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Harvey-Thompson AJ, Geissel M, Crabtree JA, Weis MR, Gomez MR, Fein JR, Lewis WE, Ampleford DJ, Awe TJ, Chandler GA, Galloway BR, Hansen SB, Hanson J, Harding EC, Jennings CA, Kimmel M, Knapp PF, Mangan MA, Maurer A, Paguio RR, Perea L, Peterson KJ, Porter JL, Rambo PK, Robertson GK, Rochau GA, Ruiz DE, Shores JE, Slutz SA, Smith GE, Smith IC, Speas CS, Yager-Elorriaga DA, York A. Demonstration of improved laser preheat with a cryogenically cooled magnetized liner inertial fusion platform. Rev Sci Instrum 2023; 94:2890454. [PMID: 37184347 DOI: 10.1063/5.0142587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
We report on progress implementing and testing cryogenically cooled platforms for Magnetized Liner Inertial Fusion (MagLIF) experiments. Two cryogenically cooled experimental platforms were developed: an integrated platform fielded on the Z pulsed power generator that combines magnetization, laser preheat, and pulsed-power-driven fuel compression and a laser-only platform in a separate chamber that enables measurements of the laser preheat energy using shadowgraphy measurements. The laser-only experiments suggest that ∼89% ± 10% of the incident energy is coupled to the fuel in cooled targets across the energy range tested, significantly higher than previous warm experiments that achieved at most 67% coupling and in line with simulation predictions. The laser preheat configuration was applied to a cryogenically cooled integrated experiment that used a novel cryostat configuration that cooled the MagLIF liner from both ends. The integrated experiment, z3576, coupled 2.32 ± 0.25 kJ preheat energy to the fuel, the highest to-date, demonstrated excellent temperature control and nominal current delivery, and produced one of the highest pressure stagnations as determined by a Bayesian analysis of the data.
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Affiliation(s)
- A J Harvey-Thompson
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - M Geissel
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - J A Crabtree
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - M R Weis
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - M R Gomez
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - J R Fein
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - W E Lewis
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - D J Ampleford
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - T J Awe
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - G A Chandler
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - B R Galloway
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - S B Hansen
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - J Hanson
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - E C Harding
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - C A Jennings
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - M Kimmel
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - P F Knapp
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - M A Mangan
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - A Maurer
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - R R Paguio
- General Atomics, San Diego, California 92121, USA
| | - L Perea
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - K J Peterson
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - J L Porter
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - P K Rambo
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - G K Robertson
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - G A Rochau
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - D E Ruiz
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - J E Shores
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - S A Slutz
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - G E Smith
- General Atomics, San Diego, California 92121, USA
| | - I C Smith
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - C S Speas
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - D A Yager-Elorriaga
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
| | - A York
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185, USA
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Cai PL, Pymer S, Raza A, Ibeggazene S, Hitchman LH, Carradice D, Chetter IC, Smith GE. O080 A double-blind, placebo-controlled, randomised trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.080] [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: 11/06/2022]
Abstract
Abstract
Introduction
Intermittent claudication (IC) is a prevalent manifestation of peripheral arterial disease and affects about 3% of the UK population. Current guidance for the management of nonlife limiting IC is supervised exercise and best medical therapy. Supervised exercise however is not readily available across the nation and has poor recruitment and retention rates. Pilot data has demonstrated that Extracorporeal ShockWave Therapy (ESWT) is effective for improving walking distance in patients with IC. This study aims to consider its effectiveness for improving quality of life (QoL).
Methods
In a double-blind, sham-controlled, randomised trial, patients with IC were randomised in a 1:1 ratio to ESWT or sham treatment. The primary endpoint was change in physical functioning at 12-week follow-up, as measured by the SF-36. Secondary endpoints included changes in walking distances and ABPI.
Results
138 patients were randomised. The ESWT group had a significantly higher physical functioning score at 12 weeks (Mdn 41 vs 34, z=-2.1, p=0.033). They also had significantly longer claudication (Mdn 125 vs 88, z=-2.9, p=0.004) and maximum (Mdn 179 vs 129, z=-2.4, p=0.013) walking distances. The change from baseline to 12-weeks was also significantly greater in the ESWT group for claudication (Mdn 51 vs 24, z=-2.8, p<0.01) and maximum (Mdn 63 vs 17, z=-4 p<0.01) walking distance. No difference observed in ABPI.
Conclusion
This study demonstrates that ESWT is safe, well tolerated and clinically effective for improving QoL and walking distances in patients with IC.
Take-home message
Extracorporeal shockwave therapy improves quality of life and walking distances, and could potentially be used as a non-invasive adjunct to supervised exercise or in institutions were supervised exercise is not available.
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Affiliation(s)
- PL Cai
- Academic Vascular Surgery Unit, Hull York Medical School
| | - S Pymer
- Academic Vascular Surgery Unit, Hull York Medical School
| | - A Raza
- Academic Vascular Surgery Unit, Hull York Medical School
| | - S Ibeggazene
- Academic Vascular Surgery Unit, Hull York Medical School
| | - LH Hitchman
- Academic Vascular Surgery Unit, Hull York Medical School
| | - D Carradice
- Academic Vascular Surgery Unit, Hull York Medical School
| | - IC Chetter
- Academic Vascular Surgery Unit, Hull York Medical School
| | - GE Smith
- Academic Vascular Surgery Unit, Hull York Medical School
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Ravindhran B, Totty JP, Carradice D, Chetter IC, Smith GE. O076 Long term outcomes of “Christmas tree” banding for the treatment of dialysis access related steal syndrome: a thirteen-year experience with the technique. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.076] [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: 11/05/2022]
Abstract
Abstract
Introduction
High flowrates in arterio-venous fistulas (AVF) and the associated distal arterial insufficiency can cause Dialysis-Access related Steal Syndrome (DASS). Various techniques including ligation, banding, and bypass with interval-ligation have been advocated to treat this difficult problem with varying success. We present the long-term outcomes following a novel banding technique.
Methods
46 patients in this prospective cohort-study from 2008–2021 underwent an adjustable banding procedure using a PTFE patch shaped with one slit-end and saw-tooth edges (resulting in a ‘‘Christmas tree’’ pattern) to provide a ratchet mechanism to progressively constrict the draining vein. Real-time finger perfusion pressure monitoring allowed an optimal compromise between distal extremity and AVF perfusion. Comparisons between groups were measured and survival curves were obtained using the Kaplan-Meier method based on the log-rank test to calculate the thrombosis-free survival.
Results
63%(n=29) presented with constant pain and 24%(n=11) presented with tissue loss due to steal syndrome. Post-intervention patency was 100%,97.7%,95%,86% and 72% at 30 days, 60 days, 180 days, 1 year and 3 years, respectively. Complete resolution of symptoms was achieved in 74%(n=34) of patients and 11%(n=5) reported partial response needing no further intervention. We also observed that pre-procedure finger pressures of 41mmHg or below was highly specific for “true” steal-syndrome and these patients were more likely to completely respond to banding (p=0.016). The overall mean thrombosis free survival was seen to be 1844±168 days.
Conclusion
This adjustable dynamic method of AVF banding demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.
Take-home message
The described adjustable dynamic method of AVF banding under local anaesthesia demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.
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Affiliation(s)
| | - JP Totty
- Hull University Teaching Hospitals NHS Trust
| | - D Carradice
- Hull University Teaching Hospitals NHS Trust
| | - IC Chetter
- Hull University Teaching Hospitals NHS Trust
| | - GE Smith
- Hull University Teaching Hospitals NHS Trust
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Smith GE, Long J, Wallace T, Carradice D, Chetter IC. Identifying the research priorities of healthcare professionals in UK vascular surgery: modified Delphi approach. BJS Open 2020; 5:6054052. [PMID: 33688955 PMCID: PMC7944495 DOI: 10.1093/bjsopen/zraa025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background The Vascular Research Collaborative was established to develop a national research strategy for patients with vascular disease in the UK. This project aimed to establish national research priorities in this patient group. Methods A modified Delphi approach, an established method for reaching a consensus opinion among a group of experts in a particular field, was used to survey national multidisciplinary vascular clinical specialists. Two rounds of online surveys were conducted involving the membership of the Vascular Society, Society of Vascular Nurses, Society for Vascular Technology, and the Rouleaux Club (vascular surgical trainees). The first round invited any suggestions for vascular research topics. A steering group then collated and rationalized the suggestions, categorizing them by consensus into pathological topics and research categories, and amalgamating the various questions relating to the same fundamental issue into a single question. The second round involved recirculating these questions to the same participants for priority scoring. Results Round 1 resulted in 1231 suggested research questions from 481 respondents. Steering group collation and rationalization resulted in 83 questions for ranking in round 2. The second round resulted in a hierarchical list of vascular research priorities. The highest scoring priorities addressed topics related to critical lower-limb ischaemia, diabetic foot disease, amputation, wound healing, carotid plaque morphology, and service organization/delivery. Conclusion It is anticipated that these results will drive the UK national vascular research agenda for the next 5–10 years. It will facilitate focused development and funding of new research projects in current clinical areas of unmet need where potential impact is greatest.
