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Pirkle LT, Jennings N, Vercammen A, Lawrance EL. Current understanding of the impact of climate change on mental health within UK parliament. Front Public Health 2022; 10:913857. [PMID: 36187615 PMCID: PMC9522908 DOI: 10.3389/fpubh.2022.913857] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/11/2022] [Indexed: 01/22/2023] Open
Abstract
There is growing evidence that climate change is linked to adverse mental health outcomes, with both direct and indirect impacts already being felt globally, including within the United Kingdom (UK). With the UK parliament tasked with passing legislation to mitigate against and adapt to climate change, it is well placed to take a lead in implementing policies that reduce the impact of climate change on mental health and even provide mental health benefits (e.g., by increasing access to green space). The extent to which the UK parliament considers the relationship between climate change and mental health in its decision-making was previously unknown. We report, through quantitative thematic analysis of the UK Hansard database, that the UK parliament has only infrequently made links between climate change and mental health. Where links have been made, the primary focus of the speeches were around flooding and anxiety. Key mental health impacts of climate change reported in the academic literature, such as high temperature and suicides, or experiences of eco-anxiety, were found to be missing entirely. Further, policies suggested in UK parliament to minimise the impact of climate change on mental health were focused on pushing adaptation measures such as flood defences rather than climate mitigation, indicating potential missed opportunities for effective policies with co-benefits for tackling climate change and mental health simultaneously. Therefore, this research suggests a need to raise awareness for UK policymakers of the costs of climate inaction on mental health, and potential co-benefits of climate action on mental health. Our results provide insight into where links have and have not been made to date, to inform targeted awareness raising and ultimately equip policymakers to protect the UK from the increasingly large impacts of climate change on mental health.
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Affiliation(s)
- Lucy T. Pirkle
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Neil Jennings
- Grantham Institute – Climate Change and the Environment, Imperial College London, London, United Kingdom
| | - Ans Vercammen
- Centre for Environmental Policy, Imperial College London, London, United Kingdom
- The School of Communication and Arts, The University of Queensland, St Lucia, QLD, Australia
| | - Emma L. Lawrance
- Grantham Institute – Climate Change and the Environment, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Mental Health Innovations, London, United Kingdom
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Lawrance EL, Jennings N, Kioupi V, Thompson R, Diffey J, Vercammen A. Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study. Lancet Planet Health 2022; 6:e726-e738. [PMID: 36087603 PMCID: PMC9451498 DOI: 10.1016/s2542-5196(22)00172-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic and climate change are both significant and pressing global challenges, posing threats to public health and wellbeing. Young people are particularly vulnerable to the distress both crises can cause, but understanding of the varied psychological responses to both issues is poor. We aimed to investigate these responses and their links with mental health conditions and feelings of agency. METHODS We conducted an online survey between Aug 5 and Oct 26, 2020, targeting a diverse sample of young people (aged 16-24 years, n=530) in the UK. The survey was distributed using a combination of a survey panel (panel sample) and direct approaches to youth groups and schools who shared the survey with young people in their networks (community sample). We collected data on respondents' psychological responses to both climate change and the COVID-19 pandemic, their sense of agency to respond to each crisis, and the range of impacts on their lives. We also collected demographics data and screened for mental health and wellbeing indicators. We used non-parametric tests for most statistical comparisons. For paired samples, we used Wilcoxon's signed-rank test, and used Mann-Whitney U-tests or Kruskal-Wallis tests for two or more independent samples. Summed scale scores were considered as interval-level data and analysed with Student's t tests and ANOVAs. Effect sizes are reported as Cohen's d and partial eta-squared (η·2p), respectively. FINDINGS After excluding 18 suspected bots and 94 incomplete responses, 530 responses were retained for analysis. Of the 518 respondents who provided demographic data, 63% were female, 71·4% were White, and the mean family affluence score was 8·22 (SD 2·29). Most participants (n=343; 70%) did not report a history of diagnosis or treatment for a mental health disorder, but mental health scores indicated a common experience of (relatively mild) symptoms of anxiety, depression, and stress. Although UK youth reported more life disruption and concern for their future due to the COVID-19 pandemic, climate change was associated with significantly greater distress overall, particularly for individuals with low levels of generalised anxiety. The COVID-19 pandemic was more associated with feelings of anxiety, isolation, disconnection, and frustration; distress around loss and grief; and effects on quality of life. Climate change was more likely to evoke emotions such as interest and engagement, guilt, shame, anger, and disgust. The greater distress attributed to climate change overall was due, in particular, to higher levels of guilt, sense of personal responsibility, and greater distress triggered by upsetting media coverage. Agency to address climate change was associated with greater climate distress, but pandemic-related distress and agency were unrelated. INTERPRETATION The COVID-19 pandemic and climate change are affecting the wellbeing of UK young people in distinct ways, with implications for health service, policy, and research responses. There is a need for mental health practitioners, policy makers, and other societal actors to account for the complex relationship between climate agency, distress, and mental wellbeing in young people. FUNDING Imperial College London.
