEAR DIMENSIONS: AN MRI VALIDATION STUDY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.405] [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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22
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Affiliation(s)
- R O'Connor
- Department of Dermatology, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - A Flynn
- Department of Dermatology, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - S Crowther
- Department of Pathology, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - A-M Tobin
- Department of Dermatology, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - M Connolly
- Department of Dermatology, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
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Feeney EL, O'Sullivan A, Nugent AP, McNulty B, Walton J, Flynn A, Gibney ER. Patterns of dairy food intake, body composition and markers of metabolic health in Ireland: results from the National Adult Nutrition Survey. Nutr Diabetes 2017; 7:e243. [PMID: 28218736 PMCID: PMC5360859 DOI: 10.1038/nutd.2016.54] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/25/2016] [Accepted: 11/21/2016] [Indexed: 01/11/2023] Open
Abstract
Background: Studies examining the association between dairy consumption and metabolic health have shown mixed results. This may be due, in part, to the use of different definitions of dairy, and to single types of dairy foods examined in isolation. Objective: The objective of the study was to examine associations between dairy food intake and metabolic health, identify patterns of dairy food consumption and determine whether dairy dietary patterns are associated with outcomes of metabolic health, in a cross-sectional survey. Design: A 4-day food diary was used to assess food and beverage consumption, including dairy (defined as milk, cheese, yogurt, cream and butter) in free-living, healthy Irish adults aged 18–90 years (n=1500). Fasting blood samples (n=897) were collected, and anthropometric measurements taken. Differences in metabolic health markers across patterns and tertiles of dairy consumption were tested via analysis of covariance. Patterns of dairy food consumption, of different fat contents, were identified using cluster analysis. Results: Higher (total) dairy was associated with lower body mass index, %body fat, waist circumference and waist-to-hip ratio (P<0.001), and lower systolic (P=0.02) and diastolic (P<0.001) blood pressure. Similar trends were observed when milk and yogurt intakes were considered separately. Higher cheese consumption was associated with higher C-peptide (P<0.001). Dietary pattern analysis identified three patterns (clusters) of dairy consumption; 'Whole milk', 'Reduced fat milks and yogurt' and 'Butter and cream'. The 'Reduced fat milks and yogurt' cluster had the highest scores on a Healthy Eating Index, and lower-fat and saturated fat intakes, but greater triglyceride levels (P=0.028) and total cholesterol (P=0.015). conclusion: Overall, these results suggest that while milk and yogurt consumption is associated with a favourable body phenotype, the blood lipid profiles are less favourable when eaten as part of a low-fat high-carbohydrate dietary pattern. More research is needed to better understand this association. Conclusion: Overall, these results suggest that although milk and yogurt consumption is associated with a favourable body phenotype, the blood lipid profiles are less favourable when eaten as part of a low-fat high-carbohydrate dietary pattern. More research is needed to better understand this association.
