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House C, Stacey M, Woods D, Allsopp A, Roiz de Sa D. Procedure for assessing patients referred to the UK's military Heat Illness Clinic: a case series. BMJ Mil Health 2023; 169:310-315. [PMID: 34266969 DOI: 10.1136/bmjmilitary-2021-001875] [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: 05/07/2021] [Accepted: 07/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The UK military operates a Heat Illness Clinic (HIC) to aid the return to exercise, training and occupational duty recommendations for individuals who have suffered exertional heat illness or heatstroke. This paper describes the process of assessment and reports representative data from n=22 patients referred to the HIC. METHOD The assessment included clinical consultation, and measurement of maximal oxygen consumption (V̇O2max) and a heat tolerance test (HTT) conducted on a treadmill in an environmental chamber with an air temperature of 34°C and 44% relative humidity. Patients began the HTT wearing military clothing, carrying a rucksack (mass 15 kg) and walking at 60% V̇O2max, at 30 min the rucksack and jacket were removed and the T-shirt at 45 min, individuals continued walking for 60-90 min. Patients were considered heat tolerant if rectal temperature achieved a plateau. RESULTS N=14 patients were heat tolerant on the first assessment and of the n=8 patients required to return for repeat assessment, five were heat tolerant on the second assessment and the remaining three on the third assessment. CONCLUSIONS In conjunction with patient history and clinical evaluation, the HTT provides a physiological basis to assist with decisions concerning patient management and return to duty following an episode of heat illness.
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Affiliation(s)
- Carol House
- Institute of Naval Medicine, Gosport, UK
- School of Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - M Stacey
- Department of Surgery and Cancer, Imperial College, London, UK
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - D Woods
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
- Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Northumbria NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - A Allsopp
- Institute of Naval Medicine, Gosport, UK
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2
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Ferentinos P, Snape D, Koivula F, Faustini S, Nicholson-Little A, Stacey M, Gifford R, Parsons I, Lamb L, Greeves J, O'Hara J, Cunningham AF, Woods D, Richter A, O'Shea MK. Validation of dried blood spot sampling for detecting SARS-CoV-2 antibodies and total immunoglobulins in a large cohort of asymptomatic young adults. J Immunol Methods 2023; 518:113492. [PMID: 37201783 DOI: 10.1016/j.jim.2023.113492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Detecting antibody responses following infection with SARS-CoV-2 is necessary for sero-epidemiological studies and assessing the role of specific antibodies in disease, but serum or plasma sampling is not always viable due to logistical challenges. Dried blood spot sampling (DBS) is a cheaper, simpler alternative and samples can be self-collected and returned by post, reducing risk for SARS-CoV-2 exposure from direct patient contact. The value of large-scale DBS sampling for the assessment of serological responses to SARS-CoV-2 has not been assessed in depth and provides a model for examining the logistics of using this approach to other infectious diseases. The ability to measure specific antigens is attractive for remote outbreak situations where testing may be limited or for patients who require sampling after remote consultation. METHODS We compared the performance of SARS-CoV-2 anti-spike and anti-nucleocapsid antibody detection from DBS samples with matched serum collected by venepuncture in a large population of asymptomatic young adults (N = 1070) living and working in congregate settings (military recruits, N = 625); university students, N = 445). We also compared the effect of self-sampling (ssDBS) with investigator-collected samples (labDBS) on assay performance, and the quantitative measurement of total IgA, IgG and IgM between DBS eluates and serum. RESULTS Baseline seropositivity for anti-Spike IgGAM antibody was significantly higher among university students than military recruits. Strong correlations were observed between matched DBS and serum samples in both university students and recruits for the anti-spike IgGAM assay. Minimal differences were found in results by ssDBS and labDBS and serum by Bland Altman and Cohen kappa analyses. LabDBS achieved 82.0% sensitivity and 98.2% specificity and ssDBS samples 86.1% sensitivity and 96.7% specificity for detecting anti-Spike IgGAM antibodies relative to serum samples. For anti-SARS-CoV-2 nucleocapsid IgG there was qualitatively 100% agreement between serum and DBS samples and weak correlation in ratio measurements. Strong correlations were observed between serum and DBS-derived total IgG, IgA, and IgM. CONCLUSIONS This is the largest validation of DBS against paired serum for SARS-CoV-2 specific antibody measurement and we have shown that DBS retains performance from prior smaller studies. There were no significant differences regarding DBS collection methods, suggesting that self-collected samples are a viable sampling collection method. These data offer confidence that DBS can be employed more widely as an alternative to classical serology.
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Affiliation(s)
- P Ferentinos
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - D Snape
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - F Koivula
- Department of Army Health and Performance Research, Andover, Hampshire, UK
| | - S Faustini
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - A Nicholson-Little
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - M Stacey
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - R Gifford
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - I Parsons
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - L Lamb
- Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Greeves
- Department of Army Health and Performance Research, Andover, Hampshire, UK
| | - J O'Hara
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK
| | - A F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - D Woods
- Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Richter
- Clinical Immunology Service, University of Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - M K O'Shea
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
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Gifford RM, Taylor N, Stacey M, Woods DR. Sex, gender or occupational psychology: what matters most to preventing heat-related illnesses and improving outcomes for women in ground close combat? BMJ Mil Health 2023; 169:75-77. [PMID: 32345677 DOI: 10.1136/bmjmilitary-2020-001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023]
Abstract
Since the advent of women in ground close combat (WGCC) roles, the impact on women of the attendant risk of heat stress and heat illness has been considered. Much emphasis has been placed on sex differences in thermal physiology. This article considers the application of evidence of sex-associated thermoregulatory variation to the occupational and environmental setting of WGCC, and weighs the relative importance of physiological differences arising from biological sex, and behaviour associated with gender normatives. Quantifying the risk of heat illness to WGCC should draw on data from their real-world occupational context.
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Affiliation(s)
- Robert M Gifford
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Academic Department of Military Medicine, HQ Joint Medical Group, Birmingham, UK
| | - N Taylor
- Academic Department of Military Medicine, HQ Joint Medical Group, Birmingham, UK
| | - M Stacey
- Academic Department of Military Medicine, HQ Joint Medical Group, Birmingham, UK
| | - D R Woods
- Academic Department of Military Medicine, HQ Joint Medical Group, Birmingham, UK.,Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University Carnegie Faculty, Leeds, UK
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Macleod T, Dubash S, Berekmeri A, Vegas X, Abignano G, Hyde I, Stacey M, Marzo-Ortega H, Wittmann M. 404 Plaque Psoriasis patients with Psoriatic Arthritis demonstrate a reduced capacity to neutralise neutrophil derived elastase compared to plaque psoriasis patients without arthritis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.417] [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: 11/19/2022]
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5
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Vora J, Leslie D, Stacey M. Awake tracheal intubation. BJA Educ 2022; 22:298-305. [PMID: 36097573 PMCID: PMC9463628 DOI: 10.1016/j.bjae.2022.03.006] [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] [Accepted: 03/15/2022] [Indexed: 10/18/2022] Open
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6
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Gott E, Stacey M. P.95 Atrial myxoma in pregnancy. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103391] [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]
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Parsons IT, Parsons AT, Balme E, Hazell G, Gifford R, Stacey M, Woods DR, Russell-Jones D. The use of routine blood tests to assist the diagnosis of COVID-19 in symptomatic hospitalized patients. Ann Clin Biochem 2021; 58:318-326. [PMID: 33591793 PMCID: PMC8258729 DOI: 10.1177/0004563221999076] [Citation(s) in RCA: 3] [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] [Indexed: 01/19/2023]
Abstract
Introduction Specific patterns of blood test results are associated with COVID-19 infection. The aim of this study was to identify which blood tests could be used to assist in diagnosing COVID-19. Method A retrospective review was performed on consecutive patients referred to hospital with a clinical suspicion of COVID-19 over a period of four weeks. The patient’s clinical presentation and severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction (SARS-CoV-2 RT-PCR) were recorded. The patients were divided by diagnosis into COVID (COVID-19 infection) or CONTROL (an alternate diagnosis). A retrospective review of consecutive patients over a further two-week period was used for the purposes of validation. Results Overall, 399 patients (53% COVID, 47% CONTROL) were analysed. White cell count, neutrophils and lymphocytes were significantly lower, while lactate dehydrogenase and ferritin were significantly higher, in the COVID group in comparison to CONTROL. Combining the white cell count, lymphocytes and ferritin results into a COVID Combined Blood Test (CCBT) had an area under the curve of 0.79. Using a threshold CCBT of –0.8 resulted in a sensitivity of 0.85 and a specificity of 0.63. Analysing this against a further retrospective review of 181 suspected COVID-19 patients, using the same CCBT threshold, resulted in a sensitivity of 0.73 and a specificity of 0.75. The sensitivity was comparable to the SARS-CoV-2 RT PCR. Discussion Mathematically combining the blood tests has the potential to assist clinical acumen allowing for rapid streaming and more accurate patient flow pending definitive diagnosis. This may be of particular use in low-resource settings.