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Affiliation(s)
- Emma L Lawrance
- Institute of Global Health Innovation, Imperial College London, London, UK; Grantham Institute-Climate Change and Environment, Imperial College London, London, UK; Mental Health Innovations, London, UK.
| | - Neil Jennings
- Grantham Institute-Climate Change and Environment, Imperial College London, London, UK
| | - Vasiliki Kioupi
- Centre for Environmental Policy, Imperial College London, London, UK
| | | | - James Diffey
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ans Vercammen
- Centre for Environmental Policy, Imperial College London, London, UK; School of Communication and Arts, The University of Queensland, Brisbane, QSL, Australia
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Roberts LF, Lounsbury O, Awuzudike V, Jennings N, Lawrance EL. Healthy Environments: Understanding Perceptions of Underrepresented Communities in the United Kingdom. Int J Environ Res Public Health 2022; 19:9643. [PMID: 35955008 PMCID: PMC9367862 DOI: 10.3390/ijerph19159643] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
A healthy environment has been defined by global health organisations as one that is safe, supportive of healthy lifestyles, and free of hazards. Such definitions disregard the complexity of what it means for an environment to be perceived as 'healthy'-such as the mental, not just physical, health effects on citizens. This study aimed to understand the attributes that underrepresented groups of the United Kingdom (UK) public assign to healthy environments-an important step for directing public policy and actions to create environments that are inclusive of all citizens. This co-created study involved 95 participants from underrepresented communities in 10 separate focus groups, each facilitated by a community member. Thematic analyses highlighted five key attributes of a healthy environment: sounds and sights, accessibility, safety, familiarity and mental health and wellbeing. This study draws a picture of key attributes underrepresented groups of the UK public assign to healthy environments that is richer than that drawn by existing definitions. These findings illustrate the importance of hearing diverse voices when directing research, policy, and actions that attempt to develop healthy environments for all.
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Affiliation(s)
- Lily F. Roberts
- Institute of Global Health Innovation, Imperial College London, London SW7 2AZ, UK
- School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Olivia Lounsbury
- Institute of Global Health Innovation, Imperial College London, London SW7 2AZ, UK
| | | | - Neil Jennings
- Grantham Institute, Imperial College London, London SW7 2AZ, UK
| | - Emma L. Lawrance
- Institute of Global Health Innovation, Imperial College London, London SW7 2AZ, UK
- Grantham Institute, Imperial College London, London SW7 2AZ, UK
- Mental Health Innovations, London EC4Y 8JJ, UK
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Lawrance EL, Thompson R, Newberry Le Vay J, Page L, Jennings N. The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications. Int Rev Psychiatry 2022; 34:443-498. [PMID: 36165756 DOI: 10.1080/09540261.2022.2128725] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people's mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.