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Affiliation(s)
- G E Smith
- Correspondence to: Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK (e-mail: )
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Amofa PA, Locke DEC, Chandler M, Crook JE, Ball CT, Phatak V, Smith GE. Comparative Effectiveness of Behavioral Interventions to Prevent or Delay Dementia: One-Year Partner Outcomes. J Prev Alzheimers Dis 2020; 8:33-40. [PMID: 33336222 DOI: 10.14283/jpad.2020.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/OBJECTIVE Various behavioral interventions are recommended to combat the distress experienced by caregivers of those with cognitive decline, but their comparative effectiveness is poorly understood. DESIGN/SETTING Caregivers in a comparative intervention study randomly had 1 of 5 possible interventions suppressed while receiving the other four. Caregivers in a full clinical program received all 5 intervention components. Care partner outcomes in the study group were compared to participants enrolled in a full clinical program. PARTICIPANTS Two hundred and seventy-two dyads of persons with amnestic mild cognitive impairment (pwMCI) and care partners enrolled in the comparative intervention study. 265 dyads participated in the full clinical program. INTERVENTION Behavioral intervention components included: memory compensation training, computerized cognitive training, yoga, support group, and wellness education. Each was administered for 10 sessions over 2 weeks. MEASUREMENTS A longitudinal mixed-effect regression model was used to analyze the effects of the interventions on partner burden, quality of life (QoL), mood, anxiety, and self-efficacy at 12 months follow-up. RESULTS At 12 months, withholding wellness education or yoga had a significantly negative impact on partner anxiety compared to partners in the clinical program (ES=0.55 and 0.44, respectively). Although not statistically significant, withholding yoga had a negative impact on partner burden and mood compared to partners in the full clinical program (ES=0.32 and 0.36, respectively). CONCLUSION Our results support the benefits of wellness education and yoga for improving partner's burden, mood, and anxiety at one year. Our findings are the first to provide an exploration of the impact of multicomponent interventions in care partners of pwMCI.
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Affiliation(s)
- P A Amofa
- Dona E.C. Locke, Division of Psychology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259; Ph: 480-301-8297; Fax: 480-301-6258;
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6
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Lake IR, Colón-González FJ, Barker GC, Morbey RA, Smith GE, Elliot AJ. Machine learning to refine decision making within a syndromic surveillance service. BMC Public Health 2019; 19:559. [PMID: 31088446 PMCID: PMC6515660 DOI: 10.1186/s12889-019-6916-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background Worldwide, syndromic surveillance is increasingly used for improved and timely situational awareness and early identification of public health threats. Syndromic data streams are fed into detection algorithms, which produce statistical alarms highlighting potential activity of public health importance. All alarms must be assessed to confirm whether they are of public health importance. In England, approximately 100 alarms are generated daily and, although their analysis is formalised through a risk assessment process, the process requires notable time, training, and maintenance of an expertise base to determine which alarms are of public health importance. The process is made more complicated by the observation that only 0.1% of statistical alarms are deemed to be of public health importance. Therefore, the aims of this study were to evaluate machine learning as a tool for computer-assisted human decision-making when assessing statistical alarms. Methods A record of the risk assessment process was obtained from Public Health England for all 67,505 statistical alarms between August 2013 and October 2015. This record contained information on the characteristics of the alarm (e.g. size, location). We used three Bayesian classifiers- naïve Bayes, tree-augmented naïve Bayes and Multinets - to examine the risk assessment record in England with respect to the final ‘Decision’ outcome made by an epidemiologist of ‘Alert’, ‘Monitor’ or ‘No-action’. Two further classifications based upon tree-augmented naïve Bayes and Multinets were implemented to account for the predominance of ‘No-action’ outcomes. Results The attributes of each individual risk assessment were linked to the final decision made by an epidemiologist, providing confidence in the current process. The naïve Bayesian classifier performed best, correctly classifying 51.5% of ‘Alert’ outcomes. If the ‘Alert’ and ‘Monitor’ actions are combined then performance increases to 82.6% correctly classified. We demonstrate how a decision support system based upon a naïve Bayes classifier could be operationalised within an operational syndromic surveillance system. Conclusions Within syndromic surveillance systems, machine learning techniques have the potential to make risk assessment following statistical alarms more automated, robust, and rigorous. However, our results also highlight the importance of specialist human input to the process.
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Affiliation(s)
- I R Lake
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ, UK. .,National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.
| | - F J Colón-González
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.,National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - G C Barker
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - R A Morbey
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.,Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, B3 2PW, UK
| | - G E Smith
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.,Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, B3 2PW, UK
| | - A J Elliot
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.,Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, B3 2PW, UK
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Carradice D, Forsyth J, Mohammed A, Leung C, Hitchman L, Harwood AE, Wallace T, Smith GE, Campbell B, Chetter I. Compliance with NICE guidelines when commissioning varicose vein procedures. BJS Open 2018; 2:419-425. [PMID: 30511042 PMCID: PMC6253791 DOI: 10.1002/bjs5.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168. Methods Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes. Results Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a 'trial' of conservative treatment; 22 (10·8 per cent) used lifestyle-related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated. Discussion The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle-related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - J Forsyth
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A Mohammed
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - C Leung
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - L Hitchman
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A E Harwood
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - T Wallace
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - G E Smith
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - B Campbell
- Department of Vascular Surgery Royal Devon and Exeter Hospital (Wonford) Exeter UK
| | - I Chetter
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
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Paguio RR, Tatum WD, Tomlinson K, Smith GE, Farrell MP, Taylor JL, Holt RR. Development of a Multi-Press Assembly Device for Planar Dynamic Material Property Targets. Fusion Science and Technology 2018. [DOI: 10.1080/15361055.2017.1387016] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R. R. Paguio
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - W. D. Tatum
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - K. Tomlinson
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - G. E. Smith
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - M. P. Farrell
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - J. L. Taylor
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - R. R. Holt
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
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9
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Affiliation(s)
- K. Tomlinson
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - C. T. Seagle
- Sandia National Laboratories, P.O. Box 5800, Albuquerque, New Mexico 87185-1168
| | - H. Huang
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - G. E. Smith
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - J. L. Taylor
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - R. R. Paguio
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
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Paguio RR, Smith GE, Taylor JL, Tomlinson K, Holt RR, Tatum WD, Farrell MP, Betcher J, Harvey-Thompson A, Geissel M, Kellogg J, Peterson K. Evolution of Gas Cell Targets for Magnetized Liner Inertial Fusion Experiments at the Sandia National Laboratories PECOS Test Facility. Fusion Science and Technology 2017. [DOI: 10.1080/15361055.2017.1387455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R. R. Paguio
- General Atomics, P.O. Box 85608, San Diego, California 92186-85608
| | - G. E. Smith
- General Atomics, P.O. Box 85608, San Diego, California 92186-85608
| | - J. L. Taylor
- General Atomics, P.O. Box 85608, San Diego, California 92186-85608
| | - K. Tomlinson
- General Atomics, P.O. Box 85608, San Diego, California 92186-85608
| | - R. R. Holt
- General Atomics, P.O. Box 85608, San Diego, California 92186-85608
| | - W. D. Tatum
- General Atomics, P.O. Box 85608, San Diego, California 92186-85608
| | - M. P. Farrell
- General Atomics, P.O. Box 85608, San Diego, California 92186-85608
| | - J. Betcher
- Luxel Corporation, Friday Harbor, Washington
| | | | - M. Geissel
- Sandia National Laboratories, Albuquerque, New Mexico
| | - J. Kellogg
- Sandia National Laboratories, Albuquerque, New Mexico
| | - K. Peterson
- Sandia National Laboratories, Albuquerque, New Mexico
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Harwood AE, Smith GE, Broadbent E, Cayton T, Carradice D, Chetter IC. Access to supervised exercise services for peripheral vascular disease patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1308/rcsbull.2017.207] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Which factors determine the current provision of supervised exercise in the UK?