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Affiliation(s)
- E L Feeney
- UCD Institute of Food and Health, Science Centre South, University College Dublin, Dublin, Ireland.,Food for Health Ireland, University College Dublin, Dublin, Ireland
| | - A O'Sullivan
- UCD Institute of Food and Health, Science Centre South, University College Dublin, Dublin, Ireland
| | - A P Nugent
- UCD Institute of Food and Health, Science Centre South, University College Dublin, Dublin, Ireland.,Food for Health Ireland, University College Dublin, Dublin, Ireland
| | - B McNulty
- UCD Institute of Food and Health, Science Centre South, University College Dublin, Dublin, Ireland
| | - J Walton
- School of Food & Nutritional Sciences, University College Cork, Cork, Ireland
| | - A Flynn
- School of Food & Nutritional Sciences, University College Cork, Cork, Ireland
| | - E R Gibney
- UCD Institute of Food and Health, Science Centre South, University College Dublin, Dublin, Ireland.,Food for Health Ireland, University College Dublin, Dublin, Ireland
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Walton J, Kehoe L, McNulty BA, Nugent AP, Flynn A. Nutrient intakes and compliance with nutrient recommendations in children aged 1-4 years in Ireland. J Hum Nutr Diet 2017; 30:665-676. [DOI: 10.1111/jhn.12452] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J. Walton
- School of Food and Nutritional Sciences; University College Cork; Cork Ireland
| | - L. Kehoe
- School of Food and Nutritional Sciences; University College Cork; Cork Ireland
| | - B. A. McNulty
- UCD Institute of Food and Health; University College Dublin; Belfield Dublin Ireland
| | - A. P. Nugent
- UCD Institute of Food and Health; University College Dublin; Belfield Dublin Ireland
| | - A. Flynn
- School of Food and Nutritional Sciences; University College Cork; Cork Ireland
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Flynn A, Kiely C, Tobin AM, Jeffers M, Connolly M. Enlarging plaques and nodules on the face and legs. Clin Exp Dermatol 2017; 42:354-356. [PMID: 28111786 DOI: 10.1111/ced.13032] [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] [Accepted: 04/12/2016] [Indexed: 11/26/2022]
Affiliation(s)
- A Flynn
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - C Kiely
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - A M Tobin
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - M Jeffers
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - M Connolly
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
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Flynn A, Molony P, Keeting C, Cullen J, Tobin AM. Image Gallery: Systemic sarcoidosis presenting within the black pigment of a cosmetic tattoo. Br J Dermatol 2017; 176:e2. [PMID: 28098390 DOI: 10.1111/bjd.15047] [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: 12/01/2022]
Affiliation(s)
- A Flynn
- Department of Dermatology, Dublin 24, Ireland
| | - P Molony
- Department of Pathology, Dublin 24, Ireland
| | - C Keeting
- Department of Dermatology, Dublin 24, Ireland
| | - J Cullen
- Department of Respiratory Medicine, Adelaide and Meath Hospital, Dublin 24, Ireland
| | - A-M Tobin
- Department of Dermatology, Dublin 24, Ireland
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27
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Kehoe L, Walton J, McNulty BA, Nugent AP, Flynn A. Dietary strategies for achieving adequate vitamin D and iron intakes in young children in Ireland. J Hum Nutr Diet 2016; 30:405-416. [PMID: 27990698 DOI: 10.1111/jhn.12449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inadequate intakes of vitamin D and iron have been reported in young children in Ireland. The present study aimed to identify the main foods determining vitamin D and iron intakes and to model the impact of dietary strategies to improve adequacy of these micronutrients in young children. METHODS The present study is based on the Irish National Pre-School Nutrition Survey (NPNS), which estimated food and nutrient intakes in a representative sample (n = 500) of children (aged 1-4 years) using a 4-day weighed food record. Dietary strategies were modelled using DaDiet© software (Dazult Ltd, Co. Kildare, Republic of Ireland) and the usual intake distribution, prevalence of inadequate intakes and risk of excessive intakes were estimated using the National Cancer Institute method. RESULTS Fortified foods and nutritional supplements were the key foods influencing the intakes of vitamin D and iron. Adding a 5 μg day-1 vitamin D supplement, fortifying cow's milk (CM) with vitamin D or replacing CM with growing-up milk (GUM) would modestly increase intakes of vitamin D. A combined strategy of fortifying CM with vitamin D or replacing CM with GUM plus a 5 μg day-1 vitamin D supplement would increase mean intakes of vitamin D (from 3.5 μg day-1 at baseline to ≥11 μg day-1 ) and substantially reduce the prevalence of inadequate intakes (from >95% to 12-36%). Fortifying CM with iron or replacing CM with GUM would increase mean intakes of iron (from 7.3 mg day-1 to >10 mg day-1 ), achieving adequate intakes across all ages. CONCLUSIONS Based on real food consumption data in a representative sample of Irish children, we have shown that through targeted dietary strategies adequate intakes of iron are achievable and intakes of vitamin D could be greatly improved.