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Affiliation(s)
- Emma L Lawrance
- Institute of Global Health Innovation, Imperial College London, UK.,Mental Health Innovations, UK.,Grantham Institute of Climate and the Environment, Imperial College London, UK
| | | | | | - Lisa Page
- Brighton & Sussex Medical School, UK
| | - Neil Jennings
- Grantham Institute of Climate and the Environment, Imperial College London, UK
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Stevenson S, Collins A, Jennings N, Koberle A, Laumann F, Laverty AA, Vineis P, Woods J, Gambhir A. A hybrid approach to identifying and assessing interactions between climate action (SDG13) policies and a range of SDGs in a UK context. Discov Sustain 2021; 2:43. [PMID: 35425918 PMCID: PMC8491187 DOI: 10.1007/s43621-021-00051-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/03/2021] [Indexed: 06/01/2023]
Abstract
In 2015 the United Nations drafted the Paris Agreement and established the Sustainable Development Goals (SDGs) for all nations. A question of increasing relevance is the extent to which the pursuit of climate action (SDG 13) interacts both positively and negatively with other SDGs. We tackle this question through a two-pronged approach: a novel, automated keyword search to identify linkages between SDGs and UK climate-relevant policies; and a detailed expert survey to evaluate these linkages through specific examples. We consider a particular subset of SDGs relating to health, economic growth, affordable and clean energy and sustainable cities and communities. Overall, we find that of the 89 UK climate-relevant policies assessed, most are particularly interlinked with the delivery of SDG 7 (Affordable and Clean Energy) and SDG 11 (Sustainable Cities and Communities) and that certain UK policies, like the Industrial Strategy and 25-Year Environment Plan, interlink with a wide range of SDGs. Focusing on these climate-relevant policies is therefore likely to deliver a wide range of synergies across SDGs 3 (Good Health and Well-being), 7, 8 (Decent Work and Economic Growth), 9 (Industry, Innovation and Infrastructure), 11, 14 (Life Below Water) and 15 (Life on Land). The expert survey demonstrates that in addition to the range of mostly synergistic interlinkages identified in the keyword search, there are also important potential trade-offs to consider. Our analysis provides an important new toolkit for the research and policy communities to consider interactions between SDGs, which can be employed across a range of national and international contexts. Supplementary Information The online version contains supplementary material available at 10.1007/s43621-021-00051-w.
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Affiliation(s)
- Samuel Stevenson
- Grantham Institute - Climate Change and the Environment, Imperial College London, Exhibition Road, London, SW7 2AZ UK
| | - Alexandra Collins
- Centre for Environmental Policy, Weeks Building, 16 - 18 Prince’s Gardens, London, SW7 1NE UK
| | - Neil Jennings
- Grantham Institute - Climate Change and the Environment, Imperial College London, Exhibition Road, London, SW7 2AZ UK
| | - Alexandre Koberle
- Grantham Institute - Climate Change and the Environment, Imperial College London, Exhibition Road, London, SW7 2AZ UK
| | - Felix Laumann
- Department of Mathematics, Imperial College London, Weeks Building, 16 - 18 Prince’s Gardens, London, SW7
1NE UK
| | - Anthony A. Laverty
- School of Public Health, Imperial College London, Reynolds Building, St Dunstan’s Road, London, W6 8RP UK
| | - Paolo Vineis
- School of Public Health, Imperial College London, St Mary’s Hospital, Praed Street, London, W2 1NY UK
| | - Jeremy Woods
- Centre for Environmental Policy, Imperial College London, Weeks Building, 16 - 18 Prince’s Gardens, London, SW7
1NE UK
| | - Ajay Gambhir
- Grantham Institute - Climate Change and the Environment, Imperial College London, Exhibition Road, London, SW7 2AZ UK
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Clout M, Blazeby J, Rogers C, Reeves B, Lazaroo M, Avery K, Blencowe NS, Vohra R, Jennings N, Hollingworth W, Thorn J, Jepson M, Collingwood J, Guthrie A, Booth E, Pathak S, Beckingham I, Culliford L, Griffiths EA, Albazaz R, Toogood G. Randomised controlled trial to establish the clinical and cost-effectiveness of expectant management versus preoperative imaging with magnetic resonance cholangiopancreatography in patients with symptomatic gallbladder disease undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones (The Sunflower Study): a study protocol. BMJ Open 2021; 11:e044281. [PMID: 34187817 PMCID: PMC8245448 DOI: 10.1136/bmjopen-2020-044281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/20/2021] [Accepted: 03/28/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Surgery to remove the gallbladder (laparoscopic cholecystectomy (LC)) is the standard treatment for symptomatic gallbladder disease. One potential complication of gallbladder disease is that gallstones can pass into the common bile duct (CBD) where they may remain dormant, pass spontaneously into the bowel or cause problems such as obstructive jaundice or pancreatitis. Patients requiring LC are assessed preoperatively for their risk of CBD stones using liver function tests and imaging. If the risk is high, guidelines recommend further investigation and treatment. Further