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Jung Y, Silber MH, Tippmann-Peikert M, St Louis EK, Smith GE, Ferman TJ, Knopman DS, Petersen RC, Boeve BF. 1154 THE EFFECTS OF CPAP ON COGNITIVE AND FUNCTIONAL MEASURES IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DEMENTIA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1153] [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: 11/13/2022] Open
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Abstract
Background Intermittent claudication (IC) is a common condition that causes pain in the lower limbs when walking and has been shown to severely impact the quality of life (QoL) of patients. The QoL is therefore often regarded as an important measure in clinical trials investigating intermittent claudication. To date, no consensus exits on the type of life questionnaire to be used. This review aims to examine the QoL questionnaires used in trials investigating peripheral arterial disease (PAD). Material and methods A systematic review of randomised clinical trials including a primary analysis of QoL via questionnaire was performed. Trials involving patients with diagnosed PAD were included (either clinically or by questionnaire). Any trial which had QoL as the primary outcome data was included with no limit being placed on the type of questionnaire used. Results The search yielded a total of 1845 articles of which 31 were deemed appropriate for inclusion in the review. In total, 14 different QoL questionnaires were used across 31 studies. Of the questionnaires 24.06% were missing at least one domain when reported in the results of the study. Mean standard deviation varied widely based on the domain reported, particularly within the SF36. Discussion Despite previous recommendations for Europewide standardisation of quality of life assessment, to date no such tool exists. This review demonstrated that a number of different questionnaires remain in use, that their completion is often inadequate and that further evidence-based guidelines on QoL assessment are required to guide future research.
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Affiliation(s)
- A E Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - J P Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - E Broadbent
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - G E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
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14
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Hine JL, de Lusignan S, Burleigh D, Pathirannehelage S, McGovern A, Gatenby P, Jones S, Jiang D, Williams J, Elliot AJ, Smith GE, Brownrigg J, Hinchliffe R, Munro N. Association between glycaemic control and common infections in people with Type 2 diabetes: a cohort study. Diabet Med 2017; 34:551-557. [PMID: 27548909 DOI: 10.1111/dme.13205] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 01/03/2023]
Abstract
AIM To investigate the impact of glycaemic control on infection incidence in people with Type 2 diabetes. METHODS We compared infection rates during 2014 in people with Type 2 diabetes and people without diabetes in a large primary care cohort in the UK (the Royal College of General Practitioners Research and Surveillance Centre database). We performed multilevel logistic regression to investigate the impact of Type 2 diabetes on presentation with infection, and the effect of glycaemic control on presentation with upper respiratory tract infections, bronchitis, influenza-like illness, pneumonia, intestinal infectious diseases, herpes simplex, skin and soft tissue infections, urinary tract infections, and genital and perineal infections. People with Type 2 diabetes were stratified by good [HbA1c < 53 mmol/mol (< 7%)], moderate [HbA1c 53-69 mmol/mol (7-8.5%)] and poor [HbA1c > 69 mmol/mol (> 8.5%)] glycaemic control using their most recent HbA1c concentration. Infection incidence was adjusted for important sociodemographic factors and patient comorbidities. RESULTS We identified 34 278 people with Type 2 diabetes and 613 052 people without diabetes for comparison. The incidence of infections was higher in people with Type 2 diabetes for all infections except herpes simplex. Worsening glycaemic control was associated with increased incidence of bronchitis, pneumonia, skin and soft tissue infections, urinary tract infections, and genital and perineal infections, but not with upper respiratory tract infections, influenza-like illness, intestinal infectious diseases or herpes simplex. CONCLUSIONS Almost all infections analysed were more common in people with Type 2 diabetes. Infections that are most commonly of bacterial, fungal or yeast origin were more frequent in people with worse glycaemic control.
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Affiliation(s)
- J L Hine
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - S de Lusignan
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - D Burleigh
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - S Pathirannehelage
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - A McGovern
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - P Gatenby
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
- Royal Surrey County Hospital, Guildford, Surrey, UK
| | - S Jones
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | - D Jiang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - J Williams
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
| | | | - G E Smith
- Public Health England, Birmingham, UK
| | - J Brownrigg
- St George's Vascular Institute, Division of Cardiovascular Sciences, St George's University of London, London, UK
| | - R Hinchliffe
- St George's Vascular Institute, Division of Cardiovascular Sciences, St George's University of London, London, UK
| | - N Munro
- Section of Clinical Medicine and Ageing, University of Surrey, Guildford
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15
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Harcourt SE, Morbey RA, Loveridge P, Carrilho L, Baynham D, Povey E, Fox P, Rutter J, Moores P, Tiffen J, Bellerby S, McIntosh P, Large S, McMenamin J, Reynolds A, Ibbotson S, Smith GE, Elliot AJ. Developing and validating a new national remote health advice syndromic surveillance system in England. J Public Health (Oxf) 2017; 39:184-192. [PMID: 26956114 PMCID: PMC6092922 DOI: 10.1093/pubmed/fdw013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Public Health England (PHE) coordinates a suite of real-time national syndromic surveillance systems monitoring general practice, emergency department and remote health advice data. We describe the development and informal evaluation of a new syndromic surveillance system using NHS 111 remote health advice data. Methods NHS 111 syndromic indicators were monitored daily at national and local level. Statistical models were applied to daily data to identify significant exceedances; statistical baselines were developed for each syndrome and area using a multi-level hierarchical mixed effects model. Results Between November 2013 and October 2014, there were on average 19 095 NHS 111 calls each weekday and 43 084 each weekend day in the PHE dataset. There was a predominance of females using the service (57%); highest percentage of calls received was in the age group 1-4 years (14%). This system was used to monitor respiratory and gastrointestinal infections over the winter of 2013-14, the potential public health impact of severe flooding across parts of southern England and poor air quality episodes across England in April 2014. Conclusions This new system complements and supplements the existing PHE syndromic surveillance systems and is now integrated into the routine daily processes that form this national syndromic surveillance service.
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Affiliation(s)
- S. E. Harcourt
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK
| | - R. A. Morbey
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK
| | - P. Loveridge
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK
| | - L. Carrilho
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK
| | - D. Baynham
- South Central Ambulance Service NHS Foundation Trust, Bicester OX26 6HR, UK
| | - E. Povey
- Digital Assessment Service, Health and Social Care Information Centre, Leeds BL1 2AX, UK
| | - P. Fox
- NHS Pathways, Health and Social Care Information Centre, Leeds LS1 4HR, UK
| | - J. Rutter
- NHS Pathways, Health and Social Care Information Centre, Leeds LS1 4HR, UK
| | - P. Moores
- Operations and Assurance Services, Health and Social Care Information Centre, Exeter EX2 5SE, UK
| | - J. Tiffen
- NHS Choices, Health and Social Care Information Centre, Southampton SO30 2UN, UK
| | - S. Bellerby
- NHS Choices, Health and Social Care Information Centre, Southampton SO30 2UN, UK
| | - P. McIntosh
- NHS Pathways, Health and Social Care Information Centre, Leeds LS1 4HR, UK
| | - S. Large
- Nursing and Quality Directorate, NHS England, South Region, UK
| | - J. McMenamin
- Respiratory Team, Health Protection Scotland, Glasgow G2 6QE, UK
| | - A. Reynolds
- Respiratory Team, Health Protection Scotland, Glasgow G2 6QE, UK
| | - S. Ibbotson
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK
| | - G. E. Smith
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK
| | - A. J. Elliot
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK
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16
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Chandler MJ, Parks AC, Marsiske M, Rotblatt LJ, Smith GE. Everyday Impact of Cognitive Interventions in Mild Cognitive Impairment: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2016; 26:225-251. [PMID: 27632385 PMCID: PMC5048589 DOI: 10.1007/s11065-016-9330-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 08/22/2016] [Indexed: 01/13/2023]
Abstract
Cognitive interventions in Mild Cognitive Impairment (MCI) seek to ameliorate cognitive symptoms in the condition. Cognitive interventions may or may not generalize beyond cognitive outcomes to everyday life. This systematic review and meta-analysis sought to assess the effect of cognitive interventions compared to a control group in MCI on generalizability outcome measures [activities of daily living (ADLs), mood, quality of life (QOL), and metacognition] rather than cognitive outcomes alone. PRISMA guidelines were followed. MEDLINE and PsychInfo were utilized as data sources to locate references related to cognitive interventions in individuals with MCI. The cognitive intervention study was required to have a control or alternative treatment comparison group to be included. Thirty articles met criteria, including six computerized cognitive interventions, 14 therapist-based interventions, and 10 multimodal (i.e., cognitive intervention plus an additional intervention) studies. Small, but significant overall median effects were seen for ADLs (d = 0.23), mood (d = 0.16), and metacognitive outcomes (d = 0.30), but not for QOL (d = 0.10). Computerized studies appeared to benefit mood (depression, anxiety, and apathy) compared to controls, while therapist-based interventions and multimodal interventions had more impact on ADLs and metacognitive outcomes than control conditions. The results are encouraging that cognitive interventions in MCI may impact everyday life, but considerably more research is needed. The current review and meta-analysis is limited by our use of only PsychInfo and MEDLINE databases, our inability to read full text non-English articles, and our reliance on only published data to complete effect sizes.
