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Graham MK, Mao S, Viswanathan AN, Wang R, Wodu B, Gupta A, Vaghasia A, Leitzel J, Lowe K, Pasquale SD, Kaplin D, DeWeese TL, Yegnasubramanian S. Defining the Transcriptional Landscapes of the Tumor Microenvironment of Cervical and Vaginal Cancers at Single-Cell Resolution. Int J Radiat Oncol Biol Phys 2023; 117:e531. [PMID: 37785648 DOI: 10.1016/j.ijrobp.2023.06.1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Malignancies found within vaginal tissue are often diagnosed as cancers of the cervix, vulva, or urethra and are clinically treated with similar modalities. However, the rarity of vaginal cancer may be an artifice of categorization; current treatment paradigms do not take into account tissue-specific mutations and differences in mechanistic pathways intracellularly. Understanding the shared and distinctly different transcriptional profiles of vaginal and cervical tumors at a single-cell resolution will provide insights in vaginal tumor biology and will open avenues for future clinical interventions. MATERIALS/METHODS Biopsies of tumor and adjacent normal tissue from 9 patients (3 adenocarcinomas (ADC), 3 squamous cell carcinomas (SCC) from the cervix, and 3 vaginal SCC) were collected and analyzed by single-cell RNA sequencing (scRNA-seq) to compare the tumor, immune, and stromal features of cervical and vaginal cancers. RESULTS Collectively, over 50,000 cells were analyzed by scRNA-seq in this study. We performed dimensionality reduction and clustering analysis of the single-cell transcriptomes to identify the major cell types composing the vaginal and cervical tumor tissues. Compared to Cervical SCC, Vaginal SCC tissues showed reduced fractions of macrophages (-2.7 log2-fold; padj < 0.02) and T cells (-3.7 log2-fold; padj < 0.02) by differential cell proportion analysis (RAISIN). Likewise, the vaginal SCC epithelial cell compartments showed downregulation of inflammatory pathways including TNF signaling via NFKB (NES = -5.7, padj = 5.0 × 10-19), IL2 STAT5 signaling (NES = -4.5, padj = 1.6 × 10-12), and interferon gamma response (NES = -4.3, padj = 9.4 × 10-12), among the Hallmark pathway collection. On the other hand, vaginal SCC epithelial cells showed significant upregulation of oxidative phosphorylation (NES = 4.8, padj = 1.7 × 10-17), p53 pathway (NES = 4.2, padj = 1.8 × 10-13), mTORC1 signaling (NES = 4.2, padj = 1.9 × 10-13), and estrogen early and late response (NES = 4.0, padj < 7.5 × 10-12) compared to cervical SCC. CONCLUSION These results highlight distinct differences in the cell type composition and cancer epithelial pathways in vaginal vs. cervical SCC. Among upregulated pathways in vaginal SCC, ER and mTORC1 pathway activation may represent targets for therapeutic intervention worthy of further investigation.
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Affiliation(s)
- M K Graham
- Department of Urology, Northwestern University, Chicago, IL; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Mao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - R Wang
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - B Wodu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - A Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - A Vaghasia
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - J Leitzel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K Lowe
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Di Pasquale
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Kaplin
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Yegnasubramanian
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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Voong KR, Shokek OB, Hill C, Hu C, Hales RK, Greco SC, Meyer JJ, Wright JL, Lowe K, McNutt TR, Narang A, PhD CS, Lee SM. Improving Cancer Care by Incorporating the Patient's Voice in Symptom Management (IMPROVE): A Multicenter-Prospective Pilot Study. Int J Radiat Oncol Biol Phys 2023; 117:e264-e265. [PMID: 37785007 DOI: 10.1016/j.ijrobp.2023.06.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) IMPROVE is a prospective multicenter pilot study. It evaluates whether routine physician review of patient-reported outcomes measures (PROMs) during radiotherapy alters physicians' perception of cancer patients' treatment-related toxicity and influences symptom management. MATERIALS/METHODS We are enrolling patients with thoracic or gastrointestinal cancers amenable to conventional-fractionated radiotherapy. Patients may receive concurrent chemotherapy. Patients report (1) symptoms, using PRO-CTCAE measures, (2) the most burdensome symptom, and (3) how symptoms interfere with daily activities. Patients complete the measures before seeing their physician during each on-treatment visit. During weekly visits and before reviewing the patient's PROMs, physicians rate the symptom burden for each patient from 0 to 10, using available clinical data. These data include vital signs, lab work, physical exams, nursing assessments, and physicians' clinical judgment. After reviewing the patients' PROMs, physicians re-rate each patient's symptom burden and report any changes in recommended interventions. Changes could include (1) additional counseling, (2) new medications or interventions, (3) referrals to other services, or (4) further testing or evaluation. After each patient's course of radiotherapy, providers complete a Clinician Feedback Form about the impact of PROM review on symptom perception and management during treatment. This study commenced November 11, 2020 at a multi-site tertiary academic cancer center (using electronic or paper questionnaires) and July 21, 2021 at a multi-site community cancer center (using paper forms). RESULTS To be determined. CONCLUSION To be determined.
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Affiliation(s)
- K R Voong
- Johns Hopkins University, Baltimore, MD
| | - O B Shokek
- Wellspan York Cancer Center, York, PA, United States
| | - C Hill
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Hu
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - R K Hales
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S C Greco
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J J Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J L Wright
- Johns Hopkins Medicine, Department of Radiation Oncology, Baltimore, MD
| | - K Lowe
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T R McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Snyder PhD
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - S M Lee
- Department of Biostatistics, Columbia University School of Medicine, New York, NY
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Tran P, Lowe K, Wang H, Tsai H, Song D, Hung A, Hearn J, Miller S, Lotan T, DeWeese T, Orton M, Jr CD, Liauw S, Heath E, Greco S, Desai N, Spratt D, Feng F, Beer T, Antonarakis E. Phase II Randomized Study of Salvage Radiation Therapy (SRT) plus Enzalutamide or Blinded Placebo for High-Risk PSA-Recurrent Prostate Cancer after Radical Prostatectomy: The SALV-ENZA Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Small A, Lowe K, Ferrante A, Smith M, Proudman S, Weedon H, Wechalekar M. POS0057 INDUCIBLE REGULATORY SYNOVIAL MACROPHAGES: A PROOF-OF-CONCEPT STUDY FOR A CELL-BASED TARGETED THERAPY FOR RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundInfiltration of monocyte-derived macrophages into the synovial tissue (ST) is a hallmark of rheumatoid arthritis (RA) pathology. These macrophages promote inflammation, local joint effusion, and joint damage via the release of cytokines, oxygen reactive species, and tissue damaging enzymes. However, balancing these, are the ‘regulatory’ macrophages with inflammation-resolving properties, characterised by expression of CD206 and MerTK, dominant within the ST of healthy individuals as well as RA patients in remission (1). Indeed, these cells are believed to actively contribute to the maintenance of remission.Macrophages are known to exhibit remarkable phenotypic plasticity and understanding the role of this characteristic in regulating inflammation and pathology remains a major challenge, as does the characterization of factors in the microenvironment such as the synovium that control such macrophage characteristics. Importantly, whether the infiltrating, inflammatory macrophages of the RA ST similarly exhibit such phenotypic plasticity, and whether this occurs during the process of reaching remission, remains to be studied.ObjectivesWe investigated the phenotypic plasticity of inflammatory synovial macrophages from patients with RA in vitro, investigating their ability to convert from an inflammatory macrophage population into ‘regulatory’ CD206+MerTK+ macrophages. These findings will provide a proof-of-concept as to the utility of these macrophage for a cell-based therapy in resolving inflammation in patients with RA, and will likely extend our understanding of the mechanisms of action of currently used therapeutics.MethodsSynovial fluid (SF) mononuclear cells were obtained from patients with active early RA (<1 year; fulfilling 2010 ACR/EULAR classification criteria). Cryopreserved SFMCs were cultured for 48hr in the presence of 10 ng/mL interferon(IFN)γ, 50 ng/mL dexamethasone, 10 μg/mL Infliximab, or diluent. Following culture, cells were immunostained and analysed using a Beckman Coulter CytoFLEX flow cytometer and FlowJo software. SF macrophages were characterised by expression of CD14, CD45, CD68 (Figure 1A), and proportions of CD206+ MerTK+ macrophages measured.Figure 1.Synovial fluid CD68+macrophage plasticity in vitro. (A) Gating strategy depicting CD68+ CD45+CD14+ SF macrophage determination. (B) Proportions of CD206 and MerTK-expressing SF macrophages after 48hr culture in the presence of 10 ng/mL IFNγ, 50 ng/mL dexamethasone or 10 µg/mL Infliximab, or absence. Data are representative of 5 individual experiments. Data were analysed by two-way ANOVA followed by Dunnett’s multiple comparison test, *p<0.05.ResultsPrior to culture, the CD68+ macrophage populations present in SF were found to be predominantly CD206-MerTK-. After 48 hours of culture, in the absence of any stimulus, there was an increase in proportions of CD206+MerTK+ macrophages. Treatment with either dexamethasone or anti-TNF (Infliximab) resulted in a further increase in proportions of CD206+ MerTK+, M2-like macrophages. In contrast, culture with IFNγ induced a reduction in this population. Importantly, we found that the generated CD206+MerTK+ macrophages were phenotypically stable in culture following removal of these differentiating agents.ConclusionOur findings demonstrate that inflammatory SF cells are indeed able to polarise to regulatory, CD206+MerTK+ macrophages in vitro. The findings provide further mechanistic insights into the basis for the therapeutic benefits of glucocorticoids and TNF inhibitors, as well as providing initial proof-of-concept in the use of regulatory macrophages as a cellular-based therapy or therapeutic target for patients with RA.References[1]Alivernini S, MacDonald L, Elmesmari A, et al., Distinct synovial tissue macrophage subsets regulate inflammation and remission in rheumatoid arthritis. Nature Medicine. 2020;26(8):1295-306 10.1038/s41591-020-0939-8.Disclosure of InterestsNone declared
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McCauley H, Lowe K, Furtado N, Mangiaterra V, van den Broek N. What are the essential components of antenatal care? A systematic review of the literature and development of signal functions to guide monitoring and evaluation. BJOG 2022; 129:855-867. [PMID: 34839568 DOI: 10.1111/1471-0528.17029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antenatal care (ANC) is one of the key care packages required to reduce global maternal and perinatal mortality and morbidity. OBJECTIVES To identify the essential components of ANC and develop signal functions. SEARCH STRATEGY MESH headings for databases including Cinahl, Cochrane, Global Health, Medline, PubMed and Web of Science. SELECTION CRITERIA Papers and reports on content of ANC published from 2000 to 2020. DATA COLLECTION AND ANALYSIS Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders. MAIN RESULTS A total of 221 papers and reports are included from which 28 essential components of ANC were extracted and used to develop 15 signal functions with the equipment, medication and consumables required for implementation of each. Signal functions for the prevention and management of infectious diseases (malaria, HIV, tuberculosis, syphilis and tetanus) can be applied depending on population disease burden. Screening and management of pre-eclampsia, gestational diabetes, anaemia, mental and social health (including intimate partner violence) are recommended universally. Three signal functions address monitoring of fetal growth and wellbeing, and identification and management of obstetric complications. Promotion of health and wellbeing via education and support for nutrition, cessation of substance abuse, uptake of family planning, recognition of danger signs and birth preparedness are included as essential components of ANC. CONCLUSIONS New signal functions have been developed which can be used for monitoring and evaluation of content and quality of ANC. Country adaptation and validation is recommended.
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Affiliation(s)
- H McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Lowe
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N Furtado
- The Global Fund for Aids Tuberculosis and Malaria, Geneva, Switzerland
| | - V Mangiaterra
- The Global Fund for Aids Tuberculosis and Malaria, Geneva, Switzerland
- Department of Government, Health and Not for Profit, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - N van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Ratti G, Rueschhoff A, Reisch J, Lowe K, Jian S, Cohen L, Mirfakhraee S, Jain R, Finklea J. 17: Development of metabolic syndrome in a single-center cohort after initiation of elexacaftor/tezacaftor/ivacaftor. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Chen P, Finklea D, Cohen L, Jain R, Lowe K, Ratti G, Becker J, Reisch J. 276: Effects of COVID-19 pandemic on adult cystic fibrosis patients’ mental health. J Cyst Fibros 2021. [PMCID: PMC8518475 DOI: 10.1016/s1569-1993(21)01701-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Matthewman J, Mansfield K, Prieto-Alhambra D, Mulick A, Smeeth L, Lowe K, Silverwood R, Langan S. 059 Atopic-eczema-associated fracture risk and oral corticosteroids: a population-based cohort study. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.061] [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: 11/29/2022]
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9
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Bernal J, Hunt K, Worth R, Shearn J, Jones E, Lowe K, Todd S. Expecting the unexpected: measures, outcomes and dying trajectories for expected and unexpected death in adults with intellectual disabilities in social care settings in the UK. J Appl Res Intellect Disabil 2020; 34:594-605. [DOI: 10.1111/jar.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/09/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Katherine Hunt
- School of Health Sciences University of Southampton Southampton UK
| | | | | | | | - Kathy Lowe
- University of South Wales Pontypridd UK
- Abertawe Bro Morgannwg University Health Board Wales UK
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Todd S, Bernal J, Shearn J, Worth R, Jones E, Lowe K, Madden P, Barr O, Forrester Jones R, Jarvis P, Kroll T, McCarron M, Read S, Hunt K. Last months of life of people with intellectual disabilities: A UK population‐based study of death and dying in intellectual disability community services. J Appl Res Intellect Disabil 2020; 33:1245-1258. [DOI: 10.1111/jar.12744] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Stuart Todd
- Care Sciences University of South Wales Pontypridd UK
| | - Jane Bernal
- Care Sciences University of South Wales Pontypridd UK
| | - Julia Shearn
- Care Sciences University of South Wales Pontypridd UK
| | - Rhian Worth
- Care Sciences University of South Wales Pontypridd UK
| | - Edwin Jones
- Care Sciences University of South Wales Pontypridd UK
| | - Kathy Lowe
- Care Sciences University of South Wales Pontypridd UK
| | | | - Owen Barr
- School of Nursing Ulster University Derry UK
| | | | - Paul Jarvis
- Care Sciences University of South Wales Pontypridd UK
| | - Thilo Kroll
- School of Nursing Midwifery and Health Systems University College Dublin Dublin UK
| | - Mary McCarron
- School of Nursing & Midwifery Trinity College Dublin Dublin UK
| | - Sue Read
- School of Nursing & Midwifery University of Keele Newcastle under Lyme UK
| | - Katherine Hunt
- Faculty of Health Sciences Southampton University Southampton UK
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Khan MA, Burggraaf VT, Thomson B, Muir P, Lowe K, Koolaard J, Heiser A, Leath S, McCoard S. Feeding forage or concentrates early in life influences rumen fermentation, metabolic response, immune function and growth of Wagyu × Friesian calves. Anim Prod Sci 2020. [DOI: 10.1071/an18636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context
Early life nutrition of calves influences their performance later in life. There is limited literature demonstrating the effects of rearing dairy calves in early life on milk with either exclusively forage or concentrate starter diets on metabolic and immune function and post-weaning growth and body composition on a pasture only diet.
Aim
This study evaluated the effects of feeding Wagyu × Holstein Friesian calves a forage starter (FS) or a concentrate starter (CS) for the first 14 weeks of rearing on rumen fermentation, blood metabolites, immune function, growth and body composition to Week 41.
Methods
Group-housed calves (Wagyu × Friesian, 10 calves per group, three groups per treatment) were fed milk (2 L per calf twice daily) until Week 7, then transitioned to once a day milk feeding until weaning by Week 9, with ad libitum access to either FS or CS. All calves were transferred to graze ryegrass pastures a week after transitioning to once daily milk feeding, with starter feeds removed gradually by Week 14. Thereafter, calves were reared together on pasture until Week 41.
Results
Solid feed intake was lower in FS than CS calves during the first 7 weeks. Total short chain fatty acids were lower, but acetate to propionate ratio and rumen pH were higher in FS than CS calves at Week 7, with no differences observed at Week 12 or 30. Plasma β-hydroxybutyrate an indicator of ketogenic ability of the rumen in developing calves was higher in FS vs CS calves at weaning. Further, FS calves had lower concentrations of circulating non-esterified fatty acids compared with CS calves at weaning. Compared with CS calves, FS calves grew slower for the first 14 weeks which was associated with lower plasma IGF-1 levels. However, FS calves had greater average daily gain after 14 weeks when on pasture and had similar plasma IGF-1 at 30 weeks and similar body weight and body composition (muscle and subcutaneous fat deposition) by Week 41 compared to CS calves.
Conclusions
These results indicate that offering a FS starter has better prepared calves for weaning onto pasture and potentially improved utilisation of forage post-weaning to achieve similar muscle and fat deposition and overall liveweight in both groups by 41 weeks.
Implications
Dairy beef calves can be successfully reared using forage as the only solid feed source without affecting their growth performance on pasture until 10 months of age. Rearing calves using forage will contribute to reducing the usage of concentrate feeds in pastoral dairy-beef production systems and provide an opportunity to fulfil the market requirements and standards for grain-free beef production.
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Hunt K, Bernal J, Worth R, Shearn J, Jarvis P, Jones E, Lowe K, Madden P, Barr O, Forrester-Jones R, Kroll T, McCarron M, Read S, Todd S. End-of-life care in intellectual disability: a retrospective cross-sectional study. BMJ Support Palliat Care 2019; 10:469-477. [DOI: 10.1136/bmjspcare-2019-001985] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 01/29/2023]
Abstract
BackgroundAdults with intellectual disability (ID) experience inequality in access to healthcare that is considered to extend to end-of-life care. Their experiences of healthcare at the end of life and how these compare with the general population are unknown.AimTo describe the end-of-life care outcomes for adults with ID living in residential care in the UK using the VOICES-SF questionnaire and compare these with the general population.DesignNationwide population-based postbereavement survey.Participants38 ID care providers took part in the study. The supported over 13 000 people with ID. Over the 18-month period of data collection, 222 deaths were reported. The survey was completed, by care staff, for 157 (70.7%) of those deaths.ResultsDecedents had complex health, functional and behavioural needs. Death was unanticipated in a high proportion of cases. Quality of care provided across care settings was generally well rated. However, hospital care and care provided at the time of was less well rated, particularly in comparison with the general population. Respondents reported low levels of involvement in care and awareness of approaching death among adults with ID, and lower than in the general population.ConclusionsAccess to end-of-life care for adults with ID may be constrained by a failure to identify approaching the end of life. The high proportion of unexpected deaths in this population warrants further study. There is a need to increase and support the involvement of adults with ID to be active partners in planning care at the end of their lives.
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Finigan J, Lowe K, Thiele C, Wilson C, Humphries S, Lynch D, Regan E. P1.11-17 Osteoporosis, Coronary Artery Calcification, and COPD in a Lung Cancer Screening Cohort. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McCoard S, Heiser A, Lowe K, Molenaar A, MacLean P, Johnstone P, Leath S, Hoskin SO, Khan MA. Effect of weaning age on growth, mammary gland development, and immune function in Holstein Friesian calves fed conserved alfalfa (FiberStart). J Dairy Sci 2019; 102:6076-6087. [PMID: 31079903 DOI: 10.3168/jds.2018-15615] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Abstract
This study aimed to evaluate intake, body growth, and the development of the rumen, mammary gland, and immune system in Holstein Friesian calves reared for 100 d on the commercially available feed FiberStart (conserved alfalfa, Medicago sativa; Fiber Fresh Feeds Ltd., Reporoa, New Zealand) and fed calf milk replacer (CMR) for either 56 or 91 d. Eighty calves (40 bulls and 40 heifer calves) were reared indoors in groups (n = 5 of the same sex/pen). All calves were fed 4 L of CMR/d (175 g/L of CMR) in 2 feeds/d for the first 10 d and then 1 feed/d until d 49 or 84. The calves were gradually weaned by d 56 (earlier weaned; n = 8 pens) and d 91 (later weaned; n = 8 pens). All calves were fed FiberStart ad libitum as the only solid feed source from d 1 to 100 of the study. Irrespective of treatment, all calves had similar body weights at d 0 (40.9 ± 3.0 kg) and d 49 (74.2 ± 5.1 kg) of the study. Calf sex had no effect on intake, growth, blood, and immune system parameters. Earlier-weaned calves consumed 18% more solid feed dry matter but had 16% lower body weight gain (28.9 vs. 38.5 kg, respectively) from d 56 to 100 relative to later-weaned calves, resulting in different body weight at 100 d (104 vs. 121 ± 1.3 kg). Although earlier-weaned calves could compensate for the loss of CMR dry matter and crude protein intake from d 56 to 100 by increasing forage intake, they were unable to compensate for the loss of energy from the CMR by increasing solid feed consumption. Plasma β-hydroxybutyrate concentrations were 52% greater in earlier-weaned calves than in later-weaned calves at d 84, indicating greater metabolic activity of the rumen wall. The duration of CMR feeding had no influence on humoral or cell-mediated immune functions of the calves, as evidenced by a lack of effect on antivaccine antibody responses as well as on immune gene expression. Earlier- versus later-weaned heifer calves had 5% lower mammary gland mass, indicating that greater energy supply increased mammary mass. The results of this experiment demonstrate the ability to artificially rear dairy calves on a conserved alfalfa as the only solid feed. Furthermore, earlier weaning off CMR promotes solid feed intake and an associated increase in blood β-hydroxybutyrate, an indicator of rumen development, but increasing the duration of CMR feeding improves growth and mammary gland mass by d 100. The implications of these findings on lifetime growth, health, and milk production in dairy heifers warrant further investigation.
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Affiliation(s)
- S McCoard
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - A Heiser
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - K Lowe
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - A Molenaar
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - P MacLean
- AgResearch Ltd., Lincoln Research Centre, Private Bag 4749, Christchurch 8140, New Zealand
| | - P Johnstone
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand; AgResearch Ltd., Ruakura Research Centre, Private Bag 3123, Hamilton 3240, New Zealand
| | - S Leath
- AgResearch Ltd., Lincoln Research Centre, Private Bag 4749, Christchurch 8140, New Zealand
| | - S O Hoskin
- Fiber Fresh Feeds Ltd, RD2, Reporoa, New Zealand
| | - M A Khan
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand.
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Abstract
The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.
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Vibart RE, Tavendale M, Otter D, Schwendel BH, Lowe K, Gregorini P, Pacheco D. Milk production and composition, nitrogen utilization, and grazing behavior of late-lactation dairy cows as affected by time of allocation of a fresh strip of pasture. J Dairy Sci 2017; 100:5305-5318. [PMID: 28501401 DOI: 10.3168/jds.2016-12413] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/21/2017] [Indexed: 11/19/2022]
Abstract
Eighty late-lactation dairy cows were used to examine the effects of allocating a new pasture strip of a sward based on ryegrass (Lolium perenne L.) in the morning (a.m.; ∼0730 h) or in the afternoon (p.m.; ∼1530 h) on milk production and composition, nitrogen (N) utilization, and grazing behavior. Cows grazed the same pasture strips for 24 h and were offered the same daily herbage allowance. Herbage composition differed among treatments; p.m. herbage had greater dry matter (DM; 22.7 vs. 19.9%), organic matter (OM; 89.5 vs. 88.9%), and water-soluble carbohydrate (10.9 vs. 7.6%) concentrations and lesser crude protein (20.5 vs. 22.2%) and neutral detergent fiber (48.8 vs. 50.4%) concentrations compared with a.m. herbage. Total fatty acids (FA), α-linolenic acid, and polyunsaturated FA (PUFA) were greater in a.m. herbage, whereas monounsaturated FA were greater in p.m. herbage. Estimates of herbage DM intake did not differ among treatments. Daily milk yields and milk fat and milk protein concentrations were similar among treatments, whereas milk fat (684 vs. 627 g/cow), milk protein (545 vs. 505 g/cow), and milk solids (milk fat + milk protein) yields (1,228 vs. 1,132 g/cow) tended to be greater for cows on p.m. herbage. Rumenic acid and total PUFA in milk were greater for cows on a.m. herbage, whereas oleic acid was greater for cows on p.m. herbage. Estimates of urinary N excretion (g/d) did not differ among treatments, but urinary N concentrations were greater for cows on a.m. herbage (5.85 vs. 5.36 g/L). Initial herbage mass (HM) available (kg of DM/ha) and instantaneous HM disappearance rates (kg of DM/ha and kg of DM/h) did not differ, but fractional disappearance rates (0.56 vs. 0.74 per hour for a.m. vs. p.m., respectively) differed. Under the current conditions, timing of pasture strip allocation altered the herbage nutrient supply to cows; allocating a fresh strip of pasture later in the day resulted in moderate increases in milk and milk solids yields in late-lactation dairy cows. Conversely, a greater concentration of precursor FA in a.m. herbage resulted in a greater concentration of beneficial FA in milk, compared with cows on p.m. herbage.
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Affiliation(s)
- R E Vibart
- AgResearch, Grasslands Research Centre, Tennent Drive, Palmerston North 4442, New Zealand
| | - M Tavendale
- AgResearch, Grasslands Research Centre, Tennent Drive, Palmerston North 4442, New Zealand
| | - D Otter
- Center for Dairy Research, College of Agriculture and Life Sciences, University of Wisconsin-Madison, Madison 53706
| | - B H Schwendel
- AgResearch, Grasslands Research Centre, Tennent Drive, Palmerston North 4442, New Zealand
| | - K Lowe
- AgResearch, Grasslands Research Centre, Tennent Drive, Palmerston North 4442, New Zealand
| | - P Gregorini
- Agriculture and Life Sciences, Lincoln University, Lincoln 7647, Christchurch, New Zealand
| | - D Pacheco
- AgResearch, Grasslands Research Centre, Tennent Drive, Palmerston North 4442, New Zealand.
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Boeckx N, Toler A, de Beeck KO, Kafatos G, Deschoolmeester V, Rolfo C, Lowe K, Van Camp G, Demonty G, Peeters M. Primary tumor sidedness impacts on prognosis and treatment outcome: results from three randomized studies of panitumumab plus chemotherapy versus chemotherapy or chemotherapy plus bevacizumab in 1st and 2nd line RAS/BRAF WT mCRC. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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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18
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Jonker A, Lowe K, Kittelmann S, Janssen PH, Ledgard S, Pacheco D. Methane emissions changed nonlinearly with graded substitution of alfalfa silage with corn silage and corn grain in the diet of sheep and relation with rumen fermentation characteristics in vivo and in vitro1,2. J Anim Sci 2016; 94:3464-3475. [DOI: 10.2527/jas.2015-9912] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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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20
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Perry J, Allen DG, Pimm C, Meek A, Lowe K, Groves S, Cohen D, Felce D. Adults with intellectual disabilities and challenging behaviour: the costs and outcomes of in- and out-of-area placements. J Intellect Disabil Res 2013; 57:139-152. [PMID: 22471517 DOI: 10.1111/j.1365-2788.2012.01558.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND People with severe challenging behaviour are vulnerable to exclusion from local services and removal to out-of-area placements if locally available supported accommodation is insufficient to meet their needs. There are concerns about the high costs and potentially poorer outcomes of out-of-area placements but relatively little is known about how costs and outcomes compare with provision for a similar population placed locally. METHODS Costs, quality of care and a wide range of quality of life outcomes for 38 people with intellectual disabilities and challenging behaviour living in-area and 38 similar people living out-of-area were compared. The two groups were matched as far as possible on risk factors for out-of-area placement. The out-of-area group represented two-thirds of the total number of people who originated from the territory served by the largest specialist health service in Wales and were placed in residential settings at least 10 miles beyond its boundaries. RESULTS There was a mixed pattern of quality of care and quality of outcome advantages between the two types of setting, although in-area placements had a greater number of advantages than out-of-area placements. Unexpectedly, out-of-area placements had lower total costs, accommodation costs and daytime activity costs. CONCLUSIONS No overall conclusion could be reached about cost-effectiveness. A number of potential reasons for the differences in cost were identified. Although additional resources may be needed to provide in-area services for those currently placed out-of-area, government policy to provide comprehensively for those who want to live locally, irrespective of their needs, appears to be attainable.
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Affiliation(s)
- J Perry
- Welsh Centre for Learning Disabilities, School of Medicine, Cardiff University, Cardiff, UK
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21
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Goff B, Lowe K, Kane J, Robertson M, Gaul M, Andersen M. The safety of symptom based screening for ovarian cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Allen D, Lowe K, Matthews H, Anness V. Screening for Psychiatric Disorders in a Total Population of Adults with Intellectual Disability and Challenging Behaviour Using the PAS-ADD Checklist. Journal of Applied Research in Intellectual Disabilities 2012; 25:342-9. [DOI: 10.1111/j.1468-3148.2011.00670.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goff B, Lowe K, Kane J, Robertson M, Gaul M, Andersen M. Symptom-triggered screening for ovarian cancer: A pilot study of feasibility and acceptability. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Felce D, Perry J, Lowe K, Jones E. The Impact of Autism or Severe Challenging Behaviour on Lifestyle Outcome in Community Housing. Journal of Applied Research in Intellectual Disabilities 2011. [DOI: 10.1111/j.1468-3148.2010.00571.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Rivkin SE, Beatty JD, Lowe K, Atwood M, Iriarte D. Abstract P4-09-05: Long Term Follow-Up of Breast Cancer Patients of the Swedish Cancer Institute Breast Cancer Research Registry. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-09-05] [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: 11/16/2022]
Abstract
Abstract
Background: Since 1990 the Swedish Cancer Institute Breast Cancer Research Registry has accrued over 10,900 cases with a 92% follow-up rate. We analyzed the incidence of recurrence over time to evaluate the appropriate duration of our long term follow-up. Methods:
Patients with stages 1-3 disease were selected for study. Stages 0 and 4 disease, and neo-adjuvant treatment patients were excluded. The incidence and time to recurrence was compared with tumor grade [Bloom Richardson (BR) score], hormone receptor, HER2 status, stage, number of positive lymph nodes, surgery, radiation therapy, chemotherapy, hormone therapy and menopausal status. Results:
The recurrence rate was 7.8% (740/9455) of which 68% (500) occurred in the first 5 years, 24% (179) occurred between 5 and 10 years, and 8% (61) occurred after 10 years. Factors that had a significant (P<0.05) relationship with the incidence of and time to recurrence were: stage, grade, hormone receptor status, number of positive lymph nodes, hormone therapy and radiation therapy. In the hormone receptor negative group, 15% (181/1205) recurred - 86% within 5 years, 12% between 5 and 10 years and 1.7% over 10 years. In the hormone receptor positive group, 7.3% (522/7201) recurred - 62% within 5 years, 28% between 5 and 10 years and 10% over 10 years. Of the patients with negative nodes, 4.7% (255/5405) recurred - 65% within 5 years, 27% within 5 to 10 years and 7.5% over 10 years. For the patients with 1 - 3 nodes positive, 12.6% (222/1769) recurred - 67% within 5 years, 24% between 5 and 10 years and 10% over 10 years. For 4-9 nodes positive, 25.3% (121/478) recurred - 79% within 5 years, 20% between 5 and 10 years and 6.6% over10 years. For greater than 10 nodes positive, 40.9% (92/225) recurred - 75% within the first 5 years, 20% between 5 and 10 years and 5.4% over 10 years. A BR score of 3-5 resulted in 2.0% (32/1574) recurrences - 63% within 5 years, 25% between 5 and 10 years and 13% over 10 years. A BR score of 6-7 resulted in 5.1% (131/2559) recurrences - 73% within 5 years, 26% between 5 and 10 years and 1.5% over 10 years. A BR score of 8-9 resulted in 11.3% (179/1581) recurrences - 89% within 5 years, 10% between 5 and 10 years and 0.6% over 10 years. Conclusion:
The incidence of recurrence and the rate of recurrence of breast cancer was greatest for tumors that were hormone receptor negative, had a high number of positive lymph nodes and were high grade (BR 8-9). The incidence of recurrence after 10 years was under 0.5% overall and under 1.0% for most groups. The exception was patients with over 10 nodes positive (2.2%). However, patients with low grade (BR 3-5), hormone receptor positive or 1-3 positive lymph nodes, or patients treated with total mastectomy without irradiation or hormone therapy had over 10% of their recurrences occur after 10 years. The old adage that after ten years one is cured does not apply to these low risk patients. Nor does it apply to the high risk patients although their outlook is markedly improved by 10 years.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-09-05.
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Affiliation(s)
- SE Rivkin
- Swedish Cancer Institute, Seattle, WA
| | - JD Beatty
- Swedish Cancer Institute, Seattle, WA
| | - K Lowe
- Swedish Cancer Institute, Seattle, WA
| | - M Atwood
- Swedish Cancer Institute, Seattle, WA
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Rogers-Cotrone T, Burgess MP, Hancock SH, Hinckley J, Lowe K, Ehrich MF, Jortner BS. Vacuolation of sensory ganglion neuron cytoplasm in rats with long-term exposure to organophosphates. Toxicol Pathol 2010; 38:554-9. [PMID: 20448080 DOI: 10.1177/0192623310369343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cytoplasmic vacuolation of sensory neurons has been reported to occur within the dorsal root ganglia in studies investigating various neuropathic conditions including the effects of neurotoxic chemicals. In this study, we investigated this lesion in adult (98-119 days old) male Long-Evans rats, after multiple exposures to two organophosphates (tri-ortho-tolyl phosphate [TOTP] and chlorpyrifos) and the modifying effects of concurrent corticosterone. Tri-ortho-tolyl phosphate was administered by gavage (75, 150, or 300 mg/kg) every other day between days 14 and 28 and between days 49 and 63, chlorpyrifos (60 mg/kg) was administered subcutaneously on days 7 and 42, and corticosterone was provided in the drinking water throughout the study at a concentration of 400 microg/mL. Although relatively uncommon, there was an increase in frequency of cytoplasmic vacuoles seen in treatment groups having multiple exposures to TOTP. They were characterized as peripherally located, single-limiting membrane-bound structures in the neuronal perikarya. There was no associated cell death, even when vacuoles were large. This is the initial report of an association of this change following exposure to neurotoxic organophosphates.
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Affiliation(s)
- T Rogers-Cotrone
- Laboratory for Neurotoxicity Studies, VA-MD Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia 24061, USA.
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Twomey D, McIntosh AS, Simon J, Lowe K, Wolf SI. Kinematic differences between normal and low arched feet in children using the Heidelberg foot measurement method. Gait Posture 2010; 32:1-5. [PMID: 20172730 DOI: 10.1016/j.gaitpost.2010.01.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 01/25/2010] [Accepted: 01/25/2010] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to investigate the kinematics of normal arched and low arched feet in children and use this data to quantify the differences between the two foot types during walking gait. Multi-segment foot motion was measured, using the Heidelberg foot measurement method (HFMM), for 25 normal arched feet and 27 low arched feet in 9-12-year-old children. The kinematic differences in the foot between the two groups during walking were relatively small, except for the medial arch and forefoot supination angles. The magnitude of the medial arch angle was approximately 10 degrees greater in the low arched group than the normal arched group throughout the gait cycle. There was a significant difference found in the forefoot supination angle (p<0.03), relative to the midfoot, between the two groups at initial heel strike, and maximum and minimum values throughout the gait cycle. The values for the normal group were significantly higher in all these angles indicating that the forefoot of the low arched foot remains less pronated during the gait cycle. There was no significant difference in the motion of the rearfoot between the two foot types. The results of this study provide normative values for children's feet and highlight the mechanical differences in flexible flat feet in this age group. This data contributes to knowledge on foot kinematics in children and will be valuable for future research on the structure, function and potential treatment of the flexible flat foot.
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Affiliation(s)
- D Twomey
- School of Safety Science, University of New South Wales, Sydney, New South Wales 2052, Australia
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29
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Felce D, Lowe K, Blackman D. RESIDENT BEHAVIOUR AND STAFF INTERACTION WITH PEOPLE WITH INTELLECTUAL DISABILITIES AND SERIOUSLY CHALLENGING BEHAVIOUR IN RESIDENTIAL SERVICES. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1468-3148.1995.tb00162.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Allen D, Lowe K, Brophy S, Moore K. Predictors of Restrictive Reactive Strategy Use in People with Challenging Behaviour. Journal of Applied Research in Intellectual Disabilities 2009. [DOI: 10.1111/j.1468-3148.2008.00484.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Avigan D, Rosenblatt J, Vasir B, Wu Z, Bissonnette A, Somaiya P, MacNamara C, Uhl L, Avivi I, Katz T, Zarwan C, Joyce R, Levine J, Lowe K, Dombagoda D, Tzachanis D, Boussiotis V, Giallombardo N, Mortellite J, Conway K, Fitzgerald D, Richardson P, Anderson K, Munshi N, Rowe J, Tsumer M, Bishart L, Kufe D. Fusion Cell Vaccination In Conjunction With Stem Cell Transplantation Is Well Tolerated, Induces Anti-Tumor Immunity and Is Associated With Responses In Patients With Multiple Myeloma. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Felce D, Baxter H, Lowe K, Dunstan F, Houston H, Jones G, Grey J, Felce J, Kerr M. The Impact of Checking the Health of Adults with Intellectual Disabilities on Primary Care Consultation Rates, Health Promotion and Contact with Specialists. Journal of Applied Research in Intellectual Disabilities 2008. [DOI: 10.1111/j.1468-3148.2008.00432.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Felce D, Baxter H, Lowe K, Dunstan F, Houston H, Jones G, Felce J, Kerr M. The Impact of Repeated Health Checks for Adults with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 2008. [DOI: 10.1111/j.1468-3148.2008.00441.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Active Support (AS) is an approach for promoting increased engagement in activities by people with intellectual disability (ID). METHOD We critically reviewed the available research on AS, and added a commentary to help guide future research and practice. RESULTS Despite weaknesses in the research design of some studies, there is consistent evidence that AS results in increased engagement in activities. There is also some limited evidence of other beneficial outcomes. All published research to date has involved people with ID in community group homes with 24-hour staffing. CONCLUSION The established efficacy of AS for increasing engagement means that research attention can now be given to: (a) developing AS to enhance its positive impact on outcomes such as choice and relationships; (b) exploring the wider implementation of AS beyond community group homes and people with ID; and (c) examining the effectiveness of wide-scale implementation of AS, with careful attention to issues such as management, organisational and staffing factors, and cost.
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Affiliation(s)
- Roger J Stancliffe
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia.
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35
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Jones E, Lowe K. Active support is person-centred by definition: a response to Harman and Sanderson (2008). J Intellect Dev Disabil 2008; 33:274-277. [PMID: 18752100 DOI: 10.1080/13668250802273265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Edwin Jones
- Abertawe Bro Morgannwg University NHS Trust, Cardiff, Wales, UK
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Abstract
Alternatives to donor blood have been developed in part to meet increasing demand. However, new biotechnologies are often associated with increased perceptions of risk and low acceptance. This paper reviews developments of alternatives and presents data, from a field-based experiment in the UK and Holland, on the risks and acceptance of donor blood and alternatives (chemical, genetically modified and bovine). UK groups perceived all substitutes as riskier than the Dutch. There is a negative association between perceived risk and acceptability. Solutions to increasing acceptance are discussed in terms of implicit attitudes, product naming and emotional responses.
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Affiliation(s)
- E Ferguson
- Risk Analysis Social Processes and Health (RASPH) Group, School of Psychology, University of Nottingham, Nottingham, UK
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37
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Rosenblatt J, Vasir B, Wu Z, Bissonnette A, MacNamara C, Uhl L, Lenahan C, Miller K, Joyce R, Levine J, Lowe K, Dombagoda D, Richardson P, Anderson K, Munshi N, Kufe D, Avigan D. 56: Vaccination with DC/MM Fusions in Conjunction with Stem Cell Transplantation. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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38
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Avigan D, Rosenblatt J, Vasir B, Wu Z, Bissonnette A, MacNamara C, Uhl L, Lenahan C, Miller K, Joyce R, Levine J, Lowe K, Donbagoda D, Richardson P, Anderson K, Munshi N, Kufe D. 172: Phase I Study of Vaccination with Dendritic Cell Myeloma Fusions. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.181] [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: 11/29/2022]
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Abstract
BACKGROUND Variations in reported prevalence of challenging behaviour indicate the need for further epidemiological research to support accurate planning of future service provision. METHODS All services providing for people with learning disabilities across seven unitary authorities, with a total population of 1.2 million, were screened to identify people with challenging behaviour. Interviews were conducted with primary carers to gain data on identified individuals' characteristics and support. Measures designed for a similar study conducted in Manchester University were incorporated to allow direct comparison with earlier findings, together with standardized tools to assess adaptive behaviour and social impairment. RESULTS In total, 4.5 (2.5-7.5) people per 10 000 population were rated as seriously challenging, representing 10% (5.5-16.8%) of the learning disability population; the most prevalent general form was other difficult/disruptive behaviour, with non-compliance being the most prevalent topography. The majority showed multiple behaviours and multiple topographies within each general behaviour category. Also identified were substantial numbers of additional people reported as presenting challenging behaviours at lower degrees of severity. CONCLUSIONS Prevalence rates for seriously challenging behaviours were comparable to those reported in the earlier studies, thus confirming previous findings. The prevalence of less serious challenging behaviour also has major clinical significance and emphasizes the need for enhanced understanding and skills among personnel within primary- and secondary-tier health, education and social care services, and for strengthening the capacity of community teams to provide behavioural expertise.
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Affiliation(s)
- K Lowe
- Special Projects Team, Bro Morgannwg NHS Trust Learning Disability Directorate, Cardiff, UK.
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40
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Allen DG, Lowe K, Moore K, Brophy S. Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour. J Intellect Disabil Res 2007; 51:409-16. [PMID: 17493024 DOI: 10.1111/j.1365-2788.2006.00877.x] [Citation(s) in RCA: 36] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Out of area placements for people with challenging behaviour represent an expensive and often ineffective strategy for meeting the needs of this service user group. METHODS More than 800 agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Detailed data on identified individuals and the services they received were collected by interviewing key informants. Univariate and multivariate statistics were employed to identify predictors of out of area placement. RESULTS In total, 1458 people were identified. Full data were available for 901 participants, 97 of whom were placed out of area. Predictors of out of area placement included behaviours resulting in physical injury and exclusion from service settings, a history of formal detention under the mental health act, the presence of mental health problems, a diagnosis of autism and higher total score on the Adaptive Behaviour Scale. Out of area placements were typically of high cost, and associated with only limited evidence of improved service quality. CONCLUSIONS Identifying predictors for out of area placement can be used to highlight deficiencies in local services and individuals at increased risk of exclusion from local services.
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Affiliation(s)
- D G Allen
- Bro Morgannwg NHS Trust, Cardiff, UK.
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Abstract
Most of the recent debate concerning the ethics of physical interventions has focused on the management of aggressive and destructive behaviours, neglecting the management of self-injurious behaviour. This is an important omission, given the extremely serious consequences that can arise from this form of challenging behaviour. The present article reviews types of restraint used to manage self-injury, prevalence of use, and main and side effects of restraint use. It describes some good practice standards and highlights the need for further research and debate in this complex area.
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Affiliation(s)
- Edwin Jones
- Bro Morgannwg NHS Trust, Wales and Unit for Development in Intellectual Disability, University of Glamorgan, Wales.
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42
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Lowe K, Jones E, Allen D, Davies D, James W, Doyle T, Andrew J, Kaye N, Jones S, Brophy S, Moore K. Staff Training in Positive Behaviour Support: Impact on Attitudes and Knowledge. J Appl Res Int Dis 2007. [DOI: 10.1111/j.1468-3148.2006.00337.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Reif S, Whetten K, Lowe K, Ostermann J. Association of unmet needs for support services with medication use and adherence among HIV-infected individuals in the southeastern United States. AIDS Care 2006; 18:277-83. [PMID: 16809104 DOI: 10.1080/09540120500161868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Unmet needs for services, such as housing and psychiatric treatment, are relatively common among HIV-infected individuals; however, the effects of different types of unmet needs on health-care outcomes are not well understood. This study describes unmet psychosocial needs and their relationship with health-care outcomes among individuals receiving HIV care in the southeastern US (n=526). We used multivariate logistic regression to examine the association of seven categories of unmet needs with HIV medication use and adherence. Most participants (84.5%) reported at least one service need in the past year. Nearly half (47%) of participants with service needs reported that at least one need was not met. Participants with one or more unmet needs were less likely to be taking any HIV medications (p = 0.007) and reported poorer medication adherence (p=0.013). The specific unmet needs for benefits (including Social Security, health insurance and prescription coverage) (p = 0.006) and a support group (p=0.040) were associated with being less likely to be taking any HIV medications. Unmet need for mental health-related counseling was associated with poorer medication adherence (p=0.003). Study findings regarding the high level of unmet need and the association of unmet need with poorer outcomes illustrate the importance of interventions to address these needs.
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Affiliation(s)
- S Reif
- Duke University Center for Health Policy, Law and Management, Health Inequalities Program, Durham, NC 28207, USA.
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Lowe K, Guerra S, Jacobs B, Jiang R, Klimecki W, Alberts D, Martinez M, Thompson P. Interactions Between PPAR-GAMMA Genotypes and Traits of Metabolic Syndrome on Risk of Recurrence for Colorectal Adenomatous Polyps. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s127-d] [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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Cusick A, McIntyre S, Novak I, Lannin N, Lowe K. A comparison of goal attainment scaling and the Canadian Occupational Performance Measure for paediatric rehabilitation research. Pediatr Rehabil 2006; 9:149-57. [PMID: 16449074 DOI: 10.1080/13638490500235581] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the relative utility of Canadian Occupational Performance Measure (COPM) (adapted for children) and Goal Attainment Scaling (GAS) as outcome measures for paediatric rehabilitation. METHODS A two-group pre-post design investigated the impact of a 3-month programme. Forty-one children with spastic hemiplegic cerebral palsy (mean 3.9 years; GMPM level 1; 21 boys, 10 girls) were randomized to occupational therapy only and occupational therapy plus one Botulinum Toxin A injection. The latter was considered a 'proven' intervention for the purpose of this instrumentation study. Intervention impact was investigated using GAS and COPM. Instrument sensitivity, convergent validity, goal/problem profiles and administration were evaluated. RESULTS Both instruments were sensitive to within group change and detected significant between group change. Likert scale coding for GAS scores was more sensitive than the traditional weighted GAS or COPM. Different constructs were measured by each instrument. COPM was more time efficient in training, development and administration. CONCLUSION Study aim, logistic and resource factors should guide the choice of COPM and/or GAS instruments as both are sensitive to change with a proven intervention and both evaluate different constructs.
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Affiliation(s)
- A Cusick
- College of Science and Health, University of Western Sydney, Australia.
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Baxter H, Lowe K, Houston H, Jones G, Felce D, Kerr M. Previously unidentified morbidity in patients with intellectual disability. Br J Gen Pract 2006; 56:93-8. [PMID: 16464321 PMCID: PMC1828252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 05/20/2005] [Accepted: 06/20/2005] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Adults with a learning disability frequently have unmet health needs. The cause for this is complex and may be related to difficulties in accessing usual primary care services. Health checks have been widely recommended as a solution to this need. AIM To determine the likelihood that a structured health check by the primary care team supported by appropriate education would identify and treat previously unrecognised morbidity in adults with an intellectual disability. DESIGN OF STUDY Individuals were identified within primary care teams and a structured health check performed by the primary care team. This process was supported by an educational resource. Face-to-face audit with the team was performed 3 months following the check. SETTING Forty general practices within three health authorities in south and mid-Wales participated. They had a combined registered patient population of 354 000. METHOD Health checks were conducted for 190 (60%) of 318 identified individuals; 128 people moved, died, withdrew from the study, or refused to participate. RESULTS Complete data were available on 181 health checks; 51% had new needs recognised, of whom 63% had one health need, 25% two health needs, and 12% more than two. Sixteen patients (9%) had serious new morbidity discovered. Management had been initiated for 93% of the identified health needs by the time of audit. This study is the first to identify new disease findings in a primary care population and the likelihood that such disease will be treated. CONCLUSIONS The findings reflect a concern that current care delivery leaves adults with an intellectual disability at risk of both severe and milder illness going unrecognised. Health checks present one mechanism for identifying and treating such illness in primary care.
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Affiliation(s)
- Helen Baxter
- Welsh Centre for Learning Disabilities, Cardiff University, Meridian Court, North Road, Cardiff CF14 3BG, Wales
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Robertson J, Hatton C, Felce D, Meek A, Carr D, Knapp M, Hallam A, Emerson E, Pinkney L, Caesar E, Lowe K. Staff Stress and Morale in Community-Based Settings for People with Intellectual Disabilities and Challenging Behaviour: A Brief Report. J Appl Res Int Dis 2005. [DOI: 10.1111/j.1468-3148.2005.00233.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Robertson J, Emerson E, Pinkney L, Caesar E, Felce D, Meek A, Carr D, Lowe K, Knapp M, Hallam A. Community-based Residential Supports for People with Intellectual Disabilities and Challenging Behaviour: The Views of Neighbours. J Appl Res Int Dis 2005. [DOI: 10.1111/j.1468-3148.2004.00208.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Robertson J, Emerson E, Pinkney L, Caesar E, Felce D, Meek A, Carr D, Lowe K, Knapp M, Hallam A. Treatment and management of challenging behaviours in congregate and noncongregate community-based supported accommodation. J Intellect Disabil Res 2005; 49:63-72. [PMID: 15634313 DOI: 10.1111/j.1365-2788.2005.00663.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To compare the nature and prevalence of use of procedures employed to treat and manage challenging behaviours across two approaches to providing community-based supported accommodation for people with intellectual disabilities (ID) and severe challenging behaviour: noncongregate settings where the minority of residents have challenging behaviour, and congregate settings where the majority of residents have challenging behaviour. SETTING Community-based supported accommodation for people with ID and challenging behaviour. DESIGN Longitudinal matched groups design. MAIN OUTCOME MEASURES The nature and prevalence of use of procedures employed to treat and manage challenging behaviours. Observed and reported severity of challenging behaviours. RESULTS Both types of settings were associated with low prevalence of use of behavioural technologies for the reduction of challenging behaviour (less than 15% of participants). In contrast, high proportions of participant received antipsychotic medication in both noncongregate (56%) and congregate (80%) settings. Congregate settings were associated with the increased use of physical restraint as a reactive management strategy, with over half of participants being in receipt of physical restraint by two or more members of staff. DISCUSSION Changes in reported and observed challenging behaviour over a 10-month period were slight. The use of evidence-based behavioural technologies for the reduction of challenging behaviour may have led to better outcomes.
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Affiliation(s)
- J Robertson
- Institute for Health Research, Lancaster University, Lancaster, UK
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Allen D, Andrew J, Brophy S, Davies D, Doyle T, Felce D, Gale C, James W, Jones E, Lowe K, Moore K, Lawrence B, Wade S. the special projects team. ACTA ACUST UNITED AC 2004. [DOI: 10.7748/ldp2004.09.7.7.16.c1585] [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: 11/09/2022]
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