investigation of patients at low or moderate risk of CBD stones is not standardised, and the practice of imaging the CBD using magnetic resonance cholangiopancreatography (MRCP) in these patients varies across the UK. The consequences of these decisions may lead to overtreatment or undertreatment of patients. METHODS AND ANALYSIS We are conducting a UK multicentre, pragmatic, open, randomised controlled trial with internal pilot phase to compare the effectiveness and cost-effectiveness of preoperative imaging with MRCP versus expectant management (ie, no preoperative imaging) in adult patients with symptomatic gallbladder disease undergoing urgent or elective LC who are at low or moderate risk of CBD stones. We aim to recruit 13 680 patients over 48 months. The primary outcome is any hospital admission within 18 months of randomisation for a complication of gallstones. This includes complications of endoscopic retrograde cholangiopancreatography for the treatment of gallstones and complications of LC. This will be determined using routine data sources, for example, National Health Service Digital Hospital Episode Statistics for participants in England. Secondary outcomes include cost-effectiveness and patient-reported quality of life, with participants followed up for a median of 18 months. ETHICS AND DISSEMINATION This study received approval from Yorkshire & The Humber - South Yorkshire Research Ethics Committee. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN10378861.
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Affiliation(s)
- Madeleine Clout
- Clinical Trials and Evaluation Unit, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
| | - Jane Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Rogers
- Clinical Trials and Evaluation Unit, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
| | - Barnaby Reeves
- Clinical Trials and Evaluation Unit, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
| | - Michelle Lazaroo
- Clinical Trials and Evaluation Unit, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
| | - Kerry Avery
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ravi Vohra
- Trent Oesophago-Gastric Unit, Nottingham City Hospital, Nottingham, UK
| | - Neil Jennings
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, UK
| | | | - Joanna Thorn
- School of Population Health Sciences, University of Bristol, Bristol, UK
| | - Marcus Jepson
- School of Population Health Sciences, University of Bristol, Bristol, UK
| | - Jane Collingwood
- School of Population Health Sciences, University of Bristol, Bristol, UK
| | - Ashley Guthrie
- Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Elizabeth Booth
- NHS Coventry and Rugby Clinical Commissioning Group, Coventry, UK
| | - Samir Pathak
- Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ian Beckingham
- Division of Gastrointestinal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lucy Culliford
- Clinical Trials and Evaluation Unit, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
| | - Ewen A Griffiths
- Department of Upper GI Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Raneem Albazaz
- Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Giles Toogood
- Department of Hepatobiliary and Transplantation Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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7
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Affiliation(s)
- Neil Jennings
- Grantham Institute-Climate Change and the Environment, Imperial College London, London, UK
| | - Mala Rao
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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8
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Jennings N, Fecht D, De Matteis S. Mapping the co-benefits of climate change action to issues of public concern in the UK: a narrative review. Lancet Planet Health 2020; 4:e424-e433. [PMID: 32918888 PMCID: PMC7494843 DOI: 10.1016/s2542-5196(20)30167-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
To avoid a 1·5°C rise in global temperatures above preindustrial levels, the next phase of reductions in greenhouse gas emissions will need to be comparatively rapid. Linking the co-benefits of climate action to wider issues that the public are concerned about can help decision makers to prioritise decarbonisation options that increase the chance of public support for such changes, while ensuring that a just transition is delivered. We identified key issues of concern to the UK public by use of Ipsos MORI public opinion data from 2007 to 2020 and used these data to guide a narrative review of academic and grey literature on the co-benefits of climate change action for the UK. Correspondence with civil servants, third sector organisations, and relevant academics allowed us to identify omissions and to ensure policy relevance of the recommendations. This evidence-based Review of the various co-benefits of climate change action for the UK identifies four main areas: health and the National Health Service; security; economy and unemployment; and poverty, housing, and inequality. Associated trade-offs are also discussed. City-level and regional-level governments are particularly well placed to incorporate co-benefits into their decision making because it is at this scale that co-benefits most clearly manifest, and where interventions can have the most immediate effects.