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Affiliation(s)
- L Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - J Walton
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - B A McNulty
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland
| | - A P Nugent
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Flynn
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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Maulsby C, Valdiserri RO, Kim JJ, Mahon N, Flynn A, Eriksson E, Jain KM, Enobun B, Holtgrave DR. The Global Engagement in Care Convening: Recommended Actions to Improve Health Outcomes for People Living With HIV. AIDS Educ Prev 2016; 28:405-416. [PMID: 27710081 DOI: 10.1521/aeap.2016.28.5.405] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The National HIV AIDS Strategy (NHAS) calls for a more coordinated response to the HIV epidemic. The Global Engagement in Care Convening created a forum for domestic and international experts to identify best practices in HIV care. This manuscript summarizes the meeting discussions and recommendations from meeting notes and an audio recording of the meeting. Recommendations include: further standardization of performance goals and performance measures; additional research; a more robust system to support competing needs of clients receiving services; electronic information exchanges for HIV-related data; an expansion of the role of other health professionals to extend the capacity of physicians and other members of the care team; and revisions to current financing systems to increase reimbursement for and access to services that promote linkage to and retention in HIV care. The recommendations provide a unique example of "reverse technical assistance" and will inform U.S. program development, research, and policy.
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Affiliation(s)
- C Maulsby
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - R O Valdiserri
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - J J Kim
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - N Mahon
- M·A·C AIDS Fund and Global Philanthropy and Corporate Citizenship, The Estée Lauder Companies, Inc
| | - A Flynn
- M·A·C AIDS Fund, New York, New York
| | | | - K M Jain
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - Blessing Enobun
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - D R Holtgrave
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
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Keating C, Flynn A, Leonard N, Crotty P, Tobin AM, Connolly M. An unsual cause of bilateral pigmentation on the upper back. Clin Exp Dermatol 2016; 41:831-3. [PMID: 27663169 DOI: 10.1111/ced.12898] [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] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- C Keating
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - A Flynn
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland.
| | - N Leonard
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - P Crotty
- Pathology Department, St James's Hospital, Dublin, Ireland
| | - A M Tobin
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - M Connolly
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
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Mandelbrot DA, Alberú J, Barama A, Marder BA, Silva HT, Flechner SM, Flynn A, Healy C, Li H, Tortorici MA, Schulman SL. Effect of Ramipril on Urinary Protein Excretion in Maintenance Renal Transplant Patients Converted to Sirolimus. Am J Transplant 2015; 15:3174-84. [PMID: 26176342 DOI: 10.1111/ajt.13384] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 05/17/2015] [Accepted: 05/17/2015] [Indexed: 01/25/2023]
Abstract
This prospective, randomized, double-blind, placebo-controlled study evaluated the effects of ramipril on urinary protein excretion in renal transplant patients treated with sirolimus following conversion from a calcineurin inhibitor. Patients received ramipril or placebo for up to 6 weeks before conversion and 52 weeks thereafter. Doses were increased if patients developed proteinuria (urinary protein/creatinine ratio ≥0.5); losartan was given as rescue therapy for persistent proteinuria. The primary end point was time to losartan initiation. Of 295 patients randomized, 264 met the criteria for sirolimus conversion (ramipril, 138; placebo, 126). At 52 weeks, the cumulative rate of losartan initiation was significantly lower with ramipril (6.2%) versus placebo (23.2%) (p < 0.001). No significant differences were observed between ramipril and placebo for change in glomerular filtration rate from baseline (p = 0.148) or in the number of patients with biopsy-confirmed acute rejection (13 vs. 5, respectively; p = 0.073). One patient in the placebo group died due to cerebrovascular accident. Treatment-emergent adverse events were consistent with the known safety profile of sirolimus and were not potentiated by ramipril co-administration. Ramipril was effective in reducing the incidence of proteinuria for up to 1 year following conversion to sirolimus in maintenance renal transplant patients.