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Affiliation(s)
- I T Parsons
- School of Life Sciences and Medicine, King's College London, St Thomas' Hospital, London, UK
| | - A T Parsons
- School of Electronic, Electrical & Systems Engineering, Edgbaston, University of Birmingham, Birmingham, UK
| | - E Balme
- Royal Surrey County Hospital NHS Trust, Guildford, UK
| | - G Hazell
- Royal Surrey County Hospital NHS Trust, Guildford, UK
| | - R Gifford
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - M Stacey
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - D R Woods
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
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8
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Middlebrooks C, Pantin K, Stacey M, Snyder C, Casey MJ, Shaw T, Bailey-Wilson JE, Lynch HT. Abstract 2300: Deleterious germline mutations in the BRCA1 gene are associated with increased risk for cancers of the female reproductive system other than breast and ovarian as well as other cancers. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Mutations within the BRCA1 gene have been linked to up to an 80% lifetime risk of breast cancer as well as increased risk for ovarian, pancreatic and melanoma cancers. In this study we examined families with known germline mutations in BRCA1 after long-term follow-up to determine whether carriers experience higher rates of other cancers that have not yet been associated with germline mutations in the BRCA1 gene.
Methods: We studied 127 Hereditary Breast and Ovarian Cancer (HBOC) syndrome families (N = 23,078 individuals who have been followed at Creighton University) in which a causal mutation in the BRCA1 gene was identified. We performed survival analysis and a mixed effects cox regression with age at follow-up or cancer event as our time variable and presence or absence of BRCA1-related or other cancers (separate analyses) as our indicator variable.
Results: The survival curves showed a significant age effect with carriers having a younger age at cancer onset for BRCA1-related (as expected) as well as other cancers than that of non-carriers. The cox regression models were also highly significant (P = 1.77E-37 and P = 1.04E-07 for the BRCA1-related and other cancers, respectively). Of the cancers with enough samples to do stratified analyses, uterine, skin, lymphoma and colon cancers occurred at higher rates and at earlier ages in mutation carriers.
Conclusions: These analyses support the hypothesis that the BRCA1 mutations carriers of HBOC syndrome have increased risk for early onset of several additional cancer types, especially cancers that arise in estrogen-influenced tissues.
Citation Format: Candace Middlebrooks, Kenzhane Pantin, Mark Stacey, Carrie Snyder, Murray J. Casey, Trudy Shaw, Joan E. Bailey-Wilson, Henry T. Lynch. Deleterious germline mutations in the BRCA1 gene are associated with increased risk for cancers of the female reproductive system other than breast and ovarian as well as other cancers [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2300.
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Stacey M, James G. The left ear/left molar, right ear/right molar approach to maximising successful tracheal intubation with videolaryngoscopy. Anaesthesia 2020; 75:1552-1553. [PMID: 32737984 DOI: 10.1111/anae.15218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- M Stacey
- University Hospital of Wales, Cardiff, UK
| | - G James
- University Hospital of Wales, Cardiff, UK
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10
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Affiliation(s)
- Felipe Urdaneta
- University of Florida/North Florida South Georgia Veterans Health Services (NFSGVHS), Gainesville, Florida
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11
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Miller T, Miller T, McCann A, Stacey M, Groom P. Cognitive psychology, the multidisciplinary operating theatre team, and managing a cannot intubate, cannot oxygenate emergency. Br J Anaesth 2020; 125:e12-e15. [PMID: 32336476 DOI: 10.1016/j.bja.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Andy McCann
- Manchester Metropolitan University, Manchester, UK
| | - Mark Stacey
- Cardiff and Vale NHS Trust or Health Education Improvement Wales, Cardiff, UK
| | - Peter Groom
- Liverpool University Hospitals, Liverpool, UK.
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12
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Ahmad I, El-Boghdadly K, Bhagrath R, Hodzovic I, McNarry AF, Mir F, O'Sullivan EP, Patel A, Stacey M, Vaughan D. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2019; 75:509-528. [PMID: 31729018 PMCID: PMC7078877 DOI: 10.1111/anae.14904] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 12/13/2022]
Abstract
Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high‐quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post‐tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.
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Affiliation(s)
- I Ahmad
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - R Bhagrath
- Department of Anaesthesia, Barts Health NHS Trust, London, UK
| | - I Hodzovic
- Department of Anaesthesia, Cardiff University School of Medicine, Cardiff, UK.,Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - A F McNarry
- Department of Anaesthesia, NHS Lothian, Edinburgh, UK
| | - F Mir
- Department of Anaesthesia, St. George's University Hospital NHS Foundation Trust, London, UK
| | - E P O'Sullivan
- Department of Anaesthesia, St James's Hospital, Dublin, Ireland
| | - A Patel
- Department of Anaesthesia, Royal National Throat Nose and Ear Hospital and University College London Hospitals NHS Foundation Trust, London, UK
| | - M Stacey
- Department of Anaesthesia, Cardiff and Vale NHS Trust (HEIW), Cardiff, UK
| | - D Vaughan
- Department of Anaesthesia, Northwick Park Hospital, London, UK
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Berekméri A, Alase A, Macleod T, Shaheed S, Sutton C, Stacey M, Wittmann M. 428 Comparative mass spectrometry proteomics of epidermal samples obtained by non-invasive tape stripping from inflammatory skin diseases. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Gifford RM, Todisco T, Stacey M, Fujisawa T, Allerhand M, Woods DR, Reynolds RM. Risk of heat illness in men and women: A systematic review and meta-analysis. Environ Res 2019; 171:24-35. [PMID: 30641370 DOI: 10.1016/j.envres.2018.10.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 08/13/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND Heat illness (HI) is a growing global concern; its incidence has risen dramatically across the world in recent years. The individual factors whereby elevated core temperature produces HI are not well-understood. Given known physiological differences between men and women pertaining to temperature regulation, we hypothesized that women would be at increased risk of HI than men. OBJECTIVES We aimed to determine the relative risk of HI in women compared with men through an exhaustive literature review and meta-analysis. METHODS We search PubMed and Ovid Medline databases from inception to Apr 2017. Search terms included all permutations of sex and heat illness (including heatstroke and exertional heat illness) with no language restrictions. We included adult or adolescent human data reporting comparable male and female HI rates. One reviewer identified and screened titles and abstracts. Two independent reviewers applied eligibility criteria. Disagreements were resolved with a third reviewer. RESULTS Of 5888 articles identified by searches, 36 were included in the systematic review and 22 in the meta-analysis. The mean (standard deviation) quality score was 3.31(1.25)/5. Overall the rate among women was consistently lower than men across the lifespan. The male: female pooled IRR was 2.28 (p < 0.001, 95% CI: 1.66-3.16). There was modest heterogeneity (between-studies variance (τ2) = 0.02). The rates did not differ significantly when corrected for severity or occupation. DISCUSSION The rate of HI was significantly increased in men compared with women. Risk for HI might be conferred by psychological and behavioral factors rather than physiological ones. Further research is required to delineate which groups are at greatest risk, leading to the development of mitigation strategies against HI. OTHER No funding was received. The authors acknowledge the support of the UK Women in Ground Close Combat Review. The Study was registered with PROSPREO CRD42017064739.