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Affiliation(s)
- Neil Jennings
- Grantham Institute-Climate Change and the Environment, Imperial College London, London, UK.
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, Medical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Sara De Matteis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; National Heart and Lung Institute, Imperial College London, London, UK
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9
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Leiris S, Coelho A, Castandet J, Bayet M, Lozano C, Bougnon J, Bousquet J, Everett M, Lemonnier M, Sprynski N, Zalacain M, Pallin TD, Cramp MC, Jennings N, Raphy G, Jones MW, Pattipati R, Shankar B, Sivasubrahmanyam R, Soodhagani AK, Juventhala RR, Pottabathini N, Pothukanuri S, Benvenuti M, Pozzi C, Mangani S, De Luca F, Cerboni G, Docquier JD, Davies DT. SAR Studies Leading to the Identification of a Novel Series of Metallo-β-lactamase Inhibitors for the Treatment of Carbapenem-Resistant Enterobacteriaceae Infections That Display Efficacy in an Animal Infection Model. ACS Infect Dis 2019; 5:131-140. [PMID: 30427656 PMCID: PMC6332448 DOI: 10.1021/acsinfecdis.8b00246] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The clinical effectiveness of carbapenem antibiotics such as meropenem is becoming increasingly compromised by the spread of both metallo-β-lactamase (MBL) and serine-β-lactamase (SBL) enzymes on mobile genetic elements, stimulating research to find new β-lactamase inhibitors to be used in conjunction with carbapenems and other β-lactam antibiotics. Herein, we describe our initial exploration of a novel chemical series of metallo-β-lactamase inhibitors, from concept to efficacy, in a survival model using an advanced tool compound (ANT431) in conjunction with meropenem.
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Affiliation(s)
- Simon Leiris
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Alicia Coelho
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Jérôme Castandet
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Maëlle Bayet
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Clarisse Lozano
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Juliette Bougnon
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Justine Bousquet
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Martin Everett
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Marc Lemonnier
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Nicolas Sprynski
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
| | - Magdalena Zalacain
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
- Zala Drug Discovery Consulting LLC, West Chester, Pennsylvania 19380, United States
| | - Thomas David Pallin
- Charles River Laboratories, 8-9 The Spire Green Centre, Harlow CM19 5TR, United Kingdom
| | - Michael C. Cramp
- Charles River Laboratories, 8-9 The Spire Green Centre, Harlow CM19 5TR, United Kingdom
| | - Neil Jennings
- Charles River Laboratories, 8-9 The Spire Green Centre, Harlow CM19 5TR, United Kingdom
| | - Gilles Raphy
- Charles River Laboratories, 8-9 The Spire Green Centre, Harlow CM19 5TR, United Kingdom
| | - Mark W. Jones
- Charles River Laboratories, 8-9 The Spire Green Centre, Harlow CM19 5TR, United Kingdom
| | - Ramesh Pattipati
- GVK Biosciences Private Limited, Plot No. 28 A, IDA Nacharam, Hyderabad 500076, India
| | - Battu Shankar
- GVK Biosciences Private Limited, Plot No. 28 A, IDA Nacharam, Hyderabad 500076, India
| | | | - Ashok K. Soodhagani
- GVK Biosciences Private Limited, Plot No. 28 A, IDA Nacharam, Hyderabad 500076, India
| | | | - Narender Pottabathini
- GVK Biosciences Private Limited, Plot No. 28 A, IDA Nacharam, Hyderabad 500076, India
| | - Srinivasu Pothukanuri
- GVK Biosciences Private Limited, Plot No. 28 A, IDA Nacharam, Hyderabad 500076, India
| | - Manuela Benvenuti
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 2 Via Aldo Moro, Siena, 53100 Italy
| | - Cecilia Pozzi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 2 Via Aldo Moro, Siena, 53100 Italy
| | - Stefano Mangani
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 2 Via Aldo Moro, Siena, 53100 Italy
| | - Filomena De Luca
- Department of Medical Biotechnology, University of Siena, 16 Viale Bracci, Siena, 53100 Italy