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Affiliation(s)
- D A Mandelbrot
- Department of Medicine, University of Wisconsin Hospital, Madison, WI
| | - J Alberú
- Transplantation Department, Instituto Nacional de Ciencias Médicas y Nutrición SZ, Mexico City, Mexico
| | - A Barama
- Department of Surgery, University of Montréal, Quebec, Canada
| | - B A Marder
- Internal Medicine/Nephrology, Presbyterian/St Luke's Medical Center, Denver, CO
| | - H T Silva
- Nephrology Division, Hospital do Rim-Universidade Federal de São Paulo, São Paulo, Brazil
| | - S M Flechner
- Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - A Flynn
- Global Innovative Pharma, Pfizer, Collegeville, PA
| | - C Healy
- Global Innovative Pharma, Pfizer, Collegeville, PA
| | - H Li
- Global Innovative Pharma, Pfizer, Collegeville, PA
| | | | - S L Schulman
- Global Innovative Pharma, Pfizer, Collegeville, PA
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O'Driscoll C, Murphy V, Doyle O, Wrenn C, Flynn A, O'Flaherty N, Fenelon L, Schaffer K, FitzGerald S. First outbreak of linezolid-resistant vancomycin-resistant Enterococcus faecium in an Irish hospital, February to September 2014. J Hosp Infect 2015; 91:367-70. [DOI: 10.1016/j.jhin.2015.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022]
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Gawron L, Lorange E, Flynn A, Sanders J, Turok D, Keefer L. Contraceptive misperceptions and misinformation among women with inflammatory bowel diseases: a qualitative study. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flynn A. Alasdair James Cameron Sneddon. Assoc Med J 2015. [DOI: 10.1136/bmj.h1455] [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: 11/04/2022]
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Donnelly N, Hunniford T, Harper R, Flynn A, Kennedy A, Branagh D, McLaughlin J. Demonstrating the accuracy of an in-hospital ambulatory patient monitoring solution in measuring respiratory rate. Annu Int Conf IEEE Eng Med Biol Soc 2014; 2013:6711-5. [PMID: 24111283 DOI: 10.1109/embc.2013.6611096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents clinical testing conducted to evaluate the accuracy of Aingeal, a wireless in-hospital patient monitor, in measuring respiration rate via impedance pneumography. Healthy volunteers were invited to simultaneously wear a CE Marked Aingeal vital signs monitor and a capnograph, the current gold standard in respiration rate measurement. During the test, participants were asked to undergo a series of defined breathing protocols which included normal breathing, paced breathing between 8-23 breaths per minute (bpm) and a recovery period following moderate exercise. Statistical analysis of the data collected shows a mean difference of -0.73, a standard deviation of 1.61, limits of agreement of -3.88 and +2.42 bpm and a P-value of 0.22. This testing demonstrates comparable performance of the Aingeal device in measuring respiration rate with a well-accepted and widely used alternative method.
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Tlustos C, Anderson W, Flynn A, Pratt I. Exposure of the adult population resident in Ireland to dioxins and PCBs from the diet. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2014; 31:1100-13. [DOI: 10.1080/19440049.2014.905713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tlustos C, Anderson W, Flynn A, Pratt I. Additional exposure of the Irish adult population to dioxins and PCBs from the diet as a consequence of the 2008 Irish dioxin food contamination incident. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2014; 31:889-904. [PMID: 24512325 DOI: 10.1080/19440049.2014.893399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In 2008, the discovery of elevated levels of dioxins and PCBs in a porcine fat sample taken as part of the national residues monitoring programme led to the detection of a major feed contamination incidence in the Republic of Ireland. To estimate additional exposure to dioxins and PCBs due to the contamination incident, all data associated with the contamination incident were collected and reviewed. An exposure model was devised that took into account the proportion of contaminated product reaching the final consumer during the contamination incident window and which utilised all additional information that became available after the incident occurred. Exposure estimates derived for both dioxins and PCBs showed that the body burden of the general population remained largely unaffected by the contamination incident and only approximately 10% were exposed to elevated levels of dioxins and PCBs. Whilst this proportion of the population experienced quite a significant additional load to the existing body burden, the estimated exposure values do not suggest that these would be associated with adverse health effects, based on current knowledge. The exposure period was also limited in time to approximately 3 months, following the recall of contaminated meat immediately on detection of the contamination.
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Affiliation(s)
- C Tlustos
- a Food Safety Authority of Ireland, Abbey Court , Dublin , Ireland
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Abstract
BACKGROUND The European Commission has identified schools as a priority setting for health promotion, including nutrition education and intervention. The present study examined the school-day diet of Irish primary-school children with the aim of identifying opportunities for dietary improvement. METHODS Data from The National Children's Food Survey (2003-2004) were used to establish a dataset of school-days. Dietary intake data were collected from 594 children (5-12 years) using a 7-day weighed food-record. The nutritional quality of the diet was examined for the total school-day and for food eaten 'before school', 'at school' and 'after school'. RESULTS Examination of dietary intake on school-days has highlighted nutritional imbalances for intakes of fat, saturated fat, added sugars, sodium and dietary fibre (DF). Mean energy (E) intake for the overall school-day was 7.1 MJ, with 16% of energy provided from food eaten 'before school', 33%E from food eaten 'at school' and 53% of energy from food eaten 'after school'. Relative to the overall school-day, food eaten 'before school' was lower in saturated fat and sodium, and higher in DF and many micronutrients. Food eaten 'at school' was relatively high in added sugars and sodium; lower in DF and micronutrients; and similar in saturated fat compared to the overall school-day. Food eaten 'after school' was relatively high in DF and vitamin A; similar in saturated fat, magnesium and sodium; and lower in added sugars and other micronutrients compared to the overall school-day. CONCLUSIONS To improve the overall nutritional quality of the school-day diet, food eaten at school should be targeted.
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Affiliation(s)
- J Walton
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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Abstract
BACKGROUND Despite evidence that even mild dehydration is associated with various morbidities, water intake estimates in free-living populations are lacking. The present study aimed to estimate water intakes and dietary sources in a nationally representative sample of the Irish adult population. METHODS A 4-day semi-weighed food record was used to collect dietary intake data from 1500 free-living adults aged 18-90 years in the Irish National Adult Nutrition Survey (NANS) (2008-2010) from which water intake was estimated. To enable fluid intake estimation, additional questions on how water and milk were consumed were incorporated. Total water intake was calculated as drinking water plus water from other beverages and food moisture. RESULTS The mean (SD) daily total water intake for Irish adults was 2.31 (0.92) L day(-1) [males 2.52 (1.00) L day(-1) ; females 2.09 (0.79) L day(-1)]. Intakes were lowest in elderly adults, as well as in those with less education, a lower social class, less energy expenditure and a higher body mass index and body fat percentage. In total, 67% of water came from beverages and 33% came from food moisture. Alcoholic beverages and teas individually contributed to total water intake in amounts similar to the drinking water contribution. CONCLUSIONS These data may be used as a foundation for further research in the area of the effect of under consumption of water on health outcomes to guide public health messages regarding adequate water intakes.
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Affiliation(s)
- L O'Connor
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland; MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
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Kelly O, Flynn A, Coleman E, O’keeffe C, Connolly M, Reddy D, Ahern E, Cotter C, Mcgovern R. EMERALD, elderly medicine early review and liaison for discharge. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Flynn A, Boardman D, Reinhard MI. The validation of synthetic spectra used in the performance evaluation of radionuclide identifiers. Appl Radiat Isot 2013; 77:145-52. [PMID: 23619192 DOI: 10.1016/j.apradiso.2013.03.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 03/14/2013] [Accepted: 03/15/2013] [Indexed: 11/29/2022]
Abstract
This work has evaluated synthetic gamma-ray spectra created by the RASE sampler using experimental data. The RASE sampler resamples experimental data to create large data libraries which are subsequently available for use in evaluation of radionuclide identification algorithms. A statistical evaluation of the synthetic energy bins has shown the variation to follow a Poisson distribution identical to experimental data. The minimum amount of statistics required in each base spectrum to ensure the subsequent use of the base spectrum in the generation of statistically robust synthetic data was determined. A requirement that the simulated acquisition time of the synthetic spectra was not more than 4% of the acquisition time of the base spectrum was also determined. Further validation of RASE was undertaken using two different radionuclide identification algorithms.
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Affiliation(s)
- A Flynn
- ANSTO, Locked Bag 2001, Kirrawee DC, NSW 2232, Australia.
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Flynn A. A study exploring the knowledge, attitudes and practices of young people regarding dengue fever and the extent of community involvement in vector control of the disease in Trinidad and Tobago. W INDIAN MED J 2012; 61:615-618. [PMID: 23441357] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study intends to explore young people's knowledge, attitudes and practices regarding dengue fever in Trinidad and Tobago. METHODS Interviews and focus groups were carried out with young people studying at the University of Trinidad and Tobago. Thematic analysis was then conducted on these scripts and recommendations for improvement were made. RESULTS All participants had some knowledge about dengue fever; however the extent of this knowledge varied greatly. Participants knew most about the mode of spread and symptoms. All participants did something at home as a means of vector control of the disease; ensuring no stagnant water was present in containers in the yard was the most popular method of vector control. All participants were aware that the government sprayed the neighbourhoods against mosquitoes; however the majority thought they did not do this often enough. CONCLUSION Following the results of this study, three recommendations were made: the government should spray on a more regular basis, particularly just before the rainy season; a pilot study should take place investigating whether a fining scheme would improve vector control and dengue fever health education should be improved.
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Affiliation(s)
- A Flynn
- University of Leeds Medical School, Leeds, England.
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Vaughan EE, Liew A, Mashayekhi K, Dockery P, McDermott J, Kealy B, Flynn A, Duffy A, Coleman C, O'Regan A, Barry FP, O'Brien T. Pretreatment of endothelial progenitor cells with osteopontin enhances cell therapy for peripheral vascular disease. Cell Transplant 2012; 21:1095-107. [PMID: 22304991 DOI: 10.3727/096368911x623880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tissue necrosis resulting from critical limb ischemia (CLI) leads to amputation in a significant number of patients. Autologous cell therapy using angiogenic cells such as endothelial progenitor cells (EPCs) holds promise as a treatment for CLI but a limitation of this treatment is that the underlying disease etiology that resulted in CLI may also contribute to dysfunction of the therapeutic EPCs. This study aimed to elucidate the mechanism of EPC dysfunction using diabetes mellitus as a model and to determine whether correction of this defect in dysfunctional EPCs ex vivo would improve the outcome after cell transplantation in the murine hind limb ischemia model. EPC dysfunction was confirmed in a homogenous population of patients with type 1 diabetes mellitus and a microarray study was preformed to identify dysregulated genes. Notably, the secreted proangiogenic protein osteopontin (OPN) was significantly downregulated in diabetic EPCs. Furthermore, OPN-deficient mice showed impaired recovery following hind limb ischemia, suggesting a critical role for OPN in postnatal neovascularization. EPCs isolated from OPN KO mice showed decreased ability to adhere to endothelial cells as well as impaired angiogenic potential. However, this dysfunction was reversed upon exposure to recombinant OPN, suggesting that OPN may act in an autocrine manner on EPCs. Indeed, exposure of OPN knockout (KO) EPCs to OPN was sufficient to induce the secretion of angiogenic proteins (IL-6, TGF-α, and FGF-α). We also demonstrated that vascular regeneration following hind limb ischemia in OPN KO mice was significantly improved upon injection of EPCs preexposed to OPN. We concluded that OPN acts in an autocrine manner on EPCs to induce the secretion of angiogenic proteins, thereby playing a critical role in EPC-mediated neovascularization. Modification of cells by exposure to OPN may improve the efficacy of autologous EPC transplantation via the enhanced secretion of angiogenic proteins.
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Affiliation(s)
- E E Vaughan
- Regenerative Medicine Institute (REMEDI), National Centre for Biomedical Engineering Science (NCBES), National University Ireland Galway (NUIG), Galway, Ireland
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Tlustos C, Sheridan M, O’Sullivan D, Anderson W, Flynn A. The dioxin contamination incident in Ireland, 2008: analytical results and congener patterns. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2012; 29:128-38. [DOI: 10.1080/19440049.2011.615030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Black L, Ireland J, Møller A, Roe M, Walton J, Flynn A, Finglas P, Kiely M. Development of an on-line Irish food composition database for nutrients. J Food Compost Anal 2011. [DOI: 10.1016/j.jfca.2011.01.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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O'Keeffe C, Browne G, O'Flaherty M, Capewell S, Walton J, Flynn A, Perry I. Potential cardiovascular mortality reductions in Ireland associated with specific food policy options. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.143586.23] [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: 11/03/2022]
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O'Keeffe C, Browne G, O'Flaherty M, Capewell S, Walton J, Flynn A, Perry I. P1-267 The potential impact of specific food policy changes on cvd mortality in Ireland. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976e.59] [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: 11/03/2022]
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O'Brien DJ, Wrenn C, Roche C, Rose L, Fenelon C, Flynn A, Murphy V, FitzGerald SF, Fenelon LE, Crowley B, Schaffer K. First isolation and outbreak of OXA-48-producing Klebsiella pneumoniae in an Irish hospital, March to June 2011. Euro Surveill 2011; 16:19921. [PMID: 21801694] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Five OXA-48-producing Klebsiella pneumoniae were detected in a tertiary referral hospital in Ireland between March and June 2011. They were found in the clinical isolates of five cases that were inpatients on general surgical wards. None of the cases had received healthcare at a facility outside of Ireland in the previous 12 months. This is the first report of OXA-48-producing K. pneumoniae in Ireland.
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Affiliation(s)
- D J O'Brien
- Department of Microbiology, St. Vincent's University Hospital, Dublin, Ireland.
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O’Brien DJ, Wrenn C, Roche C, Rose L, Fenelon C, Flynn A, Murphy V, FitzGerald SF, Fenelon LE, Crowley B, Schaffer K. First isolation and outbreak of OXA-48-producing Klebsiella pneumoniae in an Irish hospital, March to June 2011. Euro Surveill 2011. [DOI: 10.2807/ese.16.29.19921-en] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Five OXA-48-producing Klebsiella pneumoniae were detected in a tertiary referral hospital in Ireland between March and June 2011. They were found in the clinical isolates of five cases that were inpatients on general surgical wards. None of the cases had received healthcare at a facility outside of Ireland in the previous 12 months. This is the first report of OXA-48-producing K. pneumoniae in Ireland.
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Affiliation(s)
- D J O’Brien
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - C Wrenn
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - C Roche
- St. James’s Hospital, Dublin, Ireland
| | - L Rose
- St. James’s Hospital, Dublin, Ireland
| | - C Fenelon
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - A Flynn
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - V Murphy
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - S F FitzGerald
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - L E Fenelon
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - B Crowley
- St. James’s Hospital, Dublin, Ireland
| | - K Schaffer
- Department of Microbiology, St. Vincent’s University Hospital, Dublin, Ireland
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Paton C, Flynn A, Shingleton-Smith A, McIntyre S, Bhaumik S, Rasmussen J, Hardy S, Barnes T. Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. J Intellect Disabil Res 2011; 55:665-74. [PMID: 21507097 DOI: 10.1111/j.1365-2788.2011.01421.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards. METHOD Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug. RESULTS The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20-29) and 27% an affective illness (ICD-10 F30-39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous. CONCLUSIONS In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated.
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Affiliation(s)
- C Paton
- Pharmacy, Oxleas NHS Trust, Dartford, UK.
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Daines M, Flynn A, Sherwood C, Shultz S, Hoffman J, Gruzinova I, Boitano S. PAR-2 Activation by Alternaria alternata Proteases Induces Airway Epithelial Cell Activation and Lung Inflammation. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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