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Affiliation(s)
- Robert M Gifford
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - T Todisco
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - M Stacey
- Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - T Fujisawa
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - M Allerhand
- Centre for Statistics, School of Mathematics, University of Edinburgh, Edinburgh, UK
| | - D R Woods
- Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK; Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK; Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, UK; University of Newcastle, Newcastle upon Tyne, UK
| | - R M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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15
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Cook TM, Wilkes A, Bickford Smith P, Dorn L, Stacey M, Kinsella SM, Sharpe P, Phillips P. Multicentre clinical simulation evaluation of the
ISO
80369‐6 neuraxial non‐Luer connector. Anaesthesia 2019; 74:619-629. [DOI: 10.1111/anae.14585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- T. M. Cook
- Department of Anaesthesia and Intensive Care Medicine Royal United Hospitals Bath NHS Foundation Trust BathUK
- School of Medicine University of Bristol Bristol UK
| | - A. Wilkes
- Independent Medical Device Consultant Edinburgh UK
| | | | - L. Dorn
- Associate Director Clinical Development Baxter Healthcare Chicago IllinoisUSA
| | - M. Stacey
- Cardiff & Vale University Hospitals Board Cardiff UK
| | - S. M. Kinsella
- University Hospitals Bristol NHS Foundation Trust BristolUK
| | - P. Sharpe
- University Hospitals of Leicester NHS Trust LeicesterUK
| | - P. Phillips
- Surgical Materials Testing Laboratory Princess of Wales Hospital Bridgend UK
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16
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Asmar A, Semenov I, Kelly R, Stacey M. Abnormal response of costal chondrocytes to acidosis in patients with chest wall deformity. Exp Mol Pathol 2018; 106:27-33. [PMID: 30485799 DOI: 10.1016/j.yexmp.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/21/2018] [Revised: 11/08/2018] [Accepted: 11/24/2018] [Indexed: 11/30/2022]
Abstract
Costal cartilage is much understudied compared to the load bearing cartilages. Abnormally grown costal cartilages are associated with the inherited chest wall deformities pectus excavatum and pectus carinatum resulting in sunken or pigeon chest respectively. A lack of understanding of the ultrastructural and molecular biology properties of costal cartilage is a major confounder in predicting causes and outcomes of these disorders. Due to the avascular nature of cartilage, chondrocytes metabolize glycolytically, producing an acidic environment. During physical activity hydrogen ions move within cartilage driven by compressive forces, thus at any one time, chondrocytes experience transient changes in pH. A variety of ion channels on chondrocytes plasma membrane equip them to function in the rapidly changing conditions they experience. In this paper we describe reduced expression of the ASIC2 gene encoding the acid sensing ion channel isoform 2 (previously referred to as ACCN1 or ACCN) in patients with chest wall deformities. We hypothesized that chondrocytes from these patients cannot respond normally to changes in pH that are an integral part of the biology of this tissue. Activation of ASICs indirectly creates a cascade ultimately dependent on intracellular calcium transients. The objective of this paper was to compare internal calcium signaling in response to external pH changes in costal chondrocytes from patients with chest wall deformities and healthy individuals. Although the molecular mechanism through which chondrocytes are regulated by acidosis remains unknown, we observed reduced amplitudes of calcium rise in patient chondrocytes exposed to low pH that become further impaired upon repeat exposure.
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Affiliation(s)
- A Asmar
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA
| | - I Semenov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA
| | - R Kelly
- Department of Surgery, Eastern Virginia Medical School, Pediatric Surgery Division, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - M Stacey
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA.
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Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, Narata AP, Francois O, Jadhav AP, Grossberg JA, Riedel CH, Tomasello A, Clark WM, Nordmeyer H, Lin E, Nogueira RG, Yoo AJ, Jovin TG, Siddiqui AH, Bernard T, Claffey M, Andersson T, Ribo M, Hetts S, Hacke W, Mehta B, Hacein-Bey L, Kim A, Abou-Chebl A, Shabe P, Hetts S, Hacein-Bey L, Kim A, Abou-Chebl A, Dix J, Gurian J, Zink W, Dabus G, O’Leary, N, Reilly A, Lee K, Foley J, Dolan M, Hartley E, Clark T, Nadeau K, Shama J, Hull L, Brown B, Priest R, Nesbit G, Horikawa M, Hoak D, Petersen B, Beadell N, Herrick K, White C, Stacey M, Ford S, Liu J, Ribó M, Sanjuan, E, Sanchis M, Molina C, Rodríguez-Luna, D, Boned Riera S, Pagola J, Rubiera M, Juega J, Rodríguez N, Muller N, Stauder M, Stracke P, Heddier M, Charron V, Decock A, Herbreteau D, Bibi R, De Sloovere A, Doutreloigne I, Pieters D, Dewaele T, Bourgeois P, Vanhee F, Vanderdouckt P, Vancaster E, Baxendell L, Gilchrist V, Cannon Y, Graves C, Armbruster K, Jovin T, Jankowitz B, Ducruet A, Aghaebrahim A, Kenmuir C, Shoirah H, Molyneaux B, Tadi P, Walker G, Starr M, Doppelheuer S, Schindler K, Craft L, Schultz M, Perez H, Park J, Hall A, Mitchell A, Webb L, Haussen D, Frankel M, Bianchi N, Belagaje S, Mahdi N, Lahoti S, Katema A, Winningham M, Anderson A, Tilley D, Steinhauser T, Scott D, Thacker A, Calderon V, Lin E, Becke S, Krieter S, Jansen O, Wodarg F, Larsen N, Binder A, Wiesen C, Hartney M, Bookhagan L, Ross H, Gay J, Snyder K, Levy E, Davies J, Sonig A, Rangel-Castilla L, Mowla A, Shakir H, Fennell V, Atwal G, Natarajan S, Beecher J, Thornton J, Cullen A, Brennan P, O’Hare A, Asadi H, Budzik R, Taylor M, Jennings M, Laube F, Jackson J, Gatrell R, Reebel L, Albon A, Gerniak J, Groezinger K, Lauf M, Voraco N, Pema P, Davis T, Hicks W, Mejilla J, Teleb M, Sunenshine P, Russo E, Flynn R, Twyford J, Ver Hage A, Smith E, Apolinar L, Blythe S, Maxan J, Carter J, Taschner T, Bergmann U, Meckel S, Elsheik S, Urbach H, Maurer C, Egger K, Niesen W, Baxter B, Knox, A, Hazelwood B, Quarfordt S, Calvert J, Hawk H, Malek, R, Padidar A, Tolley U, Gutierrez A, Mordasini P, Seip T, Balasubramaniam R, Gralla J, Fischer U, Zibold F, Piechowiak E, DeLeacy R, Apruzzeses R, Alfonso C, Haslett J, Fifi J, Mocco J, Starkman S, Guzy, J, Grunberg N, Szeder V, Tateshima S, Duckwiler G, Nour M, Liebeskind D, Tang X, Hinman J, Tipirneni A, Yavagal D, Guada L, Bates K, Balladeras S, Bokka S, Suir S, Caplan J, Kandewall P, Peterson E, Starke R, Puri A, Hawk M, Brooks C, L’Heurex J, Ty K, Rex D, Massari F, Wakhloo A, Lozano D, Rodrigua K, Pierot L, Fabienne M, Sebastien S, Emmoinoli M. Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischemic Stroke With EmboTrap). Stroke 2018; 49:1107-1115. [DOI: 10.1161/strokeaha.117.020125] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/05/2018] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Osama O. Zaidat
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | | | - Marc Ribó
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, University of Bern, Switzerland (H.P.M.)
| | - René Chapot
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Ana Paula Narata
- Centre Hospitalier Régional Universitaire, Hôpitaux de Tours, France (A.P.N.)
| | | | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | - Jonathan A. Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | | | - Alejandro Tomasello
- Department of Neuroradiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden (T.A.)
| | - Wayne M. Clark
- Oregon Health and Science University Hospital, Portland (H.B., W.M.C.)
| | - Hannes Nordmeyer
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Eugene Lin
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | - Raul G. Nogueira
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | - Albert J. Yoo
- Department of Interventional Radiology, Texas Stroke Institute, Dallas–Fort Worth (A.J.Y.)
| | - Tudor G. Jovin
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | | | | | | | - Tommy Andersson
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
- AZ Groeninge, Kortrijk, Belgium (O.F., T.A.)
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Hiatt MJ, Casey MJ, Lynch HT, Snyder CL, Stacey M, Walters RW. Efficacy of proximal colectomy for surgical management of right-sided first colorectal cancer in Lynch Syndrome mutation carriers. Am J Surg 2017; 216:99-105. [PMID: 29153248 DOI: 10.1016/j.amjsurg.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/19/2017] [Accepted: 11/02/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study analyzes the occurrence of colorectal cancer (CRC) in Lynch syndrome (LS) mutation carriers, interval until diagnosis of metachronous CRC, and survival after proximal colectomy (PC) compared with total (TC) and subtotal colectomy (STC) for right-sided first CRC in LS mutation carriers. METHODS Sixty-four LS mutation carriers with right-sided first CRC treated with PC or TC + STC were confirmed by clinical records. Bivariate analyses were examined for significance and life tables were generated for risk of metachronous CRC and survival estimates following surgery. RESULTS One of 16 (6.3%) mutation carriers treated with TC + STC developed subsequent CRC compared with 13/48 (27%) treated by PC. There was no significant difference in survival estimates between PC compared with TC + STC through 25 years after surgery. CONCLUSION Risk of subsequent CRC and survival estimates following PC and TC + STC should be considered in surgical management of right-sided first CRC in LS mutation carriers.
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Affiliation(s)
- Molly J Hiatt
- Creighton Hereditary Cancer Center, Department of Preventive Medicine and Public Health, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA; Department of Obstetrics and Gynecology, Gynecologic Oncology, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Murray Joseph Casey
- Creighton Hereditary Cancer Center, Department of Preventive Medicine and Public Health, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA; Department of Obstetrics and Gynecology, Gynecologic Oncology, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
| | - Henry T Lynch
- Creighton Hereditary Cancer Center, Department of Preventive Medicine and Public Health, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Carrie L Snyder
- Creighton Hereditary Cancer Center, Department of Preventive Medicine and Public Health, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Mark Stacey
- Creighton Hereditary Cancer Center, Department of Preventive Medicine and Public Health, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
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19
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Zisimopoulos O, Flouty E, Stacey M, Muscroft S, Giataganas P, Nehme J, Chow A, Stoyanov D. Can surgical simulation be used to train detection and classification of neural networks? Healthc Technol Lett 2017; 4:216-222. [PMID: 29184668 PMCID: PMC5683210 DOI: 10.1049/htl.2017.0064] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 01/25/2023] Open
Abstract
Computer-assisted interventions (CAI) aim to increase the effectiveness, precision and repeatability of procedures to improve surgical outcomes. The presence and motion of surgical tools is a key information input for CAI surgical phase recognition algorithms. Vision-based tool detection and recognition approaches are an attractive solution and can be designed to take advantage of the powerful deep learning paradigm that is rapidly advancing image recognition and classification. The challenge for such algorithms is the availability and quality of labelled data used for training. In this Letter, surgical simulation is used to train tool detection and segmentation based on deep convolutional neural networks and generative adversarial networks. The authors experiment with two network architectures for image segmentation in tool classes commonly encountered during cataract surgery. A commercially-available simulator is used to create a simulated cataract dataset for training models prior to performing transfer learning on real surgical data. To the best of authors' knowledge, this is the first attempt to train deep learning models for surgical instrument detection on simulated data while demonstrating promising results to generalise on real data. Results indicate that simulated data does have some potential for training advanced classification methods for CAI systems.
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Affiliation(s)
| | - Evangello Flouty
- Touch Surgery, Kinosis, Ltd, 230 City Road, EC1 V 2QY, London, UK
| | - Mark Stacey
- Touch Surgery, Kinosis, Ltd, 230 City Road, EC1 V 2QY, London, UK
| | - Sam Muscroft
- Touch Surgery, Kinosis, Ltd, 230 City Road, EC1 V 2QY, London, UK
| | | | - Jean Nehme
- Touch Surgery, Kinosis, Ltd, 230 City Road, EC1 V 2QY, London, UK
| | - Andre Chow
- Touch Surgery, Kinosis, Ltd, 230 City Road, EC1 V 2QY, London, UK
| | - Danail Stoyanov
- Touch Surgery, Kinosis, Ltd, 230 City Road, EC1 V 2QY, London, UK
- Computer Science, University College London, Gower Street, WC1E 6BT, London, UK
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20
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Abstract
Performing a stressful task under pressure is challenging. Strategies to optimise our training must focus on learning a skill correctly, and then practising that skill sufficiently to avoid compromising that performance in the cauldron of the clinical environment. This article discusses ways of doing things better, based on practical strategies employed in anaesthesia, but developed primarily in elite sport and the military. It involves taking a skill, practising it until it becomes a habit and over time making it part of normal behaviour. The philosophy is simple (but difficult to apply): control what you can control and always do your best. The best summary of this strategy is: learn it right, practise it right, perform it right.
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Affiliation(s)
- Mark Stacey
- Department of Anaesthetics, Cardiff and Vale University Health Board, Cardiff, UK.,Department of Anaesthetics, University Hospital Llandough, Llandough, UK
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21
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McClure G, Belley-Cote E, Harlock J, Lamy A, Stacey M, Devereaux P, Whitlock R. P6064Steroids in cardiac surgery (SIRS): infection substudy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6064] [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: 11/13/2022] Open
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22
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Abstract
OBJECTIVES To explore how a medical textbook app ('iDoc') supports newly qualified doctors in providing high-quality patient care. DESIGN The iDoc project, funded by the Wales Deanery, provides new doctors with an app which gives access to key medical textbooks. Participants' submitted case reports describing self-reported accounts of specific instances of app use. The size of the data set enabled analysis of a subsample of 'complex' case reports. Of the 568 case reports submitted by Foundation Year 1s (F1s)/Year 2s (F2s), 142 (25%) detailed instances of diagnostic decision-making and were identified as 'complex'. We analysed these data against the Quality Improvement (QI) Framework using thematic content analysis. SETTING Clinical settings across Wales, UK. PARTICIPANTS Newly qualified doctors (2012-2014; n=114), F1 and F2. INTERVENTIONS The iDoc app, powered by Dr Companion software, provided newly qualified doctors in Wales with a selection of key medical textbooks via individuals' personal smartphone. RESULTS Doctors' use of the iDoc app supported 5 of the 6 QI elements: efficiency, timeliness, effectiveness, safety and patient-centredness. None of the case reports were coded to the equity element. Efficiency was the element which attracted the highest number of case report references. We propose that the QI Framework should be expanding to include 'learning' as a 7th element. CONCLUSIONS Access to key medical textbooks via an app provides trusted and valuable support to newly qualified doctors during a period of transition. On the basis of these doctors' self-reported accounts, our evidence indicates that the use of the app enhances efficiency, effectiveness and timeliness of patient-care in addition consolidating a safe, patient-centred approach. We propose that there is scope to extend the QI Framework by incorporating 'learning' as a 7th element in recognition of the relationship between providing high-quality care through educational engagement.
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Affiliation(s)
- Katie Webb
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Dimond
- Cardiff University School of Social Sciences, Cardiff, UK
| | - Mark Stacey
- Wales Deanery, School of Postgraduate Medical and Dental Education, Cardiff University, Wales, UK
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23
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Keszegpál A, Latzko A, Macleod T, Laws P, Goodfield M, Stacey M, Wittmann M. 425 Identification of the skin psoriatic inflammation profile by cytokine analysis from tape stripping. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Bridgewood C, Stacey M, Alase A, Graham A, Lagos D, Wittmann M. 323 IL-36y stimulation induces proinflammatory effects on human endothelial cells. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.343] [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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25
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Macleod T, Doble R, Wittmann M, Stacey M, McGonagle D. 408 Neutrophil mediated proteolysis of IL-36 members has both regulatory and inflammatory consequences. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Ainscough J, Macleod T, Alase A, Latzko A, Whittmann M, Stacey M. 385 Cathepsin S is up-regulated in psoriatic inflammation and activates the pro-inflammatory cytokine IL-36γ. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Dimond R, Bullock A, Lovatt J, Stacey M. Mobile learning devices in the workplace: 'as much a part of the junior doctors' kit as a stethoscope'? BMC Med Educ 2016; 16:207. [PMID: 27530343 PMCID: PMC4988031 DOI: 10.1186/s12909-016-0732-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 05/04/2015] [Accepted: 08/09/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Smartphones are ubiquitous and commonly used as a learning and information resource. They have potential to revolutionize medical education and medical practice. The iDoc project provides a medical textbook smartphone app to newly-qualified doctors working in Wales. The project was designed to assist doctors in their transition from medical school to workplace, a period associated with high levels of cognitive demand and stress. METHODS Newly qualified doctors submitted case reports (n = 293) which detail specific instances of how the textbook app was used. Case reports were submitted via a structured online form (using Bristol Online Surveys - BOS) which gave participants headings to elicit a description of: the setting/context; the problem/issue addressed; what happened; any obstacles involved; and their reflections on the event. Case reports were categorised by the purpose of use, and by elements of the quality improvement framework (IoM 2001). They were then analysed thematically to identify challenges of use. RESULTS Analysis of the case reports revealed how smartphones are a viable tool to address clinical questions and support mobile learning. They contribute to novice doctors' provision of safe, effective, timely, efficient and patient-centred care. The case reports also revealed considerable challenges for doctors using mobile technology within the workplace. Participants reported concern that using a mobile phone in front of patients and staff might appear unprofessional. CONCLUSION Mobile phones blur boundaries between the public and private, and the personal and professional. In contrast to using a mobile as a communication device, using a smartphone as an information resource in the workplace requires different rituals. Uncertain etiquette of mobile use may reduce the capacity of smartphone technology to improve the learning experience of newly qualified doctors.
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Affiliation(s)
- Rebecca Dimond
- Rebecca Dimond, Cardiff School of Social Sciences, 10/12 Museum Place, Cardiff, CF10 3BG UK
| | - Alison Bullock
- Rebecca Dimond, Cardiff School of Social Sciences, 10/12 Museum Place, Cardiff, CF10 3BG UK
| | - Joseph Lovatt
- Rebecca Dimond, Cardiff School of Social Sciences, 10/12 Museum Place, Cardiff, CF10 3BG UK
| | - Mark Stacey
- Rebecca Dimond, Cardiff School of Social Sciences, 10/12 Museum Place, Cardiff, CF10 3BG UK
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Abstract
A double blind placebo-controlled clinical trial was undertaken to investigate the effect of 500 mg bd of Paroven taken for four weeks on the tissue oxygenation, ankle oedema and calf pump function of 48 patients with chronic venous disease. There was no evidence that Paroven reduced ankle swelling or improved calf pump function, but it did cause a significant improvement in transcutaneous oxygen levels measured in the calf skin of the ulcer hearing area ( p = 0.026) which was confirmed when the oxygen levels of the active and placebo treated groups were compared at the end of four weeks treatment ( p = 0.02). This improvement in tissue oxygenation may be the result of alterations in the capillary exchange produced by the drug and may account for the symptomatic benefit associated with its use.
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Affiliation(s)
- K.G. Burnand
- Department of Surgery, St Thomas' Hospital Medical School, St. Thomas' Hospital, London, SE1 UK
| | - S. Powell
- Department of Surgery, St Thomas' Hospital Medical School, St. Thomas' Hospital, London, SE1 UK
| | - C. Bishop
- Department of Surgery, St Thomas' Hospital Medical School, St. Thomas' Hospital, London, SE1 UK
| | - M. Stacey
- Department of Surgery, St Thomas' Hospital Medical School, St. Thomas' Hospital, London, SE1 UK
| | - T. Pulvertaft
- Department of Surgery, St Thomas' Hospital Medical School, St. Thomas' Hospital, London, SE1 UK
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Abstract
Chondrocytes are the uniquely resident cells found in all types of cartilage and key to their function is the ability to respond to mechanical loads with changes of metabolic activity. This mechanotransduction property is, in part, mediated through the activity of a range of expressed transmembrane channels; ion channels, gap junction proteins, and porins. Appropriate expression of ion channels has been shown essential for production of extracellular matrix and differential expression of transmembrane channels is correlated to musculoskeletal diseases such as osteoarthritis and Albers-Schönberg. In this study we analyzed the consistency of gene expression between channelomes of chondrocytes from human articular and costal (teenage and fetal origin) cartilages. Notably, we found 14 ion channel genes commonly expressed between articular and both types of costal cartilage chondrocytes. There were several other ion channel genes expressed only in articular (6 genes) or costal chondrocytes (5 genes). Significant differences in expression of BEST1 and KCNJ2 (Kir2.1) were observed between fetal and teenage costal cartilage. Interestingly, the large Ca2+ activated potassium channel (BKα, or KCNMA1) was very highly expressed in all chondrocytes examined. Expression of the gap junction genes for Panx1, GJA1 (Cx43) and GJC1 (Cx45) was also observed in chondrocytes from all cartilage samples. Together, this data highlights similarities between chondrocyte membrane channel gene expressions in cells derived from different anatomical sites, and may imply that common electrophysiological signaling pathways underlie cellular control. The high expression of a range of mechanically and metabolically sensitive membrane channels suggest that chondrocyte mechanotransduction may be more complex than previously thought.
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Affiliation(s)
- A Asmar
- a Frank Reidy Research Center for Bioelectrics, Old Dominion University , Norfolk , VA , USA
| | - R Barrett-Jolley
- b Department of Musculoskeletal Biology , University of Liverpool , England , UK
| | - A Werner
- c Department of Pathology , Eastern Virginia Medical School and Med Director of Laboratories, Children's Hospital of The King's Daughters , Norfolk , VA , USA
| | - R Kelly
- d Department of Surgery , Eastern Virginia Medical School and Pediatric Surgery Division, Children's Hospital of the King's Daughters , Norfolk , VA , USA
| | - M Stacey
- a Frank Reidy Research Center for Bioelectrics, Old Dominion University , Norfolk , VA , USA
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30
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Lewis SM, Treacher DF, Edgeworth J, Mahalingam G, Brown CS, Mare TA, Stacey M, Beale R, Brown KA. Expression of CD11c and EMR2 on neutrophils: potential diagnostic biomarkers for sepsis and systemic inflammation. Clin Exp Immunol 2015; 182:184-94. [PMID: 26153037 DOI: 10.1111/cei.12679] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 12/26/2022] Open
Abstract
There is a need for cellular biomarkers to differentiate patients with sepsis from those with the non-infectious systemic inflammatory response syndrome (SIRS). In this double-blind study we determined whether the expression of known (CD11a/b/c, CD62L) and putative adhesion molecules [CD64, CD97 and epidermal growth factor (EGF)-like molecule containing mucin-like hormone receptor (EMR2)] on blood neutrophils could serve as useful biomarkers of infection and of non-infectious SIRS in critically ill patients. We studied 103 patients with SIRS, 83 of whom had sepsis, and 50 healthy normal subjects, using flow cytometry to characterize neutrophils phenotypically in whole blood samples. Patients with SIRS had an increased prevalence of neutrophils expressing CD11c, CD64 and EMR2 in comparison with healthy subjects (P < 0.001), but normal expression of CD11a, CD11b, CD62L and CD97. An increase in the percentage of neutrophils bearing CD11c was associated with sepsis, EMR2 with SIRS and CD64 with sepsis and SIRS. Neutrophils expressing CD11c had the highest sensitivity (81%) and specificity (80%) for the detection of sepsis, and there was an association between the percentage of neutrophils expressing EMR2 and the extent of organ failure (P < 0.05). Contrary to other reports, we did not observe an abnormal expression of CD11b or CD62L on neutrophils from patients with SIRS, and suggest that this discrepancy is due to differences in cell processing protocols. We propose that blood neutrophils expressing CD11c and EMR2 be considered as potential biomarkers for sepsis and SIRS, respectively.
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Affiliation(s)
- S M Lewis
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London.,Department of Vascular Immunology, Division of Asthma, Allergy and Lung Biology, King's College London
| | - D F Treacher
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London
| | - J Edgeworth
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, University of Leeds, London, UK
| | - G Mahalingam
- Department of Vascular Immunology, Division of Asthma, Allergy and Lung Biology, King's College London
| | - C S Brown
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London
| | - T A Mare
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London.,Department of Vascular Immunology, Division of Asthma, Allergy and Lung Biology, King's College London
| | - M Stacey
- School of Molecular and Cellular Biology, University of Leeds, London, UK
| | - R Beale
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London.,Department of Vascular Immunology, Division of Asthma, Allergy and Lung Biology, King's College London
| | - K A Brown
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London.,Department of Vascular Immunology, Division of Asthma, Allergy and Lung Biology, King's College London
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31
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Cox AT, Lentaigne J, White S, Burns DS, Parsons I, O'Shea M, Stacey M, Sharma S, Wilson D. A 2-year review of the general internal medicine admissions to the British Role 3 Hospital in Camp Bastion, Afghanistan. J ROY ARMY MED CORPS 2015; 162:56-62. [PMID: 26040570 DOI: 10.1136/jramc-2014-000385] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 11/15/2014] [Accepted: 05/02/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Detailed knowledge of the likely volume and nature of the diseases presenting to deployed secondary care facilities aids operational planning. Now the British operation in Afghanistan has ended and a record of the experience is useful to preserve the lessons learned. METHODS Over a 2-year period from April 2011, prospective demographic and clinical data were collected on consecutive general internal medicine admissions to the Role 3 Hospital in Camp Bastion, Afghanistan. Up to four different symptoms and diagnoses were coded using the WHO International Classification of Disease, V.10 for each patient. RESULTS A total of 1368 medical patients were admitted. Of 1131 military admissions, 612 were from the UK (54.1%) and the remainder from 13 allied countries; 237 civilians came from 23 countries. Civilians were older than the military patients (p<0.001) but included five children. The 20 most frequent presenting symptoms were identified and there were 1626 diagnoses made. The 10 most frequent diagnoses were infectious gastroenteritis (12.6%), heat illness (4.3%), pneumonia (3.6%), epilepsy (2.6%), cellulitis (2.7%), migraine (1.8%), peptic ulcer disease (1.2%), myocardial infarction (1.2%), venous thromboembolism (1.2%) and pericarditis (0.7%). In 252 cases (18.4%) a firm diagnosis was not reached and a symptom was recorded. The five most frequent of these were undifferentiated febrile illnesses (4.6%), syncope (3.7%), chest pain (2.8%), headache (0.8%) and palpitations (0.7%). The mean hospital length of stay was 1.59 days and 72.2% of UK military patients were 'returned to unit'. Three civilian patients died in hospital or following aeromedical evacuation and there were no deaths of any military patients. DISCUSSION This study demonstrates the wide variety of presentations seen by physicians at an established military field hospital. This information informs the core syllabus of military physician training and will help facilitate planning for future medical support to similar military operations. TRIAL REGISTRATION NUMBER RCDM/Res/Audit/1036/12/0305.
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Affiliation(s)
- Andrew T Cox
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK St George's University of London, London, UK
| | - J Lentaigne
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - S White
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - D S Burns
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - I Parsons
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - M O'Shea
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - M Stacey
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - S Sharma
- St George's University of London, London, UK
| | - D Wilson
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Bullock A, Dimond R, Webb K, Lovatt J, Hardyman W, Stacey M. How a mobile app supports the learning and practice of newly qualified doctors in the UK: an intervention study. BMC Med Educ 2015; 15:71. [PMID: 25889996 PMCID: PMC4409746 DOI: 10.1186/s12909-015-0356-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/27/2015] [Indexed: 05/15/2023]
Abstract
BACKGROUND The transition from medical school to the workplace can be demanding, with high expectations placed on newly qualified doctors. The provision of up-to-date and accurate information is essential to support doctors at a time when they are managing increased responsibility for patient care. In August 2012, the Wales Deanery issued the Dr.Companion© software with five key medical textbooks (the iDoc app) to newly qualified doctors (the intervention). The aim of the study was to examine how a smartphone app with key medical texts was used in clinical workplace settings by newly qualified doctors in relation to other information sources and to report changes over time. METHODS Participants (newly qualified - Foundation Year 1 - doctors) completed a baseline questionnaire before downloading the iDoc app to their own personal smartphone device. At the end of Foundation Year 1 participants (n = 125) completed exit questionnaires one year later. We used Wilcoxon Signed Rank test to analyse matched quantitative data. RESULTS We report significant changes in our participants' use of workplace information resources over the year. Respondents reduced their use of hard-copy and electronic versions of texts on PCs but made more use of senior medical staff. There was no significant difference in the use of peers and other staff as information sources. We found a significant difference in how doctors felt about using a mobile device containing textbooks in front of patients and senior medical staff in the workplace. CONCLUSIONS Our study indicates that a mobile app enabling timely, internet-free access to key textbooks supports the learning and practice of newly qualified doctors. Although participants changed their use of other resources in the workplace, they continued to consult with seniors. Rather than over-reliance on technology, these findings suggest that the app was used strategically to complement, not replace discussion with members of the medical team. Participants' uncertainty about using a mobile device with textbook app in front of others eased over time.
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Affiliation(s)
- Alison Bullock
- The Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Glamorgan Building, King Edward VII Avenue, CF10 3WT, Wales, UK.
| | - Rebecca Dimond
- Cesagene, Cardiff University, 10/12 Museum Place, CF10 3BG, Wales, UK.
| | - Katie Webb
- The Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Glamorgan Building, King Edward VII Avenue, CF10 3WT, Wales, UK.
| | - Joseph Lovatt
- Capita Project Services, Module 1, Level 2, Friends Life Centre, Bristol, BS34 8SW, England, UK.
| | - Wendy Hardyman
- Cardiff Business School, Cardiff University, Aberconway Building, Column Drive, Cardiff, CF10 3EU, Wales, UK.
| | - Mark Stacey
- Wales Deanery, School of Postgraduate Medical and Dental Education (PGMDE), Neuadd Meirionnydd, Heath Park, Cardiff University, Cardiff, CF14 4YS, Wales, UK.
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Cox AT, D Linton T, Bailey K, Stacey M, Sharma S, Thomas L, Wilson D. An evaluation of the burden placed on the General Internal Medicine team at the Role 3 Hospital in Camp Bastion by UK Armed Forces personnel presenting with symptoms resulting from previously identified disease. J ROY ARMY MED CORPS 2015; 162:18-22. [DOI: 10.1136/jramc-2014-000336] [Citation(s) in RCA: 7] [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: 07/02/2014] [Accepted: 12/23/2014] [Indexed: 11/04/2022]
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Hill NE, Woods DR, Delves SK, Murphy KG, Davison AS, Brett SJ, Quinton R, Turner S, Stacey M, Allsopp AJ, Fallowfield JL. The gonadotrophic response of Royal Marines during an operational deployment in Afghanistan. Andrology 2015; 3:293-7. [DOI: 10.1111/andr.308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/26/2014] [Accepted: 10/31/2014] [Indexed: 01/21/2023]
Affiliation(s)
- N. E. Hill
- Royal Centre for Defence Medicine; Birmingham UK
- Imperial College London; London UK
| | - D. R. Woods
- Consultant Physician in Endocrinology and Diabetes; Northumbria and Newcastle NHS Trusts; Newcastle, UK
- University of Newcastle upon Tyne; Newcastle UK
- Carnegie Research Institute; Leeds Metropolitan University; Leeds UK
| | | | | | - A. S. Davison
- Department of Clinical Biochemistry; Newcastle Hospitals NHS Trust; Newcastle UK
| | | | - R. Quinton
- Institute of Genetic Medicine; University of Newcastle upon Tyne; Newcastle UK
- Department of Endocrinology; Royal Victoria Infirmary; Newcastle upon Tyne UK
| | - S. Turner
- Department of Clinical Biochemistry; Newcastle Hospitals NHS Trust; Newcastle UK
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Lopez-Granados E, Stacey M, Kienzler AK, Sierro S, Willberg CB, Fox CP, Rigaud S, Long HM, Hislop AD, Rickinson AB, Patel S, Latour S, Klenerman P, Chapel H. A mutation in X-linked inhibitor of apoptosis (G466X) leads to memory inflation of Epstein-Barr virus-specific T cells. Clin Exp Immunol 2015; 178:470-82. [PMID: 25079909 DOI: 10.1111/cei.12427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2014] [Indexed: 12/15/2022] Open
Abstract
Mutations in the X-linked inhibitor of apoptosis (XIAP) gene have been associated with XLP-like disease, including recurrent Epstein-Barr virus (EBV)-related haemophagocytic lymphohystiocytosis (HLH), but the immunopathogenic bases of EBV-related disease in XIAP deficiency is unknown. We present the first analysis of EBV-specific T cell responses in functional XIAP deficiency. In a family of patients with a novel mutation in XIAP (G466X) leading to a late-truncated protein and varying clinical features, we identified gradual hypogammaglobulinaemia and large expansions of T cell subsets, including a prominent CD4(+) CD8(+) population. Extensive ex-vivo analyses showed that the expanded T cell subsets were dominated by EBV-specific cells with conserved cytotoxic, proliferative and interferon (IFN)-γ secretion capacity. The EBV load in blood fluctuated and was occasionally very high, indicating that the XIAP(G466X) mutation could impact upon EBV latency. XIAP deficiency may unravel a new immunopathogenic mechanism in EBV-associated disease.
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Affiliation(s)
- E Lopez-Granados
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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Lynch HT, Snyder C, Stacey M, Olson B, Peterson SK, Buxbaum S, Shaw T, Lynch PM. Communication and technology in genetic counseling for familial cancer. Clin Genet 2013; 85:213-22. [PMID: 24355094 DOI: 10.1111/cge.12317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 12/13/2022]
Abstract
When a cancer predisposing germline mutation is detected in an index case, the presence of the underlying syndrome is confirmed and the potential for predictive testing of at-risk relatives is established. However, the reporting of a positive family history does not routinely lead to communication of information about risk to close, much less distant relatives. This review summarizes information technology utilized to address penetration or 'reach' of knowledge of risk within extended families, including the use of telephone and video counseling to reach distant patients, and anticipate novel internet-based processes for communication between investigators and relatives.
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Affiliation(s)
- H T Lynch
- Department of Preventive Medicine and Public Health, Creighton University, Omaha, NE, USA
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Affiliation(s)
- Sabeen Tufail
- Specialty Registrar, AnaestheticsUniversity Hospital WalesCardiffUnited Kingdom
| | - Mark Stacey
- Consultant, AnaestheticsUniversity Hospital WalesCardiffUnited Kingdom
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Jones R, Jones S, Stacey M. Peripartum management of the pre-eclamptic patient. Br J Hosp Med (Lond) 2013; 74:322-6. [PMID: 24049822 DOI: 10.12968/hmed.2013.74.6.322] [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: 11/11/2022]
Affiliation(s)
- Rhidian Jones
- Department of Anaesthetics, University Hospital Wales, Cardiff CF14 4XW.
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Stacey M, Thygesen P, Stanley L, Matas N, Risch A, Sim E. Arylarnine N-acetyltransferase as a potential biornarker in bladder cancer: fluorescent in situ hybridization and irnmunohistochernistry studies. Biomarkers 2013; 1:55-61. [PMID: 23888894 DOI: 10.3109/13547509609079347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Arylamine N-acetyltransferase isoenzymes NAT1 and NAT2 are encoded at two polymorphic loci on human chromosome 8p22. The two loci have previously been identified using chimeric Yeast Artificial Chromosome (YAC) clones encoding either NAT1 or NAT2 as probes for metaphase chromosomes using fluorescent in situ hybridization. The 8p22 region has been demonstrated to be deleted in highly invasive bladder tumours and since NAT isoenzymes participate in the metabolism of arylamine bladder carcinogens, it is important to determine whether NAT1 and NAT2 gene loci are included in the region of deletion. We describe here the application of a cosmid clone for NAT2 as a biomarker for Fluorescent In Situ Hybridization (FISH) on interphase nuclei of exfoliated bladder cells. We also describe a 70kb probe for NAT1 which is a candidate for a suitable biomarker for use in similar FISH studies. lmmunohistochemical staining of bladder tumour sections with a polyclonal anti-peptide antibody specific for the NATl isoenzyme as a biomarker for NAT1 protein expression is also shown.
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Affiliation(s)
- M Stacey
- the Department of Pharmacology, University of Oxford, Mansfieid Road, Oxford, OXI 3QT, UK
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Woods DR, Mellor A, Begley J, Stacey M, O'Hara J, Hawkins A, Yarker J, Foxen S, Smith C, Boos C. Brain natriuretic peptide and NT-proBNP levels reflect pulmonary artery systolic pressure in trekkers at high altitude. Physiol Res 2013; 62:597-603. [PMID: 23869896 DOI: 10.33549/physiolres.932544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our objective was to evaluate the utility of the natriuretic peptides BNP (brain natriuretic peptide) and NT-proBNP as markers of pulmonary artery systolic pressure (PASP) in trekkers ascending to high altitude (HA). 20 participants had BNP and NT-proBNP assayed and simultaneous echocardiographic assessment of PASP performed during a trek to 5150 m. PASP increased significantly (p=0.006) with ascent from 24+/-4 to 39+/-11 mm Hg at 5150 m. At 5150 m those with a PASP>/=40 mm Hg (n=8) (versus those with PASP<40 mm Hg) had higher post-exercise BNP (pg/ml): 54.5+/-36 vs. 13.4+/-17 (p=0.012). Their resting BNP at 5150 m was also higher: 57.3+/-43.4 vs. 12.6+/-13 (p=0.017). In those with a pathological (>/=400 pg/ml) rise in NT-proBNP at 5150 m (n=4) PASP was significantly higher: 45.9+/-7.5 vs. 32.2+/-6.2 mm Hg (p=0.015). BNP and NT-proBNP may reflect elevated PASP, a central feature of high altitude pulmonary oedema, at HA.
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Affiliation(s)
- D R Woods
- Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Lynch HT, Buxbaum SG, Snyder CL, Stacey M, Shaw TG, Lynch PM. The impact of family information services on genetic testing uptake among relatives in Lynch syndrome families. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1573 Background: A mismatch repair (MMR) pathogenic mutation in an index patient provides a basis for predictive mutation testing in at-risk members of Lynch syndrome (LS) families. Mutation carriers warrant aggressive surveillance. As importantly, non-carriers can safely follow general population screening guidelines. However, penetration of predictive testing has been disappointing in first-degree relatives (FDR), and has been even more limited in second- and more distant-degree relatives, even though the benefits can be as great as in FDRs. Family Information Services (FISs), involve an in-person session in which expert providers and counselors meet with multiple family members in a convenient geographical location. Education and counseling are intended to lead to testing for the family MMR mutation, followed by appropriate surveillance. Methods: LS families with a known MMR mutation (n=97) were targeted for this study. Selection for FIS was based on family size and convenient geographic location. Twenty-eight were offered an FIS and 69 received standard care (mailed educational material and invitation for testing). Data were collected on testing rates. Results: In at-risk patients that did receive FIS, 20.4% (std dev = 11.4%, 95% CI: 16.0 to 24.8%, range: 3 to 57.5%) were DNA tested, whereas in families that did not receive FIS, 12.9% (std dev = 10.8%, 95% CI: 10.2 to 15.5%, range: 0 to 43.5%) were DNA tested. The difference in proportions tested between the FIS and non-FIS families was statistically significant (p=0.003) and was more pronounced in family members whose relationship to the proband was beyond first-degree (p<0.0001). Of those individuals that attended an FIS, 81.1% were tested. Conclusions: Genetic counseling in the FIS setting facilitates uptake of predictive mutational testing in FDRs and in more distant at-risk relatives. However, the FIS is time-consuming and labor intensive; more efficient means of disseminating LS risk information and the benefits of predictive testing in more distant relatives are needed. A cost-effectiveness analysis as well as a randomized study that controls for participation bias must be done.
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Mellor A, Begley J, Stacey M, Smith C, Hawkins A, Woods D, Boos C. 122 HIGH ALTITUDE EXPOSURE, CARDIAC TROPONIN AND BIVENTRICULAR CARDIAC FUNCTION. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hardyman W, Bullock A, Brown A, Carter-Ingram S, Stacey M. Mobile technology supporting trainee doctors' workplace learning and patient care: an evaluation. BMC Med Educ 2013; 13:6. [PMID: 23336964 PMCID: PMC3552772 DOI: 10.1186/1472-6920-13-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 08/08/2012] [Accepted: 01/15/2013] [Indexed: 05/08/2023]
Abstract
BACKGROUND The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded "iDoc", a project offering trainee doctors a Smartphone library of medical textbooks. METHODS Data on trainee doctors' (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. RESULTS Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p < 0.01). Foundation Year 1 (newly qualified) was judged the most useful time to have a Smartphone library because of increased responsibility and lack of knowledge/experience.Preferred information source varied by question type: hard copy texts for information-based questions; varied resources for skills queries; and seniors for more complex problems. Case reports showed mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors' discussions with seniors; independent practice; patient care; and this 'just-in-time' access to reliable information supported confident and efficient decision-making. CONCLUSION A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic library was valued. It helped prepare trainee doctors for discussions with their seniors, assisting the interchange between explicit and tacit knowledge.By supporting accurate prescribing and treatment planning, the electronic library contributed to enhanced patient care. Trainees were more rapidly able to medicate patients to reduce pain and more quickly call for specific assessments. However, clinical decision-making often requires dialogue: what Smartphone technology can do is augment, not replace, discussion with their colleagues in the community of practice.
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Affiliation(s)
- Wendy Hardyman
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, Cardiff University School of Social Sciences, 2nd Floor, Glamorgan Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3WT, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, Cardiff University School of Social Sciences, 2nd Floor, Glamorgan Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3WT, UK
| | - Alice Brown
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, Cardiff University School of Social Sciences, 2nd Floor, Glamorgan Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3WT, UK
| | | | - Mark Stacey
- Wales Deanery, School of Postgraduate Medical and Dental Education, Cardiff University, 9th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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Telgarsky B, Stacey M. Sugammadex and the cannot intubate/cannot ventilate scenario in patients with predicted difficult airway (1). Letter 2. Br J Anaesth 2012; 109:459-60; author reply 461-2. [PMID: 22879658 DOI: 10.1093/bja/aes281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stacey M, Dutta D, Cao W, Asmar A, Elsayed-Ali H, Kelly R, Beskok A. Atomic force microscopy characterization of collagen 'nanostraws' in human costal cartilage. Micron 2012; 44:483-7. [PMID: 23127510 DOI: 10.1016/j.micron.2012.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 09/25/2012] [Accepted: 10/10/2012] [Indexed: 11/26/2022]
Abstract
Costal cartilage, a type of hyaline cartilage that bridges the bony ribs and sternum, is relatively understudied compared to the load bearing cartilages. Deformities of costal cartilage can result in deformation of the chest wall, where the sternum is largely pushed toward or away from the spine, pectus excavatum and pectus carinatum, respectively, with each condition having significant clinical impact. In the absence of extensive literature describing morphological features of costal cartilage, we characterized a sample from the costal margin immunohistologically and through atomic force microscopy. We had previously observed the presence of collagen 'nanostraws' running the length of costal cartilage. Hypothesizing that these structures may be responsible for fluid flow within this thick, avascular tissue, and prior to microfluidic analysis, we estimated the diameters and measured Young's modulus of elasticity of the collagen nanostraws. We found significant differences in results between treatment type and fixation. Significant differences in nanostraw elasticity and diameter obviously affect nano-fluidic transport calculations, and therefore, we consider these results of importance to the scientific community relying upon measurements in the nanoscale.
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Affiliation(s)
- M Stacey
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA 23508, USA.
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Woods DR, Begley J, Stacey M, Smith C, Boos CJ, Hooper T, Hawkins A, Hodkinson P, Green N, Mellor A. Severe acute mountain sickness, brain natriuretic peptide and NT-proBNP in humans. Acta Physiol (Oxf) 2012; 205:349-55. [PMID: 22222437 DOI: 10.1111/j.1748-1716.2012.02407.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/10/2011] [Accepted: 12/26/2011] [Indexed: 12/01/2022]
Abstract
AIM To examine the response of brain natriuretic peptide (BNP) and NT-proBNP to high altitude (HA) both at rest and following exercise. METHODS We measured NT-proBNP and BNP and Lake Louise (LL) acute mountain sickness (AMS) scores in 20 subjects at rest in Kathmandu (Kat; 1300 m), following exercise and at rest at 4270 and 5150 m. RESULTS BNP and NT-proBNP (pg ml(-1) , mean ± SEM) rose significantly from Kat (9.2 ± 2 and 36.9 ± 6.6, respectively) to arrival at 4270 m after exercise (16.6 ± 4 and 152 ± 56.1, P=0.008 and P<0.001, respectively) and remained elevated the next morning at rest (28.9 ± 9 and 207.4 ± 65.1, P = 0.004 and P<0.001 respectively). At 5150, immediately following ascent/descent to 5643 m, BNP and NT-proBNP were 32.3 ± 8.8 and 301.1 ± 96.3 (P=0.003 and P<0.001 vs. Kat, respectively) and at rest the following morning were 33.3 ± 9.7 and 258.9 ± 89.5 (P=0.008 and P=0.001 vs. Kat respectively). NT-proBNP and BNP correlated strongly at 5150 m (ρ 0.905, P<0.001 and ρ 0.914, P<0.001 for resting and post-exercise samples respectively). At 5150 m, BNP levels were significantly higher among the four subjects with severe (LL score>6) AMS (58.4 ± 18.7) compared with those without (BNP 22.7 ± 8.6, P=0.048). There were significant correlations between change in body water from baseline to 5150 m with both BNP and NT-proBNP (ρ 0.77, P=0.001, ρ 0.745, P=0.002 respectively). CONCLUSION In conclusion, these data suggest that BNP and NT-proBNP increase with ascent to HA both after exercise and at rest. We also report the novel finding that BNP is significantly greater in those with severe AMS at 5150 m.
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Affiliation(s)
| | - J. Begley
- Department of Biochemistry; Poole Hospital NHS Foundation Trust; Poole; UK
| | | | | | | | | | - A. Hawkins
- Department of Biochemistry; Poole Hospital NHS Foundation Trust; Poole; UK
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Balasanthiran A, O'Shea T, Moodambail A, Woodcock T, Poots AJ, Stacey M, Vijayaraghavan S. Type 2 diabetes in children and young adults in East London: an alarmingly high prevalence. Practical Diabetes 2012. [DOI: 10.1002/pdi.1689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
High altitude exposure normally leads to a marked natriuresis and diuresis. Acute mountain sickness is often associated with fluid retention, to which an elevated cortisol may contribute. Most investigators report a rise in resting cortisol with ascent, but little data exist regarding the cortisol response to a day trekking. We therefore measured salivary cortisol during ascent to > 5000 m in a cohort of between 42-45 subjects following a 6-h trek (samples taken between 15:30-16:30 h) and between 15-20 subjects at rest (morning samples taken between 08:00-09:00 h). Morning resting cortisol [nmol/l, mean±sd, (range)] was 5.5±2.9 (2.13-13.61) at 1300 m; 4.7±6.8 (1.4-27.02) at 3400 m, and significantly (p=0.002) rose between 4270 m [3.5±2.1 (1.4-8.34)] and 5150 m [14.5±30.3 (1.9-123.1)]. Post-exercise cortisol [nmol/l, mean±sd, (range)] dropped between 3400 m [7±6 (1.5-33.3)] and 4270 m [4.2±4.8 (1.4-29.5)] (p=0.001) followed by a significant rise in post-exercise cortisol between 4270 m [4.2±4.8 (1.4-29.5)] and 5 150 m [9.2±10.2 (1.4-61.3)] (p<0.001). There were no significant associations between severity of acute mountain sickness and cortisol levels. There was a significant though weak correlation between cortisol post-exercise at 5150 m and oxygen saturation at 5150 m (rho= - 0.451, p=0.004). In conclusion, this is the largest cohort to have their resting and post-exercise cortisol levels ascertained at high altitude. We confirm the previous findings of an elevated resting morning cortisol at > 5000 m, but present the novel finding that the cortisol response to a day trekking at HA appears suppressed at 4270 m.
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Affiliation(s)
- D R Woods
- Northumbria and Newcastle NHS Trusts, Royal Victoria Infirmary and Wansbeck General, Newcastle upon Tyne, UK.
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