| | - Giulia Cerboni
- Department of Medical Biotechnology, University of Siena, 16 Viale Bracci, Siena, 53100 Italy
| | - Jean-Denis Docquier
- Department of Medical Biotechnology, University of Siena, 16 Viale Bracci, Siena, 53100 Italy
| | - David T. Davies
- Antabio SAS, 436 rue Pierre et Marie Curie, 31670 Labège, France
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Mahawar KK, Parmar C, Carr WRJ, Jennings N, Schroeder N, Small PK. Impact of biliopancreatic limb length on severe protein-calorie malnutrition requiring revisional surgery after one anastomosis (mini) gastric bypass. J Minim Access Surg 2018; 14:37-43. [PMID: 28695878 PMCID: PMC5749196 DOI: 10.4103/jmas.jmas_198_16] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: One anastomosis (mini) gastric bypass (OAGB) is believed to be more malabsorptive than Roux-en-Y gastric bypass. A number of patients undergoing this procedure suffer from severe protein–calorie malnutrition requiring revisional surgery. The purpose of this study was to find the magnitude of severe protein–calorie malnutrition requiring revisional surgery after OAGB and any potential relationship with biliopancreatic limb (BPL) length. Methods: A questionnaire-based survey was carried out on the surgeons performing OAGB. Data were further corroborated with the published scientific literature. Results: A total of 118 surgeons from thirty countries reported experience with 47,364 OAGB procedures. Overall, 0.37% (138/36,952) of patients needed revisional surgery for malnutrition. The highest percentage of 0.51% (120/23,277) was recorded with formulae using >200 cm of BPL for some patients, and lowest rate of 0% was seen with 150 cm BPL. These data were corroborated by published scientific literature, which has a record of 50 (0.56%) patients needing surgical revision for severe malnutrition after OAGB. Conclusions: A very small number of OAGB patients need surgical correction for severe protein–calorie malnutrition. Highest rates of 0.6% were seen in the hands of surgeons using BPL length of >250 cm for some of their patients, and the lowest rate of 0% was seen with BPL of 150 cm. Future studies are needed to examine the efficacy of a standardised BPL length of 150 cm with OAGB.
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Affiliation(s)
- Kamal Kumar Mahawar
- Department of Surgery, Bariatric Unit, Sunderland Royal Hospital, United Kingdom
| | - Chetan Parmar
- Department of Surgery, Bariatric Unit, Sunderland Royal Hospital, United Kingdom
| | - William R J Carr
- Department of Surgery, Bariatric Unit, Sunderland Royal Hospital, United Kingdom
| | - Neil Jennings
- Department of Surgery, Bariatric Unit, Sunderland Royal Hospital, United Kingdom
| | - Norbert Schroeder
- Department of Surgery, Bariatric Unit, Sunderland Royal Hospital, United Kingdom
| | - Peter K Small
- Department of Surgery, Bariatric Unit, Sunderland Royal Hospital, United Kingdom
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11
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Mahawar KK, Parmar C, Graham Y, De Alwis N, Carr WRJ, Jennings N, Small PK. Monitoring of Liver Function Tests after Roux-en-Y Gastric Bypass: An Examination of Evidence Base. Obes Surg 2017; 26:2516-22. [PMID: 27381560 DOI: 10.1007/s11695-016-2280-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is no consensus on the monitoring of liver function tests after Roux-en-Y gastric bypass (RYGB). Since the main objective of such monitoring would be to diagnose early those who will eventually develop liver failure after RYGB, we performed a systematic review on this topic. An extensive search of literature revealed only 10 such cases in 6 published articles. It would hence appear that liver failure is a rare problem after RYGB. Routine lifelong monitoring of liver function tests is therefore unnecessary for otherwise asymptomatic individuals. Such monitoring should hence be reserved for high-risk groups, such as patients with liver cirrhosis, those undergoing extended limb/distal RYGB, patients with new illnesses, those abusing alcohol, those on hepatotoxic drugs and those presenting with a surgical complication.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
- Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, SR1 3SD, UK.
| | - Chetan Parmar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Yitka Graham
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
- Department of Pharmacy, Health and Well-being, University of Sunderland, Sunderland, SR1 3SD, UK
| | | | - William R J Carr
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Neil Jennings
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Peter K Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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12
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Courtney MJ, Mahawar K, Burnell P, Jennings N, Balupuri S, Schroeder N, Small P, Carr W. Occupational Outcomes of Obesity Surgery—Do the Employed Return to Work, and Do the Unemployed Find Work? Obes Surg 2017; 28:963-969. [DOI: 10.1007/s11695-017-2963-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Mahawar KK, Borg CM, Kular KS, Courtney MJ, Sillah K, Carr WRJ, Jennings N, Madhok B, Singhal R, Small PK. Understanding Objections to One Anastomosis (Mini) Gastric Bypass: A Survey of 417 Surgeons Not Performing this Procedure. Obes Surg 2017; 27:2222-2228. [DOI: 10.1007/s11695-017-2663-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Mahawar KK, Kumar P, Parmar C, Graham Y, Carr WRJ, Jennings N, Schroeder N, Balupuri S, Small PK. Small Bowel Limb Lengths and Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2016; 26:660-71. [PMID: 26749410 DOI: 10.1007/s11695-016-2050-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There is currently no consensus on the combined length of small bowel that should be bypassed as biliopancreatic or alimentary limb for optimum results with Roux-en-Y gastric bypass. A number of different limb lengths exist, and there is significant variation in practice amongst surgeons. Inevitably, this means that some patients have too much small bowel bypassed and end up with malnutrition and others end up with a less effective operation. Lack of standardisation poses further problems with interpretation and comparison of scientific literature. This systematic review concludes that a range of 100-200 cm for combined length of biliopancreatic or alimentary limb gives optimum results with Roux-en-Y gastric bypass in most patients.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
| | - Parveen Kumar
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Chetan Parmar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Yitka Graham
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.,Department of Pharmacy, Health and Well-Being, University of Sunderland, Sunderland, SR1 3SD, UK
| | - William R J Carr
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Neil Jennings
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | | | - Shlok Balupuri
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Peter K Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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15
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Abstract
Mini-gastric bypass (MGP) is a promising bariatric procedure. Tens of thousands of this procedure have been performed throughout the world since Rutledge performed the first procedure in the United States of America in 1997. Several thousands of these have even been documented in the published scientific literature. Despite a proven track record over nearly two decades, this operation continues to polarise the bariatric community. A large number of surgeons across the world have strong objections to this procedure and do not perform it. The risk of symptomatic (bile) reflux, marginal ulceration, severe malnutrition, and long-term risk of gastric and oesophageal cancers are some of the commonly voiced concerns. Despite these expressed fears, several advantages such as technical simplicity, shorter learning curve, ease of revision and reversal, non-inferior weight loss and comorbidity resolution outcomes have prompted some surgeons to advocate a wider adoption of this procedure. This review examines the current status of these controversial aspects in the light of the published academic literature in English.
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Affiliation(s)
| | - Parveen Kumar
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia
| | | | - Neil Jennings
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | | | - Shlok Balupuri
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Peter K Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
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16
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Madhok BM, Carr WRJ, McCormack C, Boyle M, Jennings N, Schroeder N, Balupuri S, Small PK. Preoperative endoscopy may reduce the need for revisional surgery for gastro-oesophageal reflux disease following laparoscopic sleeve gastrectomy. Clin Obes 2016; 6:268-72. [PMID: 27400631 DOI: 10.1111/cob.12153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 12/13/2022]
Abstract
Laparoscopic sleeve gastrectomy is a safe and effective bariