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Moore L, Yee J. Septic Abortion Complicated by Disseminated Intravascular Coagulation. J Educ Teach Emerg Med 2024; 9:S1-S26. [PMID: 38707944 PMCID: PMC11068314 DOI: 10.21980/j8gh1g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/18/2023] [Indexed: 05/07/2024]
Abstract
Audience This scenario was developed to educate emergency medicine residents on the diagnosis and management of two concurrent conditions: septic abortion and disseminated intravascular coagulation (DIC). Introduction Patients with an abortion (spontaneous or induced) of less than twenty weeks gestation may present with concurrent uterine infection, also known as septic abortion. One of the complications of septic abortion is DIC. Early management of both underlying etiology (septic abortion) and subsequent complications (DIC) is crucial to minimize morbidity and mortality. Educational Objectives At the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history including pregnancy history, medication use, and past medical history. 2) Develop a differential for fever and vaginal bleeding in a pregnant patient. 3) Discuss management of septic abortion, including empiric broad-spectrum antibiotics and obstetric consultation for source control with dilation and curettage (D&C). 4) Discuss expected laboratory findings of disseminated intravascular coagulation (DIC). 5) Discuss management of DIC, including identification of underlying etiology and supportive resuscitation with blood products. 6) Review the components of blood products. 7) Identify appropriate disposition of the patient to the intensive care unit (ICU). Educational Methods This session was conducted using high-fidelity simulation followed by a debriefing session and discussion about the diagnosis, differential, and management of both septic abortion and DIC. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. In this technique, the facilitator described something they observed in the case, outlined their reasoning as a facilitator why this observation was important or why they had questions, and then asked the learners to share their frame of reference at the time. An example: "I heard the team leader state that the platelets were normal, but then another resident disagreed. No one paused to come to a consensus. I'm wondering why this wasn't explored further in real time. Tell me more." This scenario may also be run as an oral boards case or adapted for other learners such as critical care fellows. Research Methods Our residents were provided a survey at the completion of the debriefing session so they could rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form,1 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Results Thirteen learners completed a feedback form out of seventeen participants. This session received all six and seven scores (consistently effective/very good and extremely effective/outstanding, respectively) other than two isolated 4 scores. Discussion This is a cost-effective method for reviewing septic abortion and DIC. The case may be modified for appropriate audiences, such as simplifying the case to septic abortion without DIC. You can also consider not showing an initial temperature with the initial set of vitals unless it is specifically asked for by the participants. We encourage readers to utilize bleeding moulage techniques as a visual stimulus to increase psychological buy-in. Topics Medical simulation, septic abortion, pregnancy complications, hematology emergencies, obstetric emergencies, disseminated intravascular coagulation, emergency medicine.
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Affiliation(s)
- Lauren Moore
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, OH
| | - Jennifer Yee
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, OH
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Tang TS, Yip AKW, Klein G, Moore L, Hessler D, Polonsky WH, Fisher L. Training peers to deliver mental health support to adults with type 1 diabetes using the REACHOUT mobile app. Diabet Med 2024; 41:e15210. [PMID: 37634222 DOI: 10.1111/dme.15210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
AIMS While peer support research is growing in the Type 1 diabetes (T1D) community, the peer supporter training (PST) process is rarely documented in detail. This study provides a comprehensive description of PST and evaluation for the REACHOUT mental health support intervention, and examines the feasibility and perceived utility of PST. METHODS Fifty-three adults with T1D were recruited to participate in a 6-hour, zoom-based PST program for mental health support. The program was structured in three parts: (1) internal motivation, resilience and empathy; (2) mindfulness, emotions and diabetes distress; and (3) active listening and deferring clinical questions to professionals. Candidates were evaluated based on eight pre-established competency criteria during a 5-day support trial with an assigned standardized T1D participant. Perceived usefulness of training skills was also assessed 3 months into the REACHOUT mental health support intervention. RESULTS Fifty-one of the fifty-three candidates who completed training achieved the criteria to graduate. Mean scores for the eight competency domains were: listens actively (4.55); asks open-ended questions (4.12); expresses empathy (4.42); avoids passing judgment (4.67); sits with strong emotions (4.44); refrains from giving advice (4.38); makes reflections (4.5); and defers medical questions (4.58). Of the skills learned during the PST, 95% rated interpreting and discussing diabetes distress profile and expressing empathy as moderately to extremely useful. CONCLUSIONS Findings demonstrate that it is feasible to recruit and graduate the number of trainees needed using a rigorous process. Only by making training protocols available can the PST be replicated and translated to other T1D populations (e.g. adolescents, parents of children with T1D).
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie K W Yip
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerri Klein
- BCDiabetes, Vancouver, British Columbia, Canada
| | - Lauren Moore
- Lauren Moore Counseling, British Columbia, Canada
| | - Danielle Hessler
- Department of Family Medicine, University of California, San Francisco, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Lawrence Fisher
- Department of Family Medicine, University of California, San Francisco, USA
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Eze A, Leraas H, Eze O, Chime C, Grisel B, Moore L, Cerullo M, Chang D, Agarwal S, Haines KL. Factors Associated with Discharge to Skilled Nursing Facility Following Gunshot Wounds. J Surg Res 2024; 294:1-8. [PMID: 37852139 DOI: 10.1016/j.jss.2023.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/02/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Firearm injury is a public health crisis. Most victims are minorities in underserved neighborhoods. Measuring firearm injury by mortality underestimates its impact, as most victims survive to discharge. This study was done to determine if race and insurance status are associated with discharge disposition for gunshot wound (GSW)-related trauma. METHODS Using the 2019 Trauma Quality Improvement Program database, we identified GSW patients with Abbreviated Injury Scale (AIS) = 1-3. Exclusion criteria included patients who died in hospital and routine home discharge. We compared discharge patterns of patients based on demographics (age, gender, race, ethnicity, payor, AIS, hospital designation, and length of stay [LOS]) and injury severity. Multivariable logistic regression models identified factors associated with discharge disposition. RESULTS Our sample included 2437 patients with GSWs. On univariable analysis, Black patients were more likely to discharge to home with home health (64.1% Black versus 34.7% White; P < 0.001). White patients were more likely to discharge to skilled nursing facility (SNF) (51.4% White versus 44.6% Black; P < 0.001). Controlling for age, race, Latin ethnicity, primary payor, LOS, AIS severity, and injury severity score factors independently associated with discharge to SNF included age (0.0462, P < 0.001), Medicaid (1.136, P < 0.0003), Medicare (1.452, P < 0.001), and LOS (0.03745, P < 0.001). CONCLUSIONS Postacute care following traumatic injuries is essential to recovery. Black GSW victims are more likely to be discharged to home health than White patients, who are more likely to be discharged to SNF. Targeted programs to reduce barriers to appropriate aftercare are necessary to eliminate this bias and improve the care of underserved populations.
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Affiliation(s)
- Anthony Eze
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Harold Leraas
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Oluebubechukwu Eze
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Chinecherem Chime
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Braylee Grisel
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Lauren Moore
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Marcelo Cerullo
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Doreen Chang
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Suresh Agarwal
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Krista L Haines
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina.
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O'Farrell R, Maguire S, Moore L, Murray K, Gorman A, Ball E, Riddell C, O'Neill M, Jordan N, O'Shea F, Veale D, Donnelly S, Murphy G, Fitzgerald G. Delivering Care for Pregnant Women with Rheumatic and Musculoskeletal Diseases. Ir Med J 2024; 117:894. [PMID: 38259237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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Anderson BM, Moore L, Moore KL, Bojechko C. EPIDEEP: Using a Deep Learning Model to Predict In Vivo Electronic Portal Imaging Device (EPID) Transit Images. Int J Radiat Oncol Biol Phys 2023; 117:e645. [PMID: 37785921 DOI: 10.1016/j.ijrobp.2023.06.2060] [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) To create a deep-learning model to predict in-vivo electronic portal imaging device (EPID) transit images for IMRT treatments. This model was created to predict in-vivo images to identify machine and patient-related errors that occur during beam delivery and are undetectable with current QA approaches. The deep-learning model can make image predictions much faster than Monte Carlo approaches, making image prediction feasible for application in online adaptive radiotherapy. Additionally, the model does not rely on any proprietary information and can be easily utilized by other clinics. MATERIALS/METHODS Our approach separates the primary and scatter components of in-vivo transit images. The attenuation of primary radiation reaching the EPID panel is modeled analytically, using attenuation measurements from phantoms of known thicknesses. The scatter component is estimated using a convolutional neural network (CNN). The CNN training uses information from the on-treatment cone-beam CTs (CBCTs), and a pretreatment EPID image with no patient in the beam. We acquired 193 IMRT fields/images from 118 patients previously treated on the Varian Halcyon. Treatment sites included the pelvis, abdomen, lungs, and extremities. CBCTs were collected immediately before treatment, to provide an accurate representation of the anatomy. A 3-channel input image was used, consisting of the pretreatment EPID image, a ray tracing projection through the CBCT to the EPID panel, and a projection to isocenter. Model training:validation:test set ratios were 133:20:40 images. The primary and scatter components are added together to give the predicted transit image. Prediction accuracy was assessed by comparing model-predicted and measured in-vivo EPID images with a 3%/3mm and 5%/3mm gamma pass rate. RESULTS The gamma pass rate for the patients in the training:validation:test was 91.5%:90.4%:92.1% for 3%/3mm and 96.7%:96.6%:97.0% for 5%/3mm. The model can make image predictions in 20 milliseconds. The poor passing rates of some images may be due to CBCT artifacts and patient motion that occurs between the time of CBCT and treatment. CONCLUSION This model can predict in-vivo EPID images with an average gamma pass rate greater than 90%. Image predictions from this model can be used to detect in-vivo treatment errors and changes in patient anatomy, providing an additional layer of patient-specific quality assurance. The speed of image predictions is 20 milliseconds, making use feasible for online adaptive treatments, which currently do not utilize patient-specific measurements of the delivered radiation. Upcoming studies will assess the model's ability in detecting clinically relevant errors and changes in patient anatomy that can adversely affect treatment. Future goals include acquiring more data to further improve the model and extending the model to make predictions for VMAT treatments.
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Affiliation(s)
- B M Anderson
- University of California San Diego, Department of Radiation Medicine and Applied Sciences, La Jolla, CA
| | - L Moore
- University of California San Diego, Department of Radiation Medicine and Applied Sciences, La Jolla, CA
| | - K L Moore
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - C Bojechko
- University of California San Diego, Department of Radiation Medicine and Applied Sciences, La Jolla, CA
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Dougherty A, Moore L, Atkins L. Metastatic osseous disease of unknown primary origin: a case report and review of literature. J Surg Case Rep 2023; 2023:rjad497. [PMID: 37724064 PMCID: PMC10505507 DOI: 10.1093/jscr/rjad497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Cancer of unknown primary (CUP) is a heterogeneous group of metastatic tumors in the absence of a clinically identifiable site. We describe the case of a 66-year-old female with an extensive history of non-specific imaging concerning for malignancy who did not undergo further workup and in whom a diagnosis of CUP was made. The patient initially presented to her specialist with concern of right leg pain. Imaging at that time was concerning for a progressive malignant process. Given this, the patient was referred urgently for surgery. Final surgical pathology and breast prognostic panel were consistent with metastatic breast carcinoma at that time. Follow-up imaging performed 1-week postoperatively did not show suspicious findings in either breast, further supporting a diagnosis of CUP. To this end, we highlight the importance of follow-up imaging but recognize the challenges facing healthcare professionals in navigating the ethical principles of nonmalificience and beneficence in diagnostic workup.
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Affiliation(s)
- Alleyna Dougherty
- Texas Christian University Burnett School of Medicine, Fort Worth, Texas 76109, United States
| | - Lauren Moore
- Texas Christian University Burnett School of Medicine, Fort Worth, Texas 76109, United States
| | - Lori Atkins
- Texas Christian University Burnett School of Medicine, Fort Worth, Texas 76109, United States
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Tower A, Hughes J, Moore L, Srivastava K. Mixed metaplastic carcinoma of the breast: a case report. J Surg Case Rep 2023; 2023:rjad144. [PMID: 36926632 PMCID: PMC10014167 DOI: 10.1093/jscr/rjad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
A 68 year-old woman with no significant medical history discovered a lump incidentally in her left breast. The patient's initial imaging revealed a 4.6-cm irregular mass at 11:00 categorized as a BI-RADS 5 as well as an enlarged axillary lymph node and an area of 2.5 cm of heterogeneous calcifications in the 3 o'clock position. The 4.6-cm lesion was revealed to be infiltrating ductal carcinoma with a squamous component, mixed metaplastic carcinoma, which was strongly ER (100+)/PR (100+) positive, HER-2/Neu negative on FISH. The 2.5-cm calcifications were ductal carcinoma in situ. The patient completed neoadjuvant chemotherapy, and had an excellent response. After further discussion, the patient elected for breast conservation therapy and underwent a left wireless localized partial mastectomy with a left axillary dissection. Surgical pathology revealed a near complete pathologic response with only 8-mm residual tumour as well as a negative conversion of the clipped axillary node.
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Affiliation(s)
- Amelia Tower
- Texas Health Breast Specialists, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, USA
| | - Jonathan Hughes
- Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, USA
| | - Lauren Moore
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, TX 76129, USA
| | - Kumaraman Srivastava
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, TX 76129, USA
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Abernathy S, Moore L, Morales M. PATIENT CHARACTERISTICS AND RESPONSE TO BIOLOGIC THERAPIES IN MODERATE-TO-SEVERE PEDIATRIC ASTHMA. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.644] [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: 11/11/2022]
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9
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Duval C, Sirois C, Savoie-White F, Tardif P, Bérubé M, Turgeon-Fournier A, Cook D, Lauzier F, Moore L. 83 - Compression pneumatique intermittente adjuvante : revue systématique et méta-analyse. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Campbell A, Smith R, Petersen B, Moore L, Khan A, Barrie A. O-125 Application of artificial intelligence using big data to devise and train a machine learning model on over 63,000 human embryos to automate time-lapse embryo annotation. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.025] [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: 11/12/2022] Open
Abstract
Abstract
Study question
Can a machine learning (ML) model, developed using modern neural network architecture produce comparable annotation data; utilisable for algorithmic outcome prediction, to manual time-lapse annotations?
Summary answer
The model automatically annotated unseen embryos with comparable results to manual methods, generating morphokinetic data to enable comparably predictive outputs from an embryo selection algorithm.
What is known already
The application of artificial intelligence across healthcare industries, including fertility, is increasing. Several ML models are available that seek to generate or analyse embryo images and morphokinetic data, and to determine embryo viability potential. Along with photographic images, the use of time-lapse in IVF laboratories has amassed numeric data, resulting predominantly from annotated manual assessment of images over time. Embryo annotation practice is variable in quality, can be subjective and is time-consuming; commonly taking several minutes per embryo. The development of rapid, accurate automatic annotation would represent a significant time-saving as well as an increase in reproducibility and accuracy.
Study design, size, duration
Multicentre quality assured annotation data from 63,383 time-lapse monitored embryos (EmbryoScope®), comprising over 400 million individual images, were used to train a ML model to automatically generate morphokinetic annotations. Data was derived from 8 UK clinics within a cohesive group between 2012-2021. Accuracy was assessed using 900 unseen embryos (with live birth outcome) by comparing the output of an established in-house, prospectively validated embryo selection model when the input was either ML-automated, or manual annotations.
Participants/materials, setting, methods
Multi-focal plane images were processed on the Azure cloud (Microsoft) and resampled to 300x300 pixels. A Laplacian-based focal stacking algorithm merged frames into a single image. The model consisted of an EfficientNetB4 Convolutional Neural Network classifier to extract features and classify the stage of embryo images. A Temporal Convolutional Network interpreted a time-series of image features; producing annotations from pronuclear fading through to blastocyst. Soft localisation loss function used QA data to integrate annotation subjectivities.
Main results and the role of chance
The ML model rapidly and automatically generated annotations. Efficacy and comparability of the ML model to automate reliable, utilisable annotations was demonstrated by comparison with manual annotation data and the ML model’s ability to auto-generate annotations which could be used to predict live birth by providing annotation data to an established, validated in house embryo selection model. Live birth-predictive capability was measured, and benchmarked against manual annotation, using the area under the receiver operating characteristic curve (AUC).
When tested on time-lapse images, collected from pronuclear fading to full blastulation, representing 900 previously unseen, transferred blastocysts where live birth outcomes were blinded, the in-house developed auto-annotation ML model resulted in an AUC of 0.686 compared with 0.661 for manual annotations, for live birth prediction.
Auto annotation using the developed model took only milliseconds to complete per embryo. The developed auto-annotation model, built and tested on large data, is considered suitable for productionisation with the aim of being validated and integrated into an application to support IVF laboratory practice.
Limitations, reasons for caution
Whilst this model was trained to recognise key morphokinetic events, there are other morphokinetic variables that may be useful in the prediction of live birth and further improve embryo selection, or deselection, ability. Akin to manual interpretation, some embryos may fail to be annotated or need second opinion.
Wider implications of the findings
There is increasing evidence supporting the application of ML to utilise big data from time-lapse imaging and fertility care generally. Whilst promising benefits to IVF clinics and patients, responsible use of data is required alongside large high-quality datasets, and rigorous validation, to ensure safe and robust applications.
Trial registration number
N/A
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Affiliation(s)
- A Campbell
- CARE Fertility Group , Embryology, Nottingham, United Kingdom
| | - R Smith
- CARE Fertility Group , Embryology, Nottingham, United Kingdom
| | - B Petersen
- BMP Analytics, Mathematics , Aarhus, Denmark
| | - L Moore
- BJSS, Data Science , Leeds, United Kingdom
| | - A Khan
- BJSS, Data Science , Leeds, United Kingdom
| | - A Barrie
- CARE Fertility Group , Embryology, Nottingham, United Kingdom
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Donnez J, Taylor H, Gemzell-Danielsson K, Catherino W, Bestel E, Gotteland J, Humberstone A, Moore L, Garner E. O-306 LINZAGOLIX FOR ENDOMETRIOSIS-ASSOCIATED PAIN: SAFETY RESULTS FROM EDELWEISS 3, A PHASE 3, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.103] [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: 11/12/2022] Open
Abstract
Abstract
Study question
Is once-daily linzagolix treatment for women with moderate to severe endometriosis-associated pain (EAP) safe for use for up to 6 months of treatment?
Summary answer
Both doses of linzagolix were well-tolerated with minimal BMD decrease and few TEAEs >5% in either linzagolix arm.
What is known already
Linzagolix (LGX) is an investigational once-daily oral GnRH receptor antagonist that reduces serum estradiol in a dose-dependent manner and is being developed in two dosages for the treatment of endometriosis-associated pain (EAP): 75 mg, and 200 mg dose with hormonal add-back therapy (ABT).
Study design, size, duration
EDELWEISS 3 is a randomized, double-blind, placebo-controlled, multicenter Phase 3 trial of linzagolix in women with moderate to severe EAP. The trial includes 3 treatment arms: 75 mg LGX, 200 mg LGX with ABT (E2 1 mg/ NETA 0.5 mg), or placebo. Here we present safety results up to 6 months (24 weeks) of treatment.
Participants/materials, setting, methods
Eligible reproductive-aged women with moderate-to-severe EAP were randomized and treated (n = 484) for 6 months with 75 mg LGX, 200 mg LGX with ABT (E2 1 mg/ NETA 0.5 mg), or placebo. Safety and tolerability objectives reported here include 6-month results for treatment emergent adverse events (TEAEs), assessment of mean percent change from baseline (CfB) in lumbar spine (LS) bone mineral density (BMD) and Z-scores.
The safety analysis set included 484 subjects across the 3 treatment groups.
Main results and the role of chance
The overall incidence of TEAEs was similar between the placebo and LGX 75 mg group (46.9%) and slightly higher (56.8%) in the LGX 200 mg + ABT group. There were few (3) serious TEAEs, and none were related to LGX. TEAEs that occurred in over 5% of patients in either active treatment arm included headache (10.5%, 8.1%, and 8.0%), hot flush (6.8%, 7.5%, and 2.5%), and fatigue (6.8%, 3.8%, and 2.5%) for the 200 mg LGX with ABT, 75 mg LGX, and placebo groups, respectively. Mean percent CfB (95% CI) in LS BMD was -0.79% (-1.15, -0.43%), -0.89% (-1.31, -0.47%), and +0.78% (0.41, 1.15%) for the 200 mg LGX with ABT, 75 mg LGX, and placebo groups, respectively. Z-scores at 6 months remained within the same range as baseline in all groups.
Limitations, reasons for caution
Additional efficacy and safety results from the trial's 24 weeks (6 mo) extension phase are pending. (Edelweiss 6 protocol: NCT04335591)
Wider implications of the findings
These results support further development of ABT and non-ABT doses of linzagolix that have potential to provide flexibility and choice for women seeking treatment for EAP. A non-ABT option is important for women who have a contraindication to, are at increased risk for complications, or prefer not to use ABT.
Trial registration number
ClinicalTrials.gov: NCT02778399
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Affiliation(s)
- J Donnez
- Catholic University of Louvain , Ob/Gyn, Brussels, Belgium
| | - H Taylor
- Yale University , Ob/Gyn, New Haven, U.S.A
| | | | - W Catherino
- Uniformed Services University of the Health Sciences , Ob/Gyn, Bethesda, U.S.A
| | - E Bestel
- ObsEva SA, Research & Development , Geneva, Switzerland
| | - J.P Gotteland
- ObsEva SA, Research & Development , Geneva, Switzerland
| | | | - L Moore
- ObsEva Inc., Medical Affairs , Boston, U.S.A
| | - E Garner
- ObsEva Inc., Medical Affairs , Boston, U.S.A
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Esmail A, Kodali S, Graviss E, Nguyen D, Moore L, Saharia A, Uosef A, Victor D, Abdelrahim M. P-163 Tyrosine kinase inhibitors (TKIs) plus transarterial chemoembolization (TACE) compared to TACE alone as downstaging therapy in transplant recipients with hepatocellular carcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Butler C, Argyropoulos G, Moore L, Loane C, Roca-Fernandez A, Lage-Martinez C, Gurau O, Irani S, Zeman A. Pathological emotionalism following limbic encephalitis: the neural foundations of a novel disorder. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.19] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectiveWe investigated pathological emotionalism in a large cohort of patients that had presented with autoimmune limbic encephalitis(a-LE).Methods38 patients in the post-acute phase of a-LE completed questionnaires probing emotion regula- tion. They all underwent structural/functional MRI post-acutely, along with age- and sex-matched healthy controls. We investigated correlations of questionnaire scores with demographic, clinical, neuropsycho- logical and brain MRI data across patients. We also compared patients with pathological emotionalism and those without, along with healthy controls, on grey matter volume, resting-state functional connec- tivity and activity.ResultsPathological emotionalism was reported by 50% of the patients. It was not associated with depres- sion, impulsiveness, or memory impairment. However, it correlated with abnormalities in specific emotional brain networks: volume reduction in the anterior hippocampus, fusiform gyrus and cerebellum, abnormal hippocampal resting-state functional connectivity with the posteromedial cortex and middle frontal gyrus, and abnormal hemodynamic activity in the fusiform gyrus, inferior parietal lobule, and ventral pons.ConclusionsPathological emotionalism is common following a-LE, is not a manifestation of other neu- ropsychiatric disorders, and reflects abnormalities in networks of emotion regulation including, but not limited to the acute hippocampal focus. This condition provides novel insights into the neural basis of emotion regulation and its dysfunction in disease.christopher.butler@imperial.ac.uk
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14
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Cassidy C, Moore L, Ryan J, Brennan S. Audit on Oral Health Examinations in an Approved Psychiatric Centre. Ir Med J 2022; 115:527. [PMID: 35279061] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- C Cassidy
- Department of Psychiatry, South Tipperary Hospital, Clonmel, Tipperary
| | - L Moore
- Department of Psychiatry, South Tipperary Hospital, Clonmel, Tipperary
| | - J Ryan
- Suirside Medical Practice, Clonmel, Tipperary
| | - S Brennan
- Department of Psychiatry, South Tipperary Hospital, Clonmel, Tipperary
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15
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Moore L. An evaluation of the nutritional requirements of post-operative colorectal patients. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.594] [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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16
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Ahrens L, List R, Gott K, Lonabaugh K, Haney H, Moore L, Knight D, Garrod A, Mason K, Froh D. 140: Oh gee! Time tested OGTT annual screening improvement: A single-center experience. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01565-4] [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: 11/27/2022]
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Abstract
Abstract
Few interventions are truly simple; complexity can arise from various sources, e.g.:
Aspects of the intervention itself, such as the number of intervention components, the number of groups targeted, how dynamic the intervention is permitted to be. The context in which the intervention is developed and delivered, such as the social, political, economic, and geographical context.
Complex intervention research should be approached with an awareness of these sources of complexity. Systems thinking can be helpful to understanding the dynamic interaction between interventions and their context. This presentation will introduce concepts of complex adaptive systems, e.g. feedback loops, adaptation, emergence, that should be considered when developing and evaluating complex interventions. It will then introduce participants to the research perspectives set out in the new framework: efficacy, effectiveness, theory-based, and systems perspectives. Each perspective is associated with a different type of research question, and therefore appropriate in different circumstances. The presentation will provide information to support participants to consider the research perspective(s) most suited to the research challenge that they are aiming to address.
Main messages
There are multiple sources of complexity, each of which can affect how the intervention works or contributes to change. Complex intervention research can take an efficacy, effectiveness, theory-based, or systems perspective, the choice of which is based on what is known already and what further evidence would be most useful.
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Affiliation(s)
- K Skivington
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - P Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Matthews
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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18
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Craig P, Skivington K, Moore L, Simpson S, Matthews L. The new Framework and the Core Elements of complex intervention research. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.804] [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: 11/14/2022] Open
Abstract
Abstract
The new framework will be presented. The main phases of intervention research: development or identification, feasibility, evaluation and implementation are connected to 6 core elements:
Context: any feature of the circumstances in which an intervention is conceived, developed, evaluated and implemented Programme theory: how an intervention is expected to lead to its effects and under what conditions. Programme theory should be tested and refined at all stages and used to guide the identification of uncertainties and research questions Stakeholders: those who are targeted by the intervention, involved in its development or delivery, or more broadly those whose personal or professional interests are affected, that is who have a stake in the topic. This includes patients, the public, and professionals Refinement: the process of ‘fine tuning' or making changes to the intervention once a preliminary version has been developed Uncertainties: identifying key uncertainties that exist given what is already known and what the programme theory, researchers and stakeholders identify as being most important to find out. These judgements inform the framing of research questions that, in turn, govern research perspective choice Economic considerations: exploring the comparative resource and outcome consequences of the interventions for those people and organisations affected
The presentation will discuss how to use the framework, highlighting that complex intervention research can be an iterative process. Repeating of phases is preferable to automatic progression to the next phase if uncertainties remain unresolved.
Main messages
Complex intervention research may begin at any phase, depending on what is appropriate for the intervention in question, and does not necessarily move sequentially through the phases. The core elements should be considered early and revisited continually throughout, as this will make it most likely that the intervention will be implementable in practice.
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Affiliation(s)
- P Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - K Skivington
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Matthews
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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19
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Fong JN, Miketinas D, Moore L, Everts H, Warren C, Juma S, Patterson M. Precision Nutrition Model Predicts Postprandial Glucose Response Following Potato Intake. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.08.032] [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: 11/24/2022]
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20
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Loibl S, Loirat D, Tolaney S, Punie K, Oliveira M, Rugo H, Bardia A, Hurvitz S, Brufsky A, Kalinsky K, Cortés J, O'Shaughnessy J, Dieras V, Carey L, Gianni L, Gharaibeh M, Moore L, Shi L, Piccart M. 257P Health-related quality of life (HRQoL) in the ASCENT study of sacituzumab govitecan (SG) in metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.540] [Citation(s) in RCA: 3] [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: 11/16/2022] Open
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21
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O'Donoghue J, Moore L, Bhakyapaibul T, Melin H, Stallard T, Connerney JEP, Tao C. Global upper-atmospheric heating on Jupiter by the polar aurorae. Nature 2021; 596:54-57. [PMID: 34349293 PMCID: PMC8338559 DOI: 10.1038/s41586-021-03706-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022]
Abstract
Jupiter's upper atmosphere is considerably hotter than expected from the amount of sunlight that it receives1-3. Processes that couple the magnetosphere to the atmosphere give rise to intense auroral emissions and enormous deposition of energy in the magnetic polar regions, so it has been presumed that redistribution of this energy could heat the rest of the planet4-6. Instead, most thermospheric global circulation models demonstrate that auroral energy is trapped at high latitudes by the strong winds on this rapidly rotating planet3,5,7-10. Consequently, other possible heat sources have continued to be studied, such as heating by gravity waves and acoustic waves emanating from the lower atmosphere2,11-13. Each mechanism would imprint a unique signature on the global Jovian temperature gradients, thus revealing the dominant heat source, but a lack of planet-wide, high-resolution data has meant that these gradients have not been determined. Here we report infrared spectroscopy of Jupiter with a spatial resolution of 2 degrees in longitude and latitude, extending from pole to equator. We find that temperatures decrease steadily from the auroral polar regions to the equator. Furthermore, during a period of enhanced activity possibly driven by a solar wind compression, a high-temperature planetary-scale structure was observed that may be propagating from the aurora. These observations indicate that Jupiter's upper atmosphere is predominantly heated by the redistribution of auroral energy.
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Affiliation(s)
- J O'Donoghue
- Department of Solar System Science, JAXA Institute of Space and Astronautical Science, Sagamihara, Japan.
- NASA Goddard Space Flight Center, Greenbelt, MD, USA.
| | - L Moore
- Center for Space Physics, Boston University, Boston, MA, USA
| | - T Bhakyapaibul
- Center for Space Physics, Boston University, Boston, MA, USA
| | - H Melin
- Department of Physics and Astronomy, University of Leicester, Leicester, UK
| | - T Stallard
- Department of Physics and Astronomy, University of Leicester, Leicester, UK
| | - J E P Connerney
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Space Research Corporation, Annapolis, MD, USA
| | - C Tao
- National Institute of Information and Communications Technology (NICT), Tokyo, Japan
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22
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Ouellet V, Boucher V, Beauchamp F, Neveu X, Archambault P, Berthelot S, Chauny JM, De Guise E, Émond M, Frenette J, Lang E, Lee J, Mercier, Moore L, Ouellet MC, Perry J, Le Sage N. Influence of concomitant injuries on post-concussion symptoms after a mild traumatic brain injury - a prospective multicentre cohort study. Brain Inj 2021; 35:1028-1034. [PMID: 34224275 DOI: 10.1080/02699052.2021.1945145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: To compare post-concussion symptoms (PCS) and return to normal activities between mild Traumatic Brain Injury (mTBI) patients with or without concomitant injuries at 7-and 90 days post-mTBI.Methods: Design: Sub-analysis of a multicentre prospective cohort study. PARTICIPANTS AND SETTING patients with mTBI from 7 Canadian Emergency Departments. PROCEDURE Research assistants conducted telephone follow-ups using the Rivermead Postconcussion Symptoms Questionnaire (RPQ) at 7-, 30- and 90 days post-mTBI. MAIN OUTCOME Presence of PCS (RPQ: ≥3 symptoms) at 90 days. SECONDARY OUTCOMES RPQ score ≥21, prevalence of individual RPQ symptoms and patients' return to normal activities, at 7- and 90-days. Adjusted risk ratios (RR) were calculated.Results: 1725 mTBI patients were included and 1055 (61.1%) had concomitant injuries. Patients with concomitant injuries were at higher risk of having ≥3 symptoms on the RPQ (RR:1.26 [95% CI 1.01-1.58]) at 90 days. They were also at higher risk of experiencing specific symptoms (dizziness, fatigue, headaches and taking longer to think) and of non-return to their normal activities (RR:2.11 [95% CI 1.30-3.45]).Conclusion: Patients with concomitant injuries have slightly more PCS and seemed to be at higher risk of non-return to their normal activities 90 days, compared to patients without concomitant injuries.
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Affiliation(s)
- V Ouellet
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - V Boucher
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - F Beauchamp
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - X Neveu
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - P Archambault
- Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada.,Centre Intégré De Santé Et De Services Sociaux De Chaudière-Appalaches, Centre Hospitalier Affilié Universitaire Hôtel-Dieu De Lévis, Lévis (Quebec) Canada
| | - S Berthelot
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - J M Chauny
- Université De Montréal, Montréal, Québec, Canada
| | - E De Guise
- Université De Montréal, Montréal, Québec, Canada.,Research-Institute, McGill University Health CentreMontreal, Quebec, Canada.,Centre De Recherche Interdisciplinaire En Réadaptation Du Montréal Métropolitain (CRIR), Montreal, Quebec, Canada
| | - M Émond
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - J Frenette
- Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - E Lang
- University of Calgary, Calgary, Alberta, Canada
| | - J Lee
- Schwartz/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
| | - Mercier
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - L Moore
- Department of Social and Preventive Medicine, Faculté De Médecine, Université Laval Québec Canada
| | - M C Ouellet
- Département De Psychologie, Université Laval Québec Canada.,Centre Interdisciplinaire De Recherche En Réadaptation Et Intégration Sociale CIRRIS, Quebec, Canada
| | - J Perry
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa Ottawa Canada
| | - N Le Sage
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
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23
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Low R, Young K, Verani L, Cotton DT, Welman T, Moore L, Horwitz MD. 540 Point of Care Testing for Tetanus Immunity: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.448] [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: 11/13/2022]
Abstract
Abstract
Introduction
All patients presenting to emergency departments (EDs) with traumatic injuries require tetanus immunity assessments. Inaccurate tetanus vaccination history based on patient recall incurs unnecessary costs on the NHS. Point-of-care immunochromatographic tests (Tetanus Quick Sticks [TQS]) quickly identify tetanus immunity status. We aim to evaluate the diagnostic accuracy and cost-efficacy of TQS to assess their relevance in emergency care.
Method
The systematic review followed PRISMA guidelines. A retrospective search of MEDLINE, Embase, Global Health, HMIC and The Cochrane Library was conducted. Studies were eligible if sensitivity, specificity, or cost-efficacy of TQS were reported. At least two authors independently analysed the data from each study.
Results
12 studies were suitable for inclusion (n = 1,662,865 participants): one retrospective and 11 prospective observational cohort studies. Eight studies assessed diagnostic accuracy with the median sensitivity at 86% (55-100) and the median specificity at 97.5% (1-100). All six studies investigating cost-efficacy reported greater savings when using TQS instead of using vaccination history, due to a decrease in unnecessary tetanus vaccine and immunoglobulin administration.
Conclusions
TQS is a safe diagnostic tool, especially when used by trained operators. TQS widely reduces costs in comparison to traditional vaccination history. We recommend the use of TQS in Emergency Departments throughout the NHS.
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Affiliation(s)
- R Low
- Imperial College London, London, United Kingdom
| | - K Young
- Imperial College London, London, United Kingdom
| | - L Verani
- Imperial College London, London, United Kingdom
| | - D T Cotton
- Imperial College London, London, United Kingdom
| | - T Welman
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Foundation Trust, London, United Kingdom
| | - L Moore
- Imperial College London, London, United Kingdom
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M D Horwitz
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
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O'Brien J, Fryer S, Parker J, Moore L. The effect of ego depletion on challenge and threat evaluations during a potentially stressful public speaking task. Anxiety Stress Coping 2021; 34:266-278. [PMID: 33141603 DOI: 10.1080/10615806.2020.1839732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/05/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
It has been well established that challenge and threat evaluations affect the performance of potentially stressful tasks. However, the factors that influence these evaluations have rarely been examined. Objective: This study examined the effects of ego depletion on challenge and threat evaluations during a public speaking task. Method: 262 participants (150 males, 112 females; Mage = 20.5, SD = 4.3) were randomly assigned to either an ego depletion or control group. Participants then completed self-report measures of trait self-control. The ego depletion group performed a written transcription task requiring self-control, while the control group transcribed the text normally. Before the public speaking task, participant's challenge and threat evaluations and subjective ratings of performance were assessed via self-report items. Results: The results of independent t-tests supported the effectiveness of the self-control manipulation. There were no significant differences between the ego depletion and control groups in terms of challenge and threat evaluations or subjective performance. Additional correlation analyses revealed that trait measures of self-control were significantly and negatively related to challenge and threat evaluations and subjective performance. Conclusion: Findings suggest that ego depletion might not influence appraisals of potentially stressful tasks, and thus add to recent evidence questioning the ego-depletion phenomenon.
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Affiliation(s)
- J O'Brien
- Faculty of Applied Sciences, School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - S Fryer
- Faculty of Applied Sciences, School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - J Parker
- Higher Education Sport, Hartpury University, Gloucester, UK
| | - L Moore
- Department for Health, University of Bath, Bath, UK
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Bell P, DePaepe S, Moore L. An unusual case of acute cardiac tamponade caused by a cardiac hemangioma. Am J Emerg Med 2021; 47:327.e1-327.e2. [PMID: 33678484 DOI: 10.1016/j.ajem.2021.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022] Open
Abstract
Cardiac hemangiomas are exceedingly rare and can lead to cardiac tamponade. Cardiac tamponade is a true medical emergency that can cause cardiovascular collapse and death if not managed appropriately. There are many causes of cardiac tamponade such as trauma, autoimmune causes, and malignancy. Cardiac tumors are difficult to diagnose and may be present on advanced imaging including cardiac MRI. For patients with cardiac tumors causing tamponade, emergent pericardiocentesis and cardiovascular surgery consultation are necessary in management. We present a unique case of cardiac tamponade caused by a cardiac hemangioma.
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Affiliation(s)
- Paige Bell
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Stephanie DePaepe
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lauren Moore
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, United States.
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Moore L, Moses JI, Melin H, Stallard TS, O’Donoghue J. Atmospheric implications of the lack of H 3+ detection at Neptune. Philos Trans A Math Phys Eng Sci 2020; 378:20200100. [PMID: 33161862 PMCID: PMC7658779 DOI: 10.1098/rsta.2020.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 05/04/2023]
Abstract
H3+ has been detected at all of the solar system giant planets aside from Neptune. Current observational upper limits imply that there is far less H3+ emission at Neptune than rudimentary modelling would suggest. Here, we explore via modelling a range of atmospheric conditions in order to find some that could be consistent with observational constraints. In particular, we consider that the upper atmosphere might be much cooler than it was during the 1989 Voyager 2 encounter, and we examine the impact of an enhanced influx of external material that could act to reduce H3+ density. Resulting ionosphere models that are consistent with existing H3+ observational constraints have an exospheric temperature of 450 K or less, 300 K lower than the Voyager 2 value. Alternatively, if a topside CO influx of 2 × 108 cm-2 s-1 is imposed, the upper atmospheric temperature can be higher, up to 550 K. The potential cooling of Neptune's atmosphere is relevant for poorly understood giant planet thermospheric energetics, and would also impact aerobreaking manoeuvers for any future spacecraft. Such a large CO influx, if present, could imply Triton is a very active moon with prominent atmospheric escape, and/or that Neptune's rings significantly modify its upper atmosphere, and the introduction of so much exogenic material would complicate interpretation of the origin of species observed in Neptune's lower atmosphere. This article is part a discussion meeting issue 'Future exploration of ice giant systems'.
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Affiliation(s)
- L. Moore
- Boston University, Boston, MA, USA
| | | | - H. Melin
- University of Leicester, Leicester, UK
| | | | - J. O’Donoghue
- JAXA Institute of Space and Astronautical Science, Tokyo, Japan
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27
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Davies A, Teare L, Falder S, Dumville J, Shah M, Jenkins A, Collins D, Dheansa B, Coy K, Booth S, Moore L, Marlow K, Agha R, Young A. Consensus demonstrates four indicators needed to standardize burn wound infection reporting across trials in a single-country study (ICon-B study). J Hosp Infect 2020; 106:217-225. [DOI: 10.1016/j.jhin.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/22/2020] [Indexed: 01/10/2023]
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28
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Li H, Crihfield C, Feng Y, Gaje G, Guzman E, Heckman T, Mellis A, Moore L, Romo Bechara N, Sanchez S, Whittington S, Wolf JG, Garshong R, Morales K, Petric R, Zarecky LA, Schug MD. The Weekend Effect on Urban Bat Activity Suggests Fine Scale Human-Induced Bat Movements. Animals (Basel) 2020; 10:ani10091636. [PMID: 32932924 PMCID: PMC7552248 DOI: 10.3390/ani10091636] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022] Open
Abstract
Simple Summary On weekends, people do things differently from weekdays, such as dining at a restaurant, going to a night club, attending a concert or a sporting event, or simply staying up late. These leisure activities in the city can change the environment people live in and can hurt wildlife that also lives in the same city. We recorded bats in the city center and in the city periphery and compared how active bats were. We found that in the city center, bats were less active on weekends than weekdays. The opposite pattern was found in the city periphery. It is possible that bats moved from the city center to the city periphery on weekends. Thus, continuous greenways are important to facilitate bat movements and avoid human–wildlife conflict. City planners can add new parks and/or preserve old-growth vegetation to form the center-to-periphery greenways. Abstract In the urban environment, wildlife faces novel human disturbances in unique temporal patterns. The weekend effect describes that human activities on weekends trigger changes in the environment and impact wildlife negatively. Reduced occurrence, altered behaviors, and/or reduced fitness have been found in birds, ungulates, and meso-carnivores due to the weekend effect. We aimed to investigate if urban bat activity would differ on weekends from weekdays. We analyzed year-round bat acoustic monitoring data collected from two sites near the city center and two sites in the residential area/park complex in the city periphery. We constructed generalized linear models and found that bat activity was significantly lower on weekends as compared to weekdays during spring and summer at the site in the open space near the city center. In contrast, during the same seasons, the sites in the city periphery showed increased bat activity on weekends. Hourly bat activity overnight suggested that bats might move from the city center to the periphery on weekends. We demonstrated the behavioral adaptability in urban wildlife for co-existing with human. We recommend that urban planning should implement practices such as adding new greenspaces and/or preserving old-growth vegetation to form continuous greenways from the city center to the city periphery as corridors to facilitate bat movements and reduce possible human-wildlife conflict.
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Affiliation(s)
- Han Li
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
- Correspondence: ; Tel.: +01-254-733-2891
| | - Chase Crihfield
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Yashi Feng
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Gabriella Gaje
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Elissa Guzman
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Talia Heckman
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Anna Mellis
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Lauren Moore
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Nayma Romo Bechara
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Sydney Sanchez
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Samantha Whittington
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Joseph Gazing Wolf
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
- School of Life Sciences, Arizona State University, Tempe, AZ 85281, USA
| | - Reuben Garshong
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Kristina Morales
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | - Radmila Petric
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
| | | | - Malcolm D. Schug
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC 27412, USA; (C.C.); (Y.F.); (G.G.); (E.G.); (T.H.); (A.M.); (L.M.); (N.R.B.); (S.S.); (S.W.); (J.G.W.); (R.G.); (K.M.); (R.P.); (M.D.S.)
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Abstract
Aims:To compare the effectiveness of a manualised group cognitive behaviour therapy (CBT) programme for people with bipolar disorder (BPD) and major depressive disorder (MDD).Method:In addition to treatment as usual (TAU), 17 people with BPD and 17 matched controls with MDD completed 8 or 12 sessions of twice weekly group CBT, followed by 6 booster sessions, held at monthly intervals. Participants completed the Structured Clinical Interview for DSM-IV Axis 1 Disorders, Clinician Version (SCID-1) and the University of Rhode Island Change Assessment (URICA) prior to therapy. They completed the Beck Depression Inventory - II (BDI), the Beck Anxiety Inventory (BAI), the Clinical Outcomes in Routine Evaluation (CORE), the World Health Organisation Quality of Life Brief Version (WHOQoL - BREF) and the Dysfunctional Attitudes Scale (DAS) before and after therapy and at the final follow-up session. The BDI and BAI were also completed at each group session.Results:Both groups showed statistically and clinically significant improvement on the BDI and BAI after treatment and at follow-up. Both groups showed a significant improvement on the psychological health sub-scale on the WHOQoL-BREF.Conclusions:Manualised group CBT leads to a reduction in the symptoms of depression and anxiety in people with both BPD and MDD and helps improve their perceived quality of life.Declaration of interest:None.
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Argyropoulos GPD, Moore L, Loane C, Roca-Fernandez A, Lage-Martinez C, Gurau O, Irani SR, Zeman A, Butler CR. Pathologic tearfulness after limbic encephalitis: A novel disorder and its neural basis. Neurology 2020; 94:e1320-e1335. [PMID: 31980582 PMCID: PMC7274928 DOI: 10.1212/wnl.0000000000008934] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
Objective We investigated the nature and neural foundations of pathologic tearfulness in a uniquely large cohort of patients who had presented with autoimmune limbic encephalitis (aLE). Methods We recruited 38 patients (26 men, 12 women; median age 63.06 years; interquartile range [IQR] 16.06 years) in the postacute phase of aLE who completed questionnaires probing emotion regulation. All patients underwent structural/functional MRI postacutely, along with 67 age- and sex-matched healthy controls (40 men, 27 women; median age 64.70 years; IQR 19.87 years). We investigated correlations of questionnaire scores with demographic, clinical, neuropsychological, and brain imaging data across patients. We also compared patients diagnosed with pathologic tearfulness and those without, along with healthy controls, on gray matter volume, resting-state functional connectivity, and activity. Results Pathologic tearfulness was reported by 50% of the patients, while no patient reported pathologic laughing. It was not associated with depression, impulsiveness, memory impairment, executive dysfunction in the postacute phase, or amygdalar abnormalities in the acute phase. It correlated with changes in specific emotional brain networks: volume reduction in the right anterior hippocampus, left fusiform gyrus, and cerebellum, abnormal hippocampal resting-state functional connectivity with the posteromedial cortex and right middle frontal gyrus, and abnormal hemodynamic activity in the left fusiform gyrus, right inferior parietal lobule, and ventral pons. Conclusions Pathologic tearfulness is common following aLE, is not a manifestation of other neuropsychiatric features, and reflects abnormalities in networks of emotion regulation beyond the acute hippocampal focus. The condition, which may also be present in other neurologic disorders, provides novel insights into the neural basis of affective control and its dysfunction in disease.
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Affiliation(s)
- Georgios P D Argyropoulos
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago.
| | - Lauren Moore
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
| | - Clare Loane
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
| | - Adriana Roca-Fernandez
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
| | - Carmen Lage-Martinez
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
| | - Oana Gurau
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
| | - Sarosh R Irani
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
| | - Adam Zeman
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
| | - Christopher R Butler
- From the Memory Research Group (G.P.D.A., L.M., C.L., A.R.-F., C.L.-M., O.G., C.R.B.) and Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Psychology (L.M.), University of Bath; Maurice Wohl Clinical Neuroscience Institute, Basic and Clinical Neuroscience Department (C.L.), King's College London, UK; Valdecilla Biomedical Research Institute (C.L.-M.), University Hospital Marqués de Valdecilla, Santander, Spain; Medical School (A.Z.), University of Exeter, UK; Department of Brain Sciences (C.R.B.) Imperial College London, UK; and Departamento de Neurología (C.R.B.), Pontificia Universidad Católica de Chile, Santiago
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Sawadogo D, Moore L, Tardif PA, Farhat I, Lauzier F, Turgeon AF. Trends of clinical outcomes in patients with a Traumatic Brain Injury (TBI) in Canada between 2006 and 2012. Injury 2020; 51:76-83. [PMID: 31515061 DOI: 10.1016/j.injury.2019.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 07/11/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brain injuries (TBI) are the leading cause of death for people aged <40 years. In Canada, the structure of trauma care has evolved independently across provinces during the last decade. However, little is known about the evolution of clinical outcomes. We aimed to compare trends in hospital mortality, unplanned readmission, hospital length of stay (LOS) and intensive care unit (ICU) LOS for TBI between 2006 and 2012 across Canadian provinces. METHODS We conducted a retrospective multicentre cohort study based on TBI admissions across Canadian level I and II trauma centres. Data were extracted from the National Trauma Registry linked to hospital discharge databases. All adults with an injury severity score ≥12 were included. Multilevel generalized linear models were used to evaluate trends in clinical outcomes. RESULTS Between 2006 and 2012, we observed a decrease in mortality in Canada (odd ratio [OR] = 0.95; 95% confidence intervals [CI] = 0.92-0.98) mostly driven by Ontario (OR = 0.95; 95% CI = 0.93-0.98). We observed a significant decrease in hospital length of stay in Canada (hazard ratio [HR]: hazard of being discharged alive from hospital = 1.02; 95% CI = 1.01-1.02) mostly driven by a decrease in Quebec (HR = 1.03; 95% CI = 1.01-1.04). We observed a decrease in ICU Length of stay only in Alberta (HR = 1.05; 95% CI = 1.01-1.09). No trend was observed for hospital readmissions. CONCLUSION We observed significant decreases in mortality, hospital and ICU length of stay for TBI in Canada between 2006 and 2012 but only in certain provinces. This study may represent the first step towards a better understanding of the influence of trauma system configuration on the burden of injuries in Canada.
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Affiliation(s)
- D Sawadogo
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Hôpital de l'Enfant Jésus, Québec, Canada.
| | - L Moore
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Hôpital de l'Enfant Jésus, Québec, Canada
| | - P A Tardif
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Hôpital de l'Enfant Jésus, Québec, Canada
| | - I Farhat
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Hôpital de l'Enfant Jésus, Québec, Canada
| | - F Lauzier
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Hôpital de l'Enfant Jésus, Québec, Canada; Département d'anesthésiologie, Faculté de médecine, Université Laval, Québec, Canada
| | - A F Turgeon
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Hôpital de l'Enfant Jésus, Québec, Canada
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Gutman DA, George R, Moore L. Paravertebral Block for a Patient With Achalasia Undergoing a Peroral Endoscopic Myotomy Procedure: A Case Report. A A Pract 2019; 13:413-414. [PMID: 31567272 DOI: 10.1213/xaa.0000000000001088] [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
In 2016, the American Medical Association officially dismissed pain as a vital sign quoting the opioid epidemic as a major reason. Clinically, pain remains very relevant and we present the case of a patient with achalasia treated via peroral endoscopic myotomy procedure (POEM). Given that similar patients previously failed traditional pain management modalities, regional anesthesia was used in this patient's pain management. The positive outcomes yielded from this technique convinced our gastroenterological colleagues to request regional anesthesia for future patients, altering their approach to pain management.
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Affiliation(s)
- David A Gutman
- From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
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Brown R, Bauld L, de Lacy E, Hallingberg B, Maynard O, McKell J, Moore L, Moore G. A qualitative study of e-cigarette emergence and the potential for renormalisation of smoking in UK youth. Int J Drug Policy 2019; 75:102598. [PMID: 31785547 PMCID: PMC6983925 DOI: 10.1016/j.drugpo.2019.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 03/28/2019] [Revised: 10/09/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022]
Abstract
Background Growth of e-cigarette use among smokers has raised concerns over uptake by non-smokers, particularly young people. Legislative changes aimed in part at reducing youth exposure to e-cigarettes include the EU Tobacco Products Directive (TPD). A core justification for such measures is the belief that e-cigarettes can lead to tobacco smoking through mechanisms of renormalisation including: mimicking and normalizing the act of smoking; increasing product acceptability via marketing; nicotine exposure. These mechanisms are here explored in relation to findings from qualitative research. Methods This paper reports results from twenty-one group interviews with 14–15 year olds in Wales, England and Scotland, conducted as part of an ongoing evaluation of the impact of the TPD on youth smoking and e-cigarette use. Interviews were conducted around the end of the transitional period for TPD implementation, and explored perceptions of e-cigarettes and tobacco, as well as similarities and differences between them. Results Young people differentiated between tobacco and e-cigarettes, rejecting the term e-cigarette in favour of alternatives such as ‘vapes’. Experimental or occasional use was common and generally approved of where occurring within social activity with peers. However, regular use outside of this context was widely disapproved of, unless for the purpose of stopping smoking. Increased prevalence of e-cigarettes did not challenge strongly negative views of smoking or reduce perceived harms caused by it, with disapproval of smoking remaining high. Nicotine use was variable, with flavour a stronger driver for choice of e-liquid, and interest more generally. Conclusion The extent to which participants differentiated between vaping and smoking, including styles and reasons for use in adults and young people; absence of marketing awareness; and continued strong disapproval of smoking provides limited support for some of the potential mechanisms through which e-cigarettes may renormalise smoking. However caution over nicotine exposure is still necessary.
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Affiliation(s)
- R Brown
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, UK.
| | - L Bauld
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, UK; Director, SPECTRUM Consortium
| | - E de Lacy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, UK
| | - B Hallingberg
- Department of Applied Psychology, Cardiff Metropolitan University
| | - O Maynard
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK/UK Centre for Tobacco and Alcohol Studies (UKCTAS) and School of Psychological Science, University of Bristol, Bristol, UK
| | - J McKell
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, UK
| | - L Moore
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | - G Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, UK; SPECTRUM Consortium
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Farrier AJ, Moore L, Manning W, Avila C, Collins SN, Holland J. Comparison study of temperature and deformation changes in the femoral component of a novel ceramic-on-ceramic hip resurfacing bearing to a metal standard, using a cadaveric model. Proc Inst Mech Eng H 2019; 233:1318-1326. [PMID: 31608770 DOI: 10.1177/0954411919881520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hip resurfacing is an attractive alternative to total hip replacement preserving bone and reducing dislocation risk. Recent metal-on-metal designs have caused failure due to metal wear debris. Ceramic implants may mitigate this risk. Temperature increase in periprosthetic bone during cementation can lead to osteonecrosis, while deformation of the component can affect joint lubrication and may increase wear through clamping. Both processes may lead to implant loosening. This study quantifies the temperature and deformation change in a novel ceramic hip resurfacing femoral component compared to a metal standard during cemented implantation in a fresh frozen cadaveric model. Study design and methods Eight femora were prepared from four fresh frozen cadavers. One surgeon experienced in hip resurfacing surgery (J.H.) prepared the femora by reaming. Four ceramic and four metal implants of equal and varying size were cemented in place. Bone and surface temperatures were taken using a probe in the periprosthetic bone and an infrared laser thermometer, respectively. Deformation was measured using a micrometre. Measurements were taken before implantation and every 5-min intervals up to 30 min. The average bone-temperature increment was lower for ceramic heads than for metal heads. Although this difference was not statistically significant, the average bone temperature incremental change in small sizes (42 and 46 mm) was higher than in the large sizes (48 and 50 mm). Most metal heads sustained bearing diameter change that was still near its peak value 30 min after implantation, whereas the ceramic heads suffered a lower diameter change and most of the samples recovered their original diameter 30 min after implantation. Both implants behave similarly, however, a lower temperature rise in bone was observed with ceramic heads. This may lower the risk for thermal damage on periprosthetic bone. The ceramic heads deformed less during surgical implantation. This was not significant.
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Affiliation(s)
- Adam James Farrier
- Trauma and Orthopaedics, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lauren Moore
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Will Manning
- Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | - James Holland
- Newcastle Surgical Training Centre, Freeman Hospital, Newcastle upon Tyne, UK
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Melin H, Fletcher LN, Stallard TS, Miller S, Trafton LM, Moore L, O'Donoghue J, Vervack RJ, Dello Russo N, Lamy L, Tao C, Chowdhury MN. The H 3+ ionosphere of Uranus: decades-long cooling and local-time morphology. Philos Trans A Math Phys Eng Sci 2019; 377:20180408. [PMID: 31378181 PMCID: PMC6710888 DOI: 10.1098/rsta.2018.0408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2019] [Indexed: 05/04/2023]
Abstract
The upper atmosphere of Uranus has been observed to be slowly cooling between 1993 and 2011. New analysis of near-infrared observations of emission from H3+ obtained between 2012 and 2018 reveals that this cooling trend has continued, showing that the upper atmosphere has cooled for 27 years, longer than the length of a nominal season of 21 years. The new observations have offered greater spatial resolution and higher sensitivity than previous ones, enabling the characterization of the H3+ intensity as a function of local time. These profiles peak between 13 and 15 h local time, later than models suggest. The NASA Infrared Telescope Facility iSHELL instrument also provides the detection of a bright H3+ signal on 16 October 2016, rotating into view from the dawn sector. This feature is consistent with an auroral signal, but is the only of its kind present in this comprehensive dataset. This article is part of a discussion meeting issue 'Advances in hydrogen molecular ions: H3+, H5+ and beyond'.
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Affiliation(s)
- Henrik Melin
- Department of Physics & Astronomy, University of Leicester, Leicester, UK
| | - L. N. Fletcher
- Department of Physics & Astronomy, University of Leicester, Leicester, UK
| | - T. S. Stallard
- Department of Physics & Astronomy, University of Leicester, Leicester, UK
| | - S. Miller
- Department of Physics & Astronomy, University College London, London, UK
| | - L. M. Trafton
- Department of Astronomy, University of Texas, Austin, TX, USA
| | - L. Moore
- Center for Space Physics, Boston University, Boston, MA, USA
| | | | - R. J. Vervack
- Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - N. Dello Russo
- Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - L. Lamy
- LESIA, Observatoire de Paris, PSL, CNRS, Sorbonne Université, Meudon, France
| | - C. Tao
- National Institute of Information and Communications Technology, Tokyo, Japan
| | - M. N. Chowdhury
- Department of Physics & Astronomy, University of Leicester, Leicester, UK
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Moore L, Melin H, O'Donoghue J, Stallard TS, Moses JI, Galand M, Miller S, Schmidt CA. Modelling H 3+ in planetary atmospheres: effects of vertical gradients on observed quantities. Philos Trans A Math Phys Eng Sci 2019; 377:20190067. [PMID: 31378180 PMCID: PMC6710898 DOI: 10.1098/rsta.2019.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2019] [Indexed: 05/20/2023]
Abstract
Since its detection in the aurorae of Jupiter approximately 30 years ago, the H3+ ion has served as an invaluable probe of giant planet upper atmospheres. However, the vast majority of monitoring of planetary H3+ radiation has followed from observations that rely on deriving parameters from column-integrated paths through the emitting layer. Here, we investigate the effects of density and temperature gradients along such paths on the measured H3+ spectrum and its resulting interpretation. In a non-isothermal atmosphere, H3+ column densities retrieved from such observations are found to represent a lower limit, reduced by 20% or more from the true atmospheric value. Global simulations of Uranus' ionosphere reveal that measured H3+ temperature variations are often attributable to well-understood solar zenith angle effects rather than indications of real atmospheric variability. Finally, based on these insights, a preliminary method of deriving vertical temperature structure is demonstrated at Jupiter using model reproductions of electron density and H3+ measurements. The sheer diversity and uncertainty of conditions in planetary atmospheres prohibits this work from providing blanket quantitative correction factors; nonetheless, we illustrate a few simple ways in which the already formidable utility of H3+ observations in understanding planetary atmospheres can be enhanced. This article is part of a discussion meeting issue 'Advances in hydrogen molecular ions: H3+, H5+ and beyond'.
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Affiliation(s)
- L. Moore
- Boston University, Boston, MA, USA
| | - H. Melin
- University of Leicester, Leicester, UK
| | - J. O'Donoghue
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | | | | | - M. Galand
- Department of Physics, Imperial College London, London, UK
| | - S. Miller
- University College London, London, UK
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Moore L, Jayaweera H, Redshaw M, Quigley M. Migration, ethnicity and mental health: evidence from mothers participating in the Millennium Cohort Study. Public Health 2019; 171:66-75. [PMID: 31103615 DOI: 10.1016/j.puhe.2019.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Over a quarter of UK births are to women who were born outside of the UK. Black and Minority Ethnic (BME) women are disproportionately affected by poor mental health and inequitable access to mental health care in the perinatal period, yet the influence of the migrant status (mothers' UK vs. non-UK birth) is poorly understood. This study aimed to explore the relationship between ethnicity, migration and mental health indicators among mothers participating in a large nationally representative cohort study. STUDY DESIGN This is a secondary analysis of data from the Millennium Cohort Study. METHODS Logistic regression quantified the crude and adjusted effects of self-reported ethnicity and migrant status on prevalence of psychological distress and treatment for anxiety/depression at 9-month and 5-year postpartum. RESULTS We found substantial variation in the prevalence of distress according to ethnicity and migrant status, with Indian and Pakistani women at greatest risk. Despite equal or greater risk, BME and migrant women were less likely to report treatment for anxiety/depression. Mutually adjusted analyses showed ethnicity to be a stronger predictor of both outcomes than migrant status; however, at 5 years, being a migrant independently predicted lower odds of treatment, for a statistically similar level of distress. CONCLUSIONS Migrant women are likely to be at high risk of poor mental health in the perinatal period and beyond, yet may face significant barriers to accessing mental health care. A better understanding of ethnicity and migration as interrelated risk factors for perinatal mental ill-health is needed to help National Health Service organisations develop policy and practice that is flexible and responsive to diversity.
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Affiliation(s)
- L Moore
- Oxford School of Public Health, Old Road Campus, Headington, Oxford OX3 7LF, UK.
| | - H Jayaweera
- School of Anthropology, University of Oxford, 53 Banbury Rd, Oxford OX2 6PF, UK.
| | - M Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
| | - M Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
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Stanczak H, Nastasi N, Helmick D, CHEN X, Windreich R, Barnum J, Carella B, Byersdorfer C, Donnenberg A, Moore L, Szabolcs P. Processing and CD3+/CD19+ depletion of cadaveric vertebral bone marrow for primary immunodeficiency patients undergoing sequential bilateral orthotopic lung transplant (BOLT) and bone marrow transplant (BMT). Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.04.012] [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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Farrier AJ, Moore L, Manning W, Avila C, Collins SN, Holland J. Comparing the cup deformation following implantation of a novel ceramic-on-ceramic hip resurfacing bearing to a metal standard in a cadaveric model. Proc Inst Mech Eng H 2019; 233:603-610. [PMID: 31017527 DOI: 10.1177/0954411919845721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hip resurfacing is an attractive alternative to total hip replacement preserving bone and reducing dislocation risk. Recent metal-on-metal designs have caused failure due to metal wear debris. Ceramic implants may mitigate this risk. Deformation of the acetabular cup can affect the lubrication, producing high friction torques between the femoral head and the cup that would increase wear and/or lead to cup loosening due to femoral head clamping. Our objective was to quantify the deformation of a novel monobloc ceramic hip resurfacing cup component compared to a metal standard, in a fresh frozen cadaveric model using a press-fit technique representative of standard surgical conditions. For this study eight acetabula were prepared from four fresh frozen cadavers. One surgeon with extensive experience in hip resurfacing surgery (J.H.) prepared the acetabulum by sequential reaming. The implants were then impacted into the acetabulum. Four ceramic and four metal implants were used of equal and varying size. Deformation was measured peri-implantation, and at 30 min, using an optical high-precision deformation sensor (GOM GmbH, Braunschweig, Germany). The maximum inscribed circle and the measurement of radial segment techniques were used. Deformation was greater in the metal implants (mean: 34-22mm) immediately after implantation. At 30 min after implantation, the deformation increased to 36mm in the metal and 26mm in the ceramic cup. Greater diameter changes were observed in larger cups. Metal and ceramic implants did not return to the initial diameter. We conclude the ceramic resurfacing acetabular implants undergo similar deformation to existing metal-on-metal implants. The deformation observed was significantly less in the ceramic component at 30 min on one measure. Less deformation may result in better surface conditions and wear characteristics. Deformation change did not resolve after 30 min for both implants.
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Affiliation(s)
- Adam James Farrier
- 1 Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lauren Moore
- 2 School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Will Manning
- 1 Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - James Holland
- 1 Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Beaudoin C, Moore L, Gagné M, Bessette L, Ste-Marie LG, Brown JP, Jean S. Performance of predictive tools to identify individuals at risk of non-traumatic fracture: a systematic review, meta-analysis, and meta-regression. Osteoporos Int 2019; 30:721-740. [PMID: 30877348 DOI: 10.1007/s00198-019-04919-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/26/2019] [Indexed: 01/28/2023]
Abstract
UNLABELLED There is no consensus on which tool is the most accurate to assess fracture risk. The results of this systematic review suggest that QFracture, Fracture Risk Assessment Tool (FRAX) with BMD, and Garvan with BMD are the tools with the best discriminative ability. More studies assessing the comparative performance of current tools are needed. INTRODUCTION Many tools exist to assess fracture risk. This review aims to determine which tools have the best predictive accuracy to identify individuals at high risk of non-traumatic fracture. METHODS Studies assessing the accuracy of tools for prediction of fracture were searched in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Global Health. Studies were eligible if discrimination was assessed in a population independent of the derivation cohort. Meta-analyses and meta-regressions were performed on areas under the ROC curve (AUCs). Gender, mean age, age range, and study quality were used as adjustment variables. RESULTS We identified 53 validation studies assessing the discriminative ability of 14 tools. Given the small number of studies on some tools, only FRAX, Garvan, and QFracture were compared using meta-regression models. In the unadjusted analyses, QFracture had the best discriminative ability to predict hip fracture (AUC = 0.88). In the adjusted analysis, FRAX with BMD (AUC = 0.81) and Garvan with BMD (AUC = 0.79) had the highest AUCs. For prediction of major osteoporotic fracture, QFracture had the best discriminative ability (AUC = 0.77). For prediction of osteoporotic or any fracture, FRAX with BMD and Garvan with BMD had higher discriminative ability than their versions without BMD (FRAX: AUC = 0.72 vs 0.69, Garvan: AUC = 0.72 vs 0.65). A significant amount of heterogeneity was present in the analyses. CONCLUSIONS QFracture, FRAX with BMD, and Garvan with BMD have the highest discriminative performance for predicting fracture. Additional studies in which the performance of current tools is assessed in the same individuals may be performed to confirm this conclusion.
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Affiliation(s)
- C Beaudoin
- Department of Social and Preventive Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada.
- Bureau d'information et d'études en santé des populations, Institut National de Santé Publique du Québec, 945, Avenue Wolfe, Québec, G1V 5B3, Canada.
| | - L Moore
- Department of Social and Preventive Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | - M Gagné
- Bureau d'information et d'études en santé des populations, Institut National de Santé Publique du Québec, 945, Avenue Wolfe, Québec, G1V 5B3, Canada
| | - L Bessette
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada
- Department of Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - L G Ste-Marie
- Department of Medicine, Medicine Faculty, University of Montréal, Montréal, QC, Canada
| | - J P Brown
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada
- Department of Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - S Jean
- Bureau d'information et d'études en santé des populations, Institut National de Santé Publique du Québec, 945, Avenue Wolfe, Québec, G1V 5B3, Canada
- Department of Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
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Goranova T, Ennis D, Piskorz AM, Macintyre G, Lewsley LA, Stobo J, Wilson C, Kay D, Glasspool RM, Lockley M, Brockbank E, Montes A, Walther A, Sundar S, Edmondson R, Hall GD, Clamp A, Gourley C, Hall M, Fotopoulou C, Gabra H, Freeman S, Moore L, Jimenez-Linan M, Paul J, Brenton JD, McNeish IA. Correction: Safety and utility of image-guided research biopsies in relapsed high-grade serous ovarian carcinoma-experience of the BriTROC consortium. Br J Cancer 2019; 120:868. [PMID: 30862952 PMCID: PMC6474310 DOI: 10.1038/s41416-019-0433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This article was originally published under a CC BY NC SA License, but has now been made available under a CC BY 4.0 License.
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Affiliation(s)
- T Goranova
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
| | - D Ennis
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - A M Piskorz
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
| | - G Macintyre
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
| | - L A Lewsley
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - J Stobo
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - C Wilson
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - D Kay
- Department of Radiology, Gartnavel General Hospital, Glasgow, G12 0YN, UK
| | - R M Glasspool
- Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK
| | - M Lockley
- Barts Cancer Institute, London, EC1M 6BQ, UK
- University College Hospital, London, WC1E 6BD, UK
| | - E Brockbank
- Barts Cancer Institute, London, EC1M 6BQ, UK
| | - A Montes
- Guy's Hospital, London, SE1 9RT, UK
| | - A Walther
- Bristol Haematology and Oncology Centre, Bristol, BS2 8ED, UK
| | - S Sundar
- City Hospital, Birmingham, B18 7QH, UK
| | | | - G D Hall
- St James Hospital, Leeds, LS9 7TF, UK
| | - A Clamp
- The Christie Hospital, Manchester, M20 4BX, UK
| | - C Gourley
- Edinburgh Cancer Research Centre, Edinburgh, EH4 2XR, UK
| | - M Hall
- Mount Vernon Cancer Centre, Northwood, HA6 2RN, UK
| | | | - H Gabra
- Imperial College, London, W12 0HS, UK
| | - S Freeman
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - L Moore
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | | | - J Paul
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - J D Brenton
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK.
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| | - I A McNeish
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK.
- Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK.
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Vetsch J, Wakefield CE, Doolan EL, Signorelli C, McGill BM, Moore L, Techakesari P, Pieters R, Patenaude AF, McCarthy M, Cohn RJ. 'Why us?' Causal attributions of childhood cancer survivors, survivors' parents and community comparisons - a mixed methods analysis. Acta Oncol 2019; 58:209-217. [PMID: 30614350 DOI: 10.1080/0284186x.2018.1532600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Understanding the cause of their cancer is important for many cancer patients. Childhood cancer survivors'/survivors' parents' beliefs about cancer etiology are understudied. We aimed to assess survivors'/parents' beliefs about what causes childhood cancer, compared with beliefs in the community. We also investigated the influence of clinical and socio-demographic characteristics on the participants' beliefs about cancer etiology. METHODS This two-stage study investigated the participants' beliefs, by using questionnaires assessing causal attributions related to childhood cancer (stage 1) and then undertaking telephone interviews (stage 2; survivors/survivors' parents only) to get an in-depth understanding of survivors'/survivors' parents beliefs. We computed multivariable regressions to identify factors associated with the most commonly endorsed attributions: bad luck/chance, environmental factors and genetics. We analyzed interviews using thematic analysis. RESULTS Six hundred one individuals (64.6% survivors and 35.4% survivors' parents) and 510 community comparisons (53.1% community adults, 46.9% community parents) completed the question on causal attributions. We conducted 87 in-depth interviews. Survivors/survivors' parents (73.9%) were more likely to believe that chance/bad luck caused childhood cancer than community participants (42.4%). Community participants more frequently endorsed that genetics (75.3%) and environmental factors (65.3%) played a major role in childhood cancer etiology (versus survivors' and survivors' parents: genetics 20.6%, environmental factors: 19.3%). Community participants, participants with a first language other than English, and reporting a lower quality of life were less likely to attribute bad luck as a cause of childhood cancer. Community participants, all participants with a higher income and higher education were more likely to attribute childhood cancer etiology to environmental factors. CONCLUSION Causal attributions differed between survivors/survivors' parents and community participants. Most of the parents and survivors seem to understand that there is nothing they have done to cause the cancer. Understanding survivors' and survivors' parents' causal attributions may be crucial to address misconceptions, offer access to services and to adapt current and future health behaviors.
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Affiliation(s)
- J. Vetsch
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - C. E. Wakefield
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - E. L. Doolan
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - C. Signorelli
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - B. M. McGill
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - L. Moore
- John Hunter Children’s Hospital, New Lambton Heights NSW, Sydney, Australia
| | - P. Techakesari
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - R. Pieters
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - A. F. Patenaude
- Department of Psychiatry at The Children’s Hospital, Boston, MA, USA
- Department of Psychiatry at Harvard Medical School, Boston, MA, USA
| | - M. McCarthy
- Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Hospital, Melbourne, Australia
| | - R. J. Cohn
- School of Women’s and Children’s Health, UNSW, Sydney, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
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Dunn C, Moore L. GENETIC TESTING IDENTIFIES CAUSE OF ENTEROPATHY AND GROWTH FAILURE IN A 10 YEAR OLD MALE. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.312] [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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Waite JH, Perryman RS, Perry ME, Miller KE, Bell J, Cravens TE, Glein CR, Grimes J, Hedman M, Cuzzi J, Brockwell T, Teolis B, Moore L, Mitchell DG, Persoon A, Kurth WS, Wahlund JE, Morooka M, Hadid LZ, Chocron S, Walker J, Nagy A, Yelle R, Ledvina S, Johnson R, Tseng W, Tucker OJ, Ip WH. Chemical interactions between Saturn’s atmosphere and its rings. Science 2018; 362:362/6410/eaat2382. [DOI: 10.1126/science.aat2382] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/10/2018] [Indexed: 11/03/2022]
Abstract
The Pioneer and Voyager spacecraft made close-up measurements of Saturn’s ionosphere and upper atmosphere in the 1970s and 1980s that suggested a chemical interaction between the rings and atmosphere. Exploring this interaction provides information on ring composition and the influence on Saturn’s atmosphere from infalling material. The Cassini Ion Neutral Mass Spectrometer sampled in situ the region between the D ring and Saturn during the spacecraft’s Grand Finale phase. We used these measurements to characterize the atmospheric structure and material influx from the rings. The atmospheric He/H2 ratio is 10 to 16%. Volatile compounds from the rings (methane; carbon monoxide and/or molecular nitrogen), as well as larger organic-bearing grains, are flowing inward at a rate of 4800 to 45,000 kilograms per second.
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Erdman P, Forest S, Carroll B, Fenelus M, Moore L, Babady NE, Carlow D, Goss C, Peerschke E. Justification for the Creation of a Client Services Call Center Based on Results of a Laboratory Staff Communication Survey and Review of Laboratory Medicine Fellow Call Log. Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqy112.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Maly Fenelus
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lauren Moore
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Dean Carlow
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Cheryl Goss
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Walker GJ, Moore L, Heerasing N, Hendy P, Perry MH, McDonald TJ, Debenham T, Bethune R, Bewshea C, Hyde C, Heap GA, Singh A, Calvert C, Kennedy NA, Goodhand JR, Ahmad T. Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study. Aliment Pharmacol Ther 2018; 47:1103-1116. [PMID: 29508423 DOI: 10.1111/apt.14563] [Citation(s) in RCA: 19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/16/2017] [Accepted: 01/22/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Primary care faecal calprotectin testing distinguishes inflammatory bowel disease (IBD) from functional gut disorder in young patients presenting with abdominal symptoms; however, previous evaluations have excluded patients with alarm symptoms. AIMS We sought to evaluate the diagnostic accuracy of calprotectin to distinguish IBD from functional gut disorder in young adults in whom general practitioners (GPs) suspected IBD; including patients reporting gastrointestinal alarm symptoms. We hypothesised that calprotectin would reduce secondary care referrals and healthcare costs. METHODS We undertook a prospective cohort study of 789 young adults (18-46 years old) presenting with gastrointestinal symptoms to 49 local general practices that had undergone calprotectin testing (1053 tests: between Jan 2014 and May 2016) because of suspected IBD. We considered calprotectin levels of ≥100 μg/g positive. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard. RESULTS Overall, 39% (308/789) patients reported gastrointestinal alarm symptoms and 6% (50/789) tested patients were diagnosed with IBD. The positive and negative predictive values of calprotectin testing for distinguishing IBD from functional gut disorder in patients with gastrointestinal alarm symptoms were 50% (95% CI 36%-64%) and 98% (96%-100%): and in patients without gastrointestinal alarm symptoms were 27% (16%-41%) and 99% (98%-100%), respectively. We estimate savings of 279 referrals and £160 per patient. CONCLUSIONS Calprotectin testing of young adults with suspected IBD in primary care accurately distinguishes IBD from functional gut disorder, even in patients with gastrointestinal alarm symptoms and reduces secondary care referrals and diagnostic healthcare costs.
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McCarthy D, Matz B, Wright J, Moore L. Investigation of the HotDog patient warming system: detection of thermal gradients. J Small Anim Pract 2018; 59:298-304. [PMID: 29363138 DOI: 10.1111/jsap.12816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the performance of an active patient-warming device. MATERIALS AND METHODS Temperatures of an active patient-warming device (HotDog system) were measured at various time points using an infrared thermometer. The study was conducted in two phases: Phase 1 compared temperatures among four different areas of the warming blanket. Phase 2 compared conditions simulating different scenarios using a weighted patient simulator. RESULTS Phase 1: Three out of four positions on the warming blanket had significantly different temperature measurements. Phase 2: Temperature output by the warming blanket was reduced: (1) in the absence of the patient simulator placed across the blanket (-1·9°C, P=0·013); (2) if the patient simulator was placed away from the blanket sensor (-2·0°C, P=0·009); and (3) if there was fluid between the patient simulator and warming blanket (-2·2°C, P=0·004). In a majority of measurements (95%), the set temperature of 43°C on the control unit was not reached (range, 29·8 to 42·9°C) and 2·3% of measurements were higher (range, 43·1 to 45·8°C) than the control unit set temperature of 43°C. CLINICAL SIGNIFICANCE Measured temperatures on the active warming blanket did not reflect control unit settings. This could result in the potential for hyperthermic injury, ineffectual heating and uneven heat distribution.
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Affiliation(s)
- D McCarthy
- Coral Springs Animal Hospital, 2160 North University Drive, Coral Springs, FL, 33071, USA
| | - B Matz
- Department of Clinical Sciences, Auburn University, Auburn, AL 36849, USA.,Auburn University College of Veterinary Medicine, 1220 Wire Rd, Auburn, AL 36849, USA
| | - J Wright
- Auburn University College of Veterinary Medicine, 1220 Wire Rd, Auburn, AL 36849, USA.,Department of Pathobiology, Auburn University, Auburn, AL 36849, USA
| | - L Moore
- IndyVet Emergency & Specialty Hospital, 5425 Victory Drive, Indianapolis, IN 46203, USA
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Shum P, Moore L, Pampoulie C, Di Muri C, Vandamme S, Mariani S. Harnessing mtDNA variation to resolve ambiguity in 'Redfish' sold in Europe. PeerJ 2017; 5:e3746. [PMID: 29018597 PMCID: PMC5628605 DOI: 10.7717/peerj.3746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022] Open
Abstract
Morphology-based identification of North Atlantic Sebastes has long been controversial and misidentification may produce misleading data, with cascading consequences that negatively affect fisheries management and seafood labelling. North Atlantic Sebastes comprises of four species, commonly known as ‘redfish’, but little is known about the number, identity and labelling accuracy of redfish species sold across Europe. We used a molecular approach to identify redfish species from ‘blind’ specimens to evaluate the performance of the Barcode of Life (BOLD) and Genbank databases, as well as carrying out a market product accuracy survey from retailers across Europe. The conventional BOLD approach proved ambiguous, and phylogenetic analysis based on mtDNA control region sequences provided a higher resolution for species identification. By sampling market products from four countries, we found the presence of two species of redfish (S. norvegicus and S. mentella) and one unidentified Pacific rockfish marketed in Europe. Furthermore, public databases revealed the existence of inaccurate reference sequences, likely stemming from species misidentification from previous studies, which currently hinders the efficacy of DNA methods for the identification of Sebastes market samples.
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Affiliation(s)
- Peter Shum
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, USA.,School of Environment & Life Sciences, University of Salford, Salford, Greater Manchester, United Kingdom
| | - Lauren Moore
- School of Environment & Life Sciences, University of Salford, Salford, Greater Manchester, United Kingdom
| | | | - Cristina Di Muri
- School of Environment & Life Sciences, University of Salford, Salford, Greater Manchester, United Kingdom.,Evolutionary and Environmental Genomics Group, School of Environmental Sciences, University of Hull, Hull, United Kingdom
| | - Sara Vandamme
- School of Environment & Life Sciences, University of Salford, Salford, Greater Manchester, United Kingdom.,North Western Waters Advisory Council, Dublin, Ireland
| | - Stefano Mariani
- School of Environment & Life Sciences, University of Salford, Salford, Greater Manchester, United Kingdom
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Rule A, Moore L. The commissioning and implementation of total body irradiation at Livingstone Hospital. Phys Med 2017. [DOI: 10.1016/s1120-1797(17)30290-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Chan O, Moore L, Lai B, Jeong E, Nelson L, Malik F, Sykes J, Mathur S, Wu K. WS04.5 Predicting six-minute walk distance in adults with cystic fibrosis during hospitalisation. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30179-0] [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: 11/28/2022]
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