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Affiliation(s)
- M J Chandler
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - A C Parks
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - M Marsiske
- University of Florida, Gainesville, FL, USA
| | | | - G E Smith
- University of Florida, Gainesville, FL, USA
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17
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Simms I, Fleming DM, Lowndes CM, Smith GE, Chapman RS. Surveillance of sexually transmitted diseases in general practice: a description of trends in the Royal College of General Practitioners Weekly Returns Service between 1994 and 2001. Int J STD AIDS 2016; 17:693-8. [PMID: 17059640 DOI: 10.1258/095646206780070992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes the incidence of sexually transmitted infections (STIs) recorded in the Weekly Returns Service (WRS) between 1994 and 2001. There were approximately 76,500 new diagnoses of STIs (7500 males, 71,000 females) and associated syndromes. Candidiasis was the commonest condition reported in males and females followed by pelvic inflammatory disease. The ratio of males to females was 7.1 for non-specific urethritis, and 9.1 and 2.1 for Reiter's syndrome and pediculosis pubis, respectively. The incidence of anogenital warts and genital herpes changed little over time. New diagnoses of genital herpes were higher in females than in males (ratio 2.8:1), whereas the mean annual incidence of genital warts was similar in males and females. The WRS provides an insight into the burden of STI diagnoses, and diagnoses related to STIs that are managed in general practice, and as such has the potential to make a substantial contribution to STI surveillance in England.
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Affiliation(s)
- I Simms
- Health Protection Agency, Centre for Infections, London, UK.
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18
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El-Sheikha J, Carradice D, Nandhra S, Leung C, Smith GE, Campbell B, Chetter IC. Systematic review of compression following treatment for varicose veins. Br J Surg 2015; 102:719-25. [DOI: 10.1002/bjs.9788] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/25/2014] [Accepted: 01/16/2015] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Consensus regarding compression following treatment of varicose veins has yet to be reached. This systematic review aims to establish the optimal compression regimen after venous treatment.
Methods
A systematic review of MEDLINE, Embase and CENTRAL was performed to identify randomized clinical trials (RCTs) investigating different compression strategies following treatment for superficial venous insufficiency.
Results
Seven RCTs comparing different durations and methods of compression fulfilled the inclusion criteria. The treatment modality was open surgery in three trials, foam sclerotherapy in two and endovenous laser ablation (EVLA) in two trials. The quality of the studies was variable, and significant sources of potential bias were present. Both the studies and compression regimens used were heterogeneous. Ten products were used in six general regimens for a duration of 0–42 days. One study suggested that 7 days rather than 2 days of stockings following EVLA was associated with superior quality of life and less pain at 1 week. Another study reported that, following surgery, application of a compression stocking after 3 days of bandaging was associated with a slightly longer recovery than no compression after 3 days. One study recorded compliance clearly, finding it to be only 40 per cent. The quality and heterogeneity of the studies precluded meta-analysis.
Conclusion
There is currently little quality evidence upon which to base any recommendations concerning compression following treatment for varicose veins.
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Affiliation(s)
- J El-Sheikha
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - D Carradice
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - S Nandhra
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - C Leung
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - G E Smith
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - B Campbell
- Department of Vascular Surgery, Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK
| | - I C Chetter
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
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19
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Bawa Z, Elliot AJ, Morbey RA, Ladhani S, Cunliffe NA, O'Brien SJ, Regan M, Smith GE. Assessing the Likely Impact of a Rotavirus Vaccination Program in England: The Contribution of Syndromic Surveillance. Clin Infect Dis 2015; 61:77-85. [DOI: 10.1093/cid/civ264] [Citation(s) in RCA: 25] [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] [Received: 01/09/2015] [Accepted: 03/21/2015] [Indexed: 11/14/2022] Open
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20
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Elliot AJ, Bermingham A, Charlett A, Lackenby A, Ellis J, Sadler C, Sebastianpillai P, Powers C, Foord D, Povey E, Evans B, Durnall H, Fleming DM, Brown D, Smith GE, Zambon M. Self-sampling for community respiratory illness: a new tool for national virological surveillance. ACTA ACUST UNITED AC 2015; 20:21058. [PMID: 25788252 DOI: 10.2807/1560-7917.es2015.20.10.21058] [Citation(s) in RCA: 18] [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: 11/20/2022]
Abstract
This report aims to evaluate the usefulness of self-sampling as an approach for future national surveillance of emerging respiratory infections by comparing virological data from two parallel surveillance schemes in England. Nasal swabs were obtained via self-administered sampling from consenting adults (≥ 16 years-old) with influenza symptoms who had contacted the National Pandemic Flu Service (NPFS) health line during the 2009 influenza pandemic. Equivalent samples submitted by sentinel general practitioners participating in the national influenza surveillance scheme run jointly by the Royal College of General Practitioners (RCGP) and Health Protection Agency were also obtained. When comparable samples were analysed there was no significant difference in results obtained from self-sampling and clinician-led sampling schemes. These results demonstrate that self-sampling can be applied in a responsive and flexible manner, to supplement sentinel clinician-based sampling, to achieve a wide spread and geographically representative way of assessing community transmission of a known organism.
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Affiliation(s)
- A J Elliot
- Public Health England, Birmingham, United Kingdom
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21
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El-Sheikha J, Nandhra S, Carradice D, Acey C, Smith GE, Campbell B, Chetter IC. Compression regimes after endovenous ablation for superficial venous insufficiency – A survey of members of the Vascular Society of Great Britain and Ireland. Phlebology 2015; 31:16-22. [DOI: 10.1177/0268355514567732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The optimal compression regime following ultrasound guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) for varicose veins is not known. The aim of this study was to document current practice. Methods Postal questionnaire sent to 348 consultant members of the Vascular Society of Great Britain and Ireland. Results Valid replies were received from 41% ( n = 141) surgeons representing at least 68 (61%) vascular units. UGFS was used by 74% surgeons, RFA by 70% and EVLA by 32%, but fewer patients received UGFS (median 30) annually, than endothermal treatment (median 50) – P = 0.019. All surgeons prescribed compression: following UGFS for median seven days (range two days to three months) and after endothermal ablation for 10 days (range two days to six weeks) – P = 0.298. Seven different combinations of bandages, pads and compression stockings were reported following UGFS and four after endothermal ablation. Some surgeons advised changing from bandages to stockings from five days (range 1–14) after UGFS. Following endothermal ablation, 71% used bandages only, followed by compression stockings after two days (range 1–14). The majority of surgeons (87%) also treated varicose tributaries: 65% used phlebectomy, the majority (65%) synchronously with endothermal ablation. Concordance of compression regimes between surgeons within vascular units was uncommon. Only seven units using UGFS and six units using endothermal ablation had consistent compression regimes. Conclusion Compression regimes after treatments for varicose veins vary significantly: more evidence is needed to guide practice.
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Affiliation(s)
- J El-Sheikha
- Academic Vascular Surgery Unit, Hull York Medical School/Hull University, Hull, UK
| | - S Nandhra
- Academic Vascular Surgery Unit, Hull York Medical School/Hull University, Hull, UK
| | - D Carradice
- Academic Vascular Surgery Unit, Hull York Medical School/Hull University, Hull, UK
| | - C Acey
- Academic Vascular Surgery Unit, Hull York Medical School/Hull University, Hull, UK
| | - GE Smith
- Academic Vascular Surgery Unit, Hull York Medical School/Hull University, Hull, UK
| | - B Campbell
- Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK
| | - IC Chetter
- Academic Vascular Surgery Unit, Hull York Medical School/Hull University, Hull, UK
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22
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Hawker JI, Smith S, Smith GE, Morbey R, Johnson AP, Fleming DM, Shallcross L, Hayward AC. Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations. J Antimicrob Chemother 2014; 69:3423-30. [DOI: 10.1093/jac/dku291] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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El-Sheikha J, Nandhra S, Carradice D, Wallace T, Samuel N, Smith GE, Chetter IC. Clinical outcomes and quality of life 5 years after a randomized trial of concomitant or sequential phlebectomy following endovenous laser ablation for varicose veins. Br J Surg 2014; 101:1093-7. [DOI: 10.1002/bjs.9565] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/16/2014] [Accepted: 04/17/2014] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Endovenous laser ablation (EVLA) is a popular treatment for superficial venous insufficiency. Debate continues regarding the optimal management of symptomatic varicose tributaries following ablation of the main saphenous trunk. This randomized trial compared the 5-year outcomes of endovenous laser therapy with ambulatory phlebectomy (EVLTAP) with concomitant ambulatory phlebectomy, and EVLA alone with sequential treatment if required following a delay of at least 6 weeks.
Methods
Patients undergoing EVLA for great saphenous vein insufficiency were randomized to receive EVLTAP or EVLA alone with sequential phlebectomy, if required. Outcomes included disease-specific quality of life (QoL) (Aberdeen Varicose Vein Questionnaire; AVVQ), requirement for secondary procedures, clinical severity (Venous Clinical Severity Score; VCSS), residual and recurrent varicose tributaries, and generic QoL. Patients were followed up for 5 years.
Results
Fifty patients were randomized equally into two parallel groups. The EVLTAP group had lower VCSS scores at 12 weeks (median 0 (i.q.r. 0–1) versus 2 (0–2); P <0·001), and lower AVVQ scores at 6 weeks (median 7·9 (i.q.r. 4·1–10·7) versus 13·5 (10·9–18·1); P < 0·001) and 12 weeks (2·0 (0·4–7·7) versus 9·6 (2·2–13·8); P = 0·015). VCSS and AVVQ scores were equivalent by 1 year, but only after 16 of 24 patients in the EVLA group, compared with one of 25 in the EVLTAP group (P < 0·001), had received a secondary intervention. From 1 to 5 years both groups had equivalent outcomes.
Conclusion
EVLA with either concomitant or sequential management of tributaries is acceptable treatment for symptomatic varicose veins, with both treatments achieving excellent results at 5 years. Concomitant treatment of varicosities is associated with optimal improvement in both clinical disease severity and QoL.
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Affiliation(s)
- J El-Sheikha
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - S Nandhra
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - D Carradice
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - T Wallace
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - N Samuel
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - G E Smith
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - I C Chetter
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
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24
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Pebody RG, Green HK, Andrews N, Zhao H, Boddington N, Bawa Z, Durnall H, Singh N, Sunderland A, Letley L, Ellis J, Elliot AJ, Donati M, Smith GE, de Lusignan S, Zambon M. Uptake and impact of a new live attenuated influenza vaccine programme in England: early results of a pilot in primary school-age children, 2013/14 influenza season. Euro Surveill 2014. [DOI: 10.2807/ese.19.22.20823-en] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
| | - H K Green
- Public Health England, United Kingdom
| | - N Andrews
- Public Health England, United Kingdom
| | - H Zhao
- Public Health England, United Kingdom
| | | | - Z Bawa
- Public Health England, United Kingdom
| | - H Durnall
- Royal College of General Practitioners Research and Surveillance Unit, Birmingham, United Kingdom
| | - N Singh
- Public Health England, United Kingdom
| | | | - L Letley
- Public Health England, United Kingdom
| | - J Ellis
- Public Health England, United Kingdom
| | | | - M Donati
- Public Health England, United Kingdom
| | - G E Smith
- Public Health England, United Kingdom
| | - S de Lusignan
- Royal College of General Practitioners Research and Surveillance Unit, Birmingham, United Kingdom
- University of Surrey, Guildford, United Kingdom
| | - M Zambon
- Public Health England, United Kingdom
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25
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Pebody RG, Green HK, Andrews N, Zhao H, Boddington N, Bawa Z, Durnall H, Singh N, Sunderland A, Letley L, Ellis J, Elliot AJ, Donati M, Smith GE, de Lusignan S, Zambon M. Uptake and impact of a new live attenuated influenza vaccine programme in England: early results of a pilot in primary school-age children, 2013/14 influenza season. ACTA ACUST UNITED AC 2014; 19. [PMID: 24925457 DOI: 10.2807/1560-7917.es2014.19.22.20823] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [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]
Abstract
As part of the introduction and roll-out of a universal childhood live-attenuated influenza vaccination programme, 4–11 year-olds were vaccinated in seven pilot areas in England in the 2013/14 influenza season. This paper presents the uptake and impact of the programme for a range of disease indicators. End-of-season uptake was defined as the number of children in the target population who received at least one dose of influenza vaccine. Between week 40 2013 and week 15 2014, cumulative disease incidence per 100,000 population (general practitioner consultations for influenza-like illness and laboratory-confirmed influenza hospitalisations), cumulative influenza swab positivity in primary and secondary care and cumulative proportion of emergency department respiratory attendances were calculated. Indicators were compared overall and by age group between pilot and non-pilot areas. Direct impact was defined as reduction in cumulative incidence based on residence in pilot relative to non-pilot areas in 4–11 year-olds. Indirect impact was reduction between pilot and non-pilot areas in <4 year-olds and >11 year-olds. Overall vaccine uptake of 52.5% (104,792/199,475) was achieved. Although influenza activity was low, a consistent, though not statistically significant, decrease in cumulative disease incidence and influenza positivity across different indicators was seen in pilot relative to non-pilot areas in both targeted and non-targeted age groups, except in older age groups, where no difference was observed for secondary care indicators.
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26
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Smith GE, Barnes R, Chetter IC. Randomized clinical trial of selective versus routine preoperative duplex ultrasound imaging before arteriovenous fistula surgery. Br J Surg 2014; 101:469-74. [DOI: 10.1002/bjs.9435] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Anatomical suitability for arteriovenous fistula (AVF) formation was formerly determined by clinical examination alone. There are potential benefits from imaging to assess anatomical suitability. Existing studies examined the role of routine preoperative ultrasonography versus clinical examination alone. The role of a selective duplex ultrasound imaging policy is unknown. This study aimed to compare a policy of selective versus routine ultrasound assessment before AVF formation.
Methods
All patients referred for fistula formation were assessed for inclusion. Suitable patients were randomized to either routine or selective preoperative ultrasound imaging; selective imaging was performed only when clinical criteria were not met. The primary outcome measures were site of AVF formation and 30-day primary failure rate, and secondary outcome measures included the rate of complications.
Results
A total of 106 patients were assessed, and 94 were randomized: 47 to selective and 47 to routine duplex ultrasonography. The groups were well matched for age, co-morbidities and medications. The primary failure rate (29 per cent overall) was not significantly different between the selective and routine imaging groups: 36 per cent (14 of 39) and 21 per cent (8 of 38) respectively (P = 0·144). There were no significant differences in the sites of AVF formation or complication rates.
Conclusion
Routine preoperative ultrasound vessel imaging did not significantly reduce early failure rates, influence the site of AVF formation or reduce complications. If clinical evaluation detects anatomy suitable for AVF formation, duplex imaging may not be needed. Registration number: NCT01004627 (http://www.clinicaltrials.gov).
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Affiliation(s)
- G E Smith
- Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK
| | - R Barnes
- Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, Hull and East Yorkshire NHS Trust/Hull York Medical School, Hull, UK
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Elliot AJ, Hughes HE, Hughes TC, Locker TE, Brown R, Sarran C, Clewlow Y, Murray V, Bone A, Catchpole M, McCloskey B, Smith GE. The impact of thunderstorm asthma on emergency department attendances across London during July 2013. Emerg Med J 2013; 31:675-8. [PMID: 24099832 DOI: 10.1136/emermed-2013-203122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma. METHODS The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis. RESULTS A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances. CONCLUSIONS This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base.
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Affiliation(s)
- A J Elliot
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham, UK
| | - H E Hughes
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham, UK
| | - T C Hughes
- Emergency Department, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK The College of Emergency Medicine, London, UK
| | - T E Locker
- The College of Emergency Medicine, London, UK Emergency Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Brown
- Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - V Murray
- Extreme Events and Health Protection, Public Health England, London, UK
| | - A Bone
- Extreme Events and Health Protection, Public Health England, London, UK
| | - M Catchpole
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - B McCloskey
- Department of Global Health, Public Health England, London, UK
| | - G E Smith
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham, UK
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Elliot AJ, Morbey RA, Hughes HE, Harcourt SE, Smith S, Loveridge P, Edeghere O, Ibbotson S, McCloskey B, Catchpole M, Smith GE. Syndromic surveillance – a public health legacy of the London 2012 Olympic and Paralympic Games. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.116] [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: 11/14/2022] Open
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Brainerd CJ, Reyna VF, Petersen RC, Smith GE, Kenney AE, Gross CJ, Taub ES, Plassman BL, Fisher GG. The apolipoprotein E genotype predicts longitudinal transitions to mild cognitive impairment but not to Alzheimer's dementia: findings from a nationally representative study. Neuropsychology 2013; 27:86-94. [PMID: 23356599 DOI: 10.1037/a0030855] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The ε4 allele of the apolipoprotein E (APOE) genotype is the most widely accepted genetic risk factor for Alzheimer's dementia (AD), but findings on whether it is a risk factor for the AD prodrome, mild cognitive impairment (MCI), have been inconsistent. In a prospective longitudinal design, we investigated (a) whether transitions to MCI and other forms of neurocognitive impairment without dementia (CIND) are more frequent among normal ε4 carriers than among noncarriers and (b) whether subsequent transitions to AD from MCI and from other forms of CIND are more frequent among ε4 carriers than among noncarriers. METHOD The frequency of the ε4 allele was studied in older adults (mean age > 70), who had participated in two or more waves of neuropsychological testing and diagnosis in the Aging, Demographics, and Memory Study (ADAMS) of the United States Department of Health and Human Services, National Institutes of Health, National Institute on Aging's Health and Retirement Study, conducted by the University of Michigan. The association between ε4 and longitudinal transitions to specific types of CIND and dementia can be determined with this data set. RESULTS Epsilon 4 increased the rate of progression from normal functioning to MCI (58% of new diagnoses were carriers) but not to other forms of CIND. The rate of progression to AD from MCI or from other forms of CIND was not increased by ε4. CONCLUSIONS The results support the hypothesis that ε4 is a risk factor for transitions from normal functioning to MCI but not for subsequent transitions to AD. In the ADAMS sample, the reason ε4 is elevated in AD individuals is because it is already elevated in MCI individuals, who are the primary source of new AD diagnoses.
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Affiliation(s)
- C J Brainerd
- Department of Human Development, Cornell University, Ithaca, NY 14853, USA.
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Elliot AJ, Morbey RA, Hughes HE, Harcourt SE, Smith S, Loveridge P, Edeghere O, Ibbotson S, McCloskey B, Catchpole M, Smith GE. Syndromic surveillance - a public health legacy of the London 2012 Olympic and Paralympic Games. Public Health 2013; 127:777-81. [PMID: 23870845 DOI: 10.1016/j.puhe.2013.05.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/14/2013] [Accepted: 05/16/2013] [Indexed: 11/17/2022]
Affiliation(s)
- A J Elliot
- Real-time Syndromic Surveillance Team, Public Health England, London, UK.
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Awofisayo A, Ibbotson S, Smith GE, Janmohamed K, Mohamed H, Olowokure B. Challenges and lessons learned from implementing a risk-based approach to school advice and closure during the containment phase of the 2009 influenza pandemic in the West Midlands, England. Public Health 2013; 127:637-43. [PMID: 23810319 DOI: 10.1016/j.puhe.2013.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 01/07/2013] [Accepted: 04/13/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE School closure as a social distancing measure was used in some countries during the initial phases of the influenza A(H1N1)pdm09 pandemic. The objective of this paper is to describe the use of a risk-based approach to public health interventions for schools during the 'containment phase' of the pandemic and to describe lessons learnt. METHODS The development of a framework for risk assessment and decision-making to determine school closures in the West Midlands, England, during the 'containment phase' of influenza A(H1N1)pdm09 pandemic is described. RESULTS Using the framework developed during the 'containment phase', assessments were conducted for 344 educational institutions who reported confirmed cases or 'particularly high absenteeism'. Of these, 209 (60%) had confirmed cases and 65 were closed, mainly for public health or operational reasons. Schools were closed on an individual basis, during the most intense period of the pandemic and for an average period of six days (maximum 11 days). The risk-based approach evolved as experience and knowledge of influenza A(H1N1)pdm09 pandemic virus increased, however some decisions were difficult to communicate to parents, schools and stakeholders particularly when the number of schools affected escalated and the pandemic response phases changed. CONCLUSION The management of school closures is an 'uncertain art'. Numerous challenges and lessons were identified in attempting, during the containment phase of the influenza A(H1N1)pdm09 pandemic, to ensure consistency and transparency in an increasingly complex process. The overall approach described could be further developed to improve decision-making for infectious diseases in schools.
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Affiliation(s)
- A Awofisayo
- Health Protection Agency West Midlands, Birmingham, UK
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Greenaway MC, Duncan NL, Smith GE. The memory support system for mild cognitive impairment: randomized trial of a cognitive rehabilitation intervention. Int J Geriatr Psychiatry 2013; 28:402-9. [PMID: 22678947 PMCID: PMC3766962 DOI: 10.1002/gps.3838] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 05/02/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Individuals with amnestic mild cognitive impairment (MCI) have few empirically based treatment options for combating their memory loss. This study sought to examine the efficacy of a calendar/notebook rehabilitation intervention, the memory support system (MSS), for individuals with amnestic MCI. METHODS Forty individuals with single domain amnestic MCI and their program partners were randomized to receive the MSS, either with training or without (controls). Measures of adherence, activities of daily living, and emotional impact were completed at the first and last intervention sessions and again at 8 weeks and 6 months post intervention. RESULTS Training in use of a notebook/calendar system significantly improved adherence over those who received the calendars but no training. Functional ability and memory self-efficacy significantly improved for those who received MSS training. Change in functional ability remained significantly better in the intervention group than in the control group out to 8-week follow-up. Care partners in the intervention group demonstrated improved mood by 8-week and 6-month follow-ups, whereas control care partners reported worse caregiver burden by 6-month follow-up. CONCLUSIONS Memory support system training resulted in improvement in activities of daily living and sense of memory self-efficacy for individuals with MCI. Although activities of daily living benefits were maintained out to 8 weeks post intervention, future inclusion of booster sessions may help extend the therapeutic effect out even further. Improved mood of care partners of trained individuals and worsening sense of caregiver burden over time for partners of untrained individuals further support the efficacy of the MSS for MCI.
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Affiliation(s)
| | - N. L. Duncan
- Emory University School of Medicine, Atlanta, Georgia
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Harcourt SE, Fletcher J, Loveridge P, Bains A, Morbey R, Yeates A, McCloskey B, Smyth B, Ibbotson S, Smith GE, Elliot AJ. Developing a new syndromic surveillance system for the London 2012 Olympic and Paralympic Games. Epidemiol Infect 2012; 140:2152-6. [PMID: 22892324 PMCID: PMC9152336 DOI: 10.1017/s0950268812001781] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 11/06/2022] Open
Abstract
Syndromic surveillance is vital for monitoring public health during mass gatherings. The London 2012 Olympic and Paralympic Games represents a major challenge to health protection services and community surveillance. In response to this challenge the Health Protection Agency has developed a new syndromic surveillance system that monitors daily general practitioner out-of-hours and unscheduled care attendances. This new national system will fill a gap identified in the existing general practice-based syndromic surveillance systems by providing surveillance capability of general practice activity during evenings/nights, over weekends and public holidays. The system will complement and supplement the existing tele-health phone line, general practitioner and emergency department syndromic surveillance systems. This new national system will contribute to improving public health reassurance, especially to meet the challenges of the London 2012 Olympic and Paralympic Games.
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Affiliation(s)
- S E Harcourt
- Health Protection Agency, Real-time Syndromic Surveillance Team, Birmingham, UK.
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Samuel N, Carradice D, Wallace T, Smith GE, Mazari FAK, Chetter I. Saphenopopliteal ligation and stripping of small saphenous vein: does extended stripping provide better results? Phlebology 2012; 27:390-7. [PMID: 22267488 DOI: 10.1258/phleb.2011.011063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Saphenopopliteal ligation (SPL) for venous insufficiency is a challenging procedure, with mixed results being reported. The role of stripping of the small saphenous vein (SSV) is contentious. This prospective observational study aimed to assess the risks and benefits of this procedure. METHODS Fifty patients underwent SPL under general anaesthesia by a single surgeon in a tertiary referral vascular centre. The aim was to perform inversion stripping in each case, but in a proportion this was not possible. Patients were grouped into SPL with short segment excision ≤5 cm (n = 23) and SPL with extended stripping >5 cm (n = 27). Outcome measures included venous clinical severity scores (VCSS), quality of life (QoL), Aberdeen varicose vein questionnaire (AVVQ), patient satisfaction, recurrence and complication rates. RESULTS Intragroup analysis demonstrated statistically significant improvements in VCSS (P < 0.001), and QoL measures (generic and disease-specific AVVQ) (P < 0.050) with both treatments. Intergroup analysis demonstrated statistically significant superior VCSS scores at one year (P = 0.001), AVVQ at three months and one year (P < 0.05), and cosmetic satisfaction at one year (P = 0.011) in the SPL extended stripping group. There was no difference in clinical recurrence 1/23 (4.3%) versus 1/27 (3.7%) (P = 0.900) or complication rates (P > 0.050). CONCLUSIONS SPL with or without stripping is an effective procedure improving clinical severity and QoL in the short term. Early outcomes favour SPL with extended stripping to offer greater improvement in disease-specific QoL, venous severity and cosmesis. With this small sample, there is no evidence of increased complications following stripping, or increased short-term recurrence without it. Greater numbers and follow-up are required to make firm conclusions.
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Affiliation(s)
- N Samuel
- Academic Vascular Surgical Unit, Tower Block, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK.
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Ferman TJ, Boeve BF, Smith GE, Lin SC, Silber MH, Pedraza O, Wszolek Z, Graff-Radford NR, Uitti R, Van Gerpen J, Pao W, Knopman D, Pankratz VS, Kantarci K, Boot B, Parisi JE, Dugger BN, Fujishiro H, Petersen RC, Dickson DW. Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology 2011; 77:875-82. [PMID: 21849645 DOI: 10.1212/wnl.0b013e31822c9148] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [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
OBJECTIVE To determine whether adding REM sleep behavior disorder (RBD) to the dementia with Lewy bodies (DLB) diagnostic criteria improves classification accuracy of autopsy-confirmed DLB. METHODS We followed 234 consecutive patients with dementia until autopsy with a mean of 4 annual visits. Clinical diagnoses included DLB, Alzheimer disease (AD), corticobasal syndrome, and frontotemporal dementia. Pathologic diagnoses used the 2005 DLB consensus criteria and included no/low likelihood DLB (non-DLB; n = 136) and intermediate/high likelihood DLB (DLB; n = 98). Regression modeling and sensitivity/specificity analyses were used to evaluate the diagnostic role of RBD. RESULTS Each of the 3 core features increased the odds of autopsy-confirmed DLB up to 2-fold, and RBD increased the odds by 6-fold. When clinically probable DLB reflected dementia and 2 or more of the 3 core features, sensitivity was 85%, and specificity was 73%. When RBD was added and clinically probable DLB reflected 2 or more of 4 features, sensitivity improved to 88%. When dementia and RBD were also designated as probable DLB, sensitivity increased to 90% while specificity remained at 73%. The VH, parkinsonism, RBD model lowered sensitivity to 83%, but improved specificity to 85%. CONCLUSIONS Inclusion of RBD as a core clinical feature improves the diagnostic accuracy of autopsy-confirmed DLB.
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Affiliation(s)
- T J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL 32224, USA.
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Kantarci K, Senjem ML, Avula R, Zhang B, Samikoglu AR, Weigand SD, Przybelski SA, Edmonson HA, Vemuri P, Knopman DS, Boeve BF, Ivnik RJ, Smith GE, Petersen RC, Jack CR. Diffusion tensor imaging and cognitive function in older adults with no dementia. Neurology 2011; 77:26-34. [PMID: 21593440 DOI: 10.1212/wnl.0b013e31822313dc] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [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
OBJECTIVE To determine the patterns of diffusivity associated with cognitive domain functions in older adults without dementia. METHODS We studied older adults without dementia (n = 220) who underwent neuropsychometric testing and a diffusion tensor imaging (DTI) examination at 3 T in a cross-sectional study. Memory, language, attention/executive function, and visual-spatial processing domains were assessed within 4 months of the MRI examination. A fluid-attenuated inversion recovery-based DTI sequence that enabled uncontaminated cortical diffusion measurements was performed. Associations between cortical mean diffusivity (MD) and cognitive function were tested using voxel-based regression analysis. Association between tract diffusivity and cognitive function was tested with regions of interest drawn on color-coded fractional anisotropy (FA) maps. RESULTS Memory function was associated with the medial temporal lobe cortical MD on voxel-based analysis (p < 0.001, corrected for multiple comparisons), and inferior longitudinal fasciculus and posterior and anterior cingulum FA on tract-based analysis (p < 0.001). Language function was associated with the left temporal lobe cortical MD (p < 0.001, corrected for multiple comparisons), inferior longitudinal fasciculus, fornix, and posterior cingulum FA (p < 0.05). Attention and executive function was associated with the posterior and anterior cingulum FA, and visual-spatial function was associated with posterior cingulum FA (p < 0.01). CONCLUSION Specific cognitive domain functions are associated with distinct patterns of cortical and white matter diffusivity in elderly with no dementia. Posterior cingulum tract FA was associated with all 4 cognitive domain functions, in agreement with the hypothesis that the posterior cingulate cortex is the main connectivity hub for cognitive brain networks. Microstructural changes identified on DTI may be associated with neurodegenerative pathologies underlying cognitive changes in older adults without dementia.
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Affiliation(s)
- K Kantarci
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Smith GE. Croonian Lectures ON THE SIGNIFICANCE OF THE CEREBRAL CORTEX: Delivered before the Royal College of Physicians of London, June, 1919. Br Med J 2011; 2:11-2. [PMID: 20769538 DOI: 10.1136/bmj.2.3053.11-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Smith GE. Croonian Lectures on the Significance of the Cerebral Cortex: Delivered before the Royal College of Physicians of London, June, 1919. Br Med J 2011; 1:796-7. [PMID: 20769534 DOI: 10.1136/bmj.1.3052.796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Smith S, Smith GE, Olowokure B, Ibbotson S, Foord D, Maguire H, Pebody R, Charlett A, Hippisley-Cox J, Elliot AJ. Early spread of the 2009 influenza A(H1N1) pandemic in the United Kingdom – use of local syndromic data, May–August 2009. Euro Surveill 2011. [DOI: 10.2807/ese.16.03.19771-en] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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
Following the confirmation of the first two cases of pandemic influenza on 27 April 2009 in the United Kingdom (UK), syndromic surveillance data from the Health Protection Agency (HPA)/QSurveillance and HPA/NHS Direct systems were used to monitor the possible spread of pandemic influenza at local level during the first phase of the outbreak. During the early weeks, syndromic indicators sensitive to influenza activity monitored through the two schemes remained low and the majority of cases were travel-related. The first evidence of community spread was seen in the West Midlands region following a school-based outbreak in central Birmingham. During the first phase several Primary Care Trusts had periods of exceptional influenza activity two to three weeks ahead of the rest of the region. Community transmission in London began slightly later than in the West Midlands but the rates of influenza-like illness recorded by general practitioners (GPs) were ultimately higher. Influenza activity in the West Midlands and London regions peaked a week before the remainder of the UK. Data from the HPA/NHS Direct and HPA/QSurveillance systems were mapped at local level and used alongside laboratory data and local intelligence to assist in the identification of hotspots, to direct limited public health resources and to monitor the progression of the outbreak. This work has demonstrated the utility of local syndromic surveillance data in the detection of increased transmission and in the epidemiological investigation of the pandemic and has prompted future spatio-temporal work.
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Affiliation(s)
- S Smith
- Real-time Syndromic Surveillance Team, Health Protection Agency, Birmingham, United Kingdom
| | - G E Smith
- Real-time Syndromic Surveillance Team, Health Protection Agency, Birmingham, United Kingdom
| | - B Olowokure
- West Midlands Regional Epidemiology Unit, Health Protection Agency, Birmingham, United Kingdom
| | - S Ibbotson
- Real-time Syndromic Surveillance Team, Health Protection Agency, Birmingham, United Kingdom
| | - D Foord
- NHS Direct, Linford Wood East, Milton Keynes, United Kingdom
| | - H Maguire
- Health Protection Agency London, Regional Epidemiology Unit, London, United Kingdom
| | - R Pebody
- Health Protection Agency, Centre for Infections, London, United Kingdom
| | - A Charlett
- Health Protection Agency London, Regional Epidemiology Unit, London, United Kingdom
| | - J Hippisley-Cox
- Division of Primary Care, School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - A J Elliot
- Real-time Syndromic Surveillance Team, Health Protection Agency, Birmingham, United Kingdom
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Smith S, Smith GE, Olowokure B, Ibbotson S, Foord D, Maguire H, Pebody R, Charlett A, Hippisley-Cox J, Elliot AJ. Early spread of the 2009 influenza A(H1N1) pandemic in the United Kingdom--use of local syndromic data, May-August 2009. Euro Surveill 2011; 16:19771. [PMID: 21262185] [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: 05/30/2023] Open
Abstract
Following the confirmation of the first two cases of pandemic influenza on 27 April 2009 in the United Kingdom (UK), syndromic surveillance data from the Health Protection Agency (HPA)/QSurveillance and HPA/NHS Direct systems were used to monitor the possible spread of pandemic influenza at local level during the first phase of the outbreak. During the early weeks, syndromic indicators sensitive to influenza activity monitored through the two schemes remained low and the majority of cases were travel-related. The first evidence of community spread was seen in the West Midlands region following a school-based outbreak in central Birmingham. During the first phase several Primary Care Trusts had periods of exceptional influenza activity two to three weeks ahead of the rest of the region. Community transmission in London began slightly later than in the West Midlands but the rates of influenza-like illness recorded by general practitioners (GPs) were ultimately higher. Influenza activity in the West Midlands and London regions peaked a week before the remainder of the UK. Data from the HPA/NHS Direct and HPA/QSurveillance systems were mapped at local level and used alongside laboratory data and local intelligence to assist in the identification of hotspots, to direct limited public health resources and to monitor the progression of the outbreak. This work has demonstrated the utility of local syndromic surveillance data in the detection of increased transmission and in the epidemiological investigation of the pandemic and has prompted future spatio-temporal work.
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Affiliation(s)
- S Smith
- Real-time Syndromic Surveillance Team, Health Protection Agency, Birmingham, United Kingdom.
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Smith S, Elliot AJ, Mallaghan C, Modha D, Hippisley-Cox J, Large S, Regan M, Smith GE. Value of syndromic surveillance in monitoring a focal waterborne outbreak due to an unusual Cryptosporidium genotype in Northamptonshire, United Kingdom, June – July 2008. Euro Surveill 2010; 15:19643. [PMID: 20738999 DOI: 10.2807/ese.15.33.19643-en] [Citation(s) in RCA: 24] [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: 11/20/2022] Open
Abstract
The United Kingdom (UK) has several national syndromic surveillance systems. The Health Protection Agency (HPA)/NHS Direct syndromic surveillance system uses pre-diagnostic syndromic data from a national telephone helpline, while the HPA/QSurveillance national surveillance system uses clinical diagnosis data extracted from general practitioner (GP)-based clinical information systems. Data from both of these systems were used to monitor a local outbreak of cryptosporidiosis that occurred following Cryptosporidium oocyst contamination of drinking water supplied from the Pitsford Reservoir in Northamptonshire, United Kingdom, in June 2008. There was a peak in the number of calls to NHS Direct concerning diarrhoea that coincided with the incident. QSurveillance data for the local areas affected by the outbreak showed a significant increase in GP consultations for diarrhoea and gastroenteritis in the week of the incident but there was no increase in consultations for vomiting. A total of 33 clinical cases of cryptosporidiosis were identified in the outbreak investigation, of which 23 were confirmed as infected with the outbreak strain. However, QSurveillance data suggest that there were an estimated 422 excess diarrhoea cases during the outbreak, an increase of about 25% over baseline weekly levels. To our knowledge, this is the first time that data from a syndromic surveillance system, the HPA/QSurveillance national surveillance system, have been able to show the extent of such a small outbreak at a local level. QSurveillance, which covers about 38% of the UK population, is currently the only GP database that is able to provide data at local health district (primary care trust) level. The Cryptosporidium contamination incident described demonstrates the potential usefulness of this information, as it is unusual for syndromic surveillance systems to be able to help monitor such a small-scale outbreak.
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Affiliation(s)
- S Smith
- Real-time Syndromic Surveillance Team, Health Protection Agency West Midlands, Birmingham, United Kingdom
| | - A J Elliot
- Real-time Syndromic Surveillance Team, Health Protection Agency West Midlands, Birmingham, United Kingdom
| | - C Mallaghan
- East Midlands South Health Protection Unit, Leicester, United Kingdom
| | - D Modha
- Department of Medical Microbiology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - J Hippisley-Cox
- Division of Primary Care, School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - S Large
- NHS Direct, Hedge End, Hampshire, United Kingdom
| | - M Regan
- East Midlands Regional Office, Health Protection Agency East Midlands, Nottingham City Hospital, Nottingham, United Kingdom
| | - G E Smith
- Real-time Syndromic Surveillance Team, Health Protection Agency West Midlands, Birmingham, United Kingdom
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47
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Abstract
The nuclear polyhedrosis virus of the alfalfa looper Autographa californica contains a double-stranded, circular DNA genome. Fourteen scientists agreed to accept an orientation of this circular genome with respect to a physical map of the restriction endonuclease cleavage sites.
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Affiliation(s)
- J M Vlak
- Department of Virology, Agricultural University, 6709 PD Wageningen, The Netherlands
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48
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Fraser MJ, Smith GE, Summers MD. Acquisition of Host Cell DNA Sequences by Baculoviruses: Relationship Between Host DNA Insertions and FP Mutants of Autographa californica and Galleria mellonella Nuclear Polyhedrosis Viruses. J Virol 2010; 47:287-300. [PMID: 16789244 PMCID: PMC255260 DOI: 10.1128/jvi.47.2.287-300.1983] [Citation(s) in RCA: 219] [Impact Index Per Article: 15.6] [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
Mutants of Autographa californica and Galleria mellonella nuclear polyhedrosis viruses, which produce an altered plaque phenotype as a result of reduced numbers of viral occlusions in infected cells, were isolated after passage in Trichoplusia ni (TN-368) cells. These mutants, termed FP (few-polyhedra) mutants, had acquired cell DNA sequences ranging from 0.8 to 2.8 kilobase pairs in size. The insertions of cell DNA occurred in a specific region between 35.0 and 37.7 map units of the A. californica viral genome. A cloned viral fragment containing one of the host DNA inserts was homologous to host DNA inserts in two other mutant viruses and to dispersed, repetitious sequences in T. ni cell DNA. Most of the homology between the cloned insert and cell DNA was contained within a 1,280-base-pair AluI fragment. Marker rescue studies and analysis of infected-cell-specific proteins suggested that the insertion of cell DNA into the viral genomes resulted in the FP plaque phenotype, possibly through the inactivation of a 25,000-molecular-weight protein.
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Affiliation(s)
- M J Fraser
- Department of Entomology, Texas A&M University and Texas Agricultural Experiment Station, College Station, Texas 77843
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49
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Abstract
A preliminary translational map of the Autographa californica genome was constructed. Eighteen viral DNA restriction fragments were either purified from agarose gels or obtained from pBR322 recombinant DNA plasmids to locate specific gene products. The DNAs were immobilized on nitrocellulose filters and used to select viral mRNAs isolated from RNA obtained from the cytoplasm of infected Spodoptera frugiperda cells at 21 h postinfection. The fragment-specific mRNAs were translated in vitro in the presence of l-[(3)H]leucine by using a rabbit reticulocyte lysate system and analyzed on sodium dodecyl sulfate-polyacrylamide gels. The approximate locations of 19 A. californica nuclear polyhedrosis virus (AcMNPV) gene products were mapped. The genes for mRNAs present late in viral infection were mapped to DNA fragments that represent nearly the entire genome. The molecular weights of many of these proteins were similar to those present in purified AcMNPV extracellular virus and to proteins being made in infected cells at 18 to 21 h postinfection. Cytoplasmic RNA was isolated at 4 h postinfection from infected cells, a time early in the viral infection cycle, and hybridized to AcMNPV DNA immobilized on nitrocellulose filters. AcMNPV-specific early RNA was translated in vitro into at least six polypeptides, the most abundant having a molecular weight of 39,000. Viral polypeptides were detected in cells pulse-labeled with l-[(3)H]leucine at 3 to 6 h postinfection, with molecular weights similar to those of polypeptides made in vitro from early AcMNPV mRNA.
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Affiliation(s)
- G E Smith
- Department of Entomology, Texas A&M University, College Station, Texas 77843
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50
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Smith GE, Fraser MJ, Summers MD. Molecular Engineering of the Autographa californica Nuclear Polyhedrosis Virus Genome: Deletion Mutations Within the Polyhedrin Gene. J Virol 2010; 46:584-93. [PMID: 16789242 PMCID: PMC255161 DOI: 10.1128/jvi.46.2.584-593.1983] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe a method to introduce site-specific mutations into the genome of Autographa californica nuclear polyhedrosis virus. Specifically, the A. californica nuclear polyhedrosis virus gene for polyhedrin, the major protein that forms viral occlusions in infected cells, was mutagenized by introducing deletions into the cloned DNA fragment containing the gene. The mutagenized polyhedrin gene was transferred to the intact viral DNA by mixing fragment and viral DNAs, cotransfecting Spodoptera frugiperda cells, and screening for viral recombinants that had undergone allelic exchange. Recombinant viruses with mutant polyhedrin genes were obtained by selecting the progeny virus that did not produce viral occlusions in infected cells (occlusion-negative mutants). Analyses of occlusion-negative mutants demonstrated that the polyhedrin gene was not essential for the production of infectious virus and that deletion of certain sequences within the gene did not alter the control, or decrease the level of expression, of polyhedrin. An early viral protein of 25,000 molecular weight was apparently not essential for virus replication in vitro, as the synthesis of this protein was not detected in cells infected with a mutant virus.
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Affiliation(s)
- G E Smith
- Department of Entomology, Texas A&M University, and The Texas Agricultural Experiment Station, College Station, Texas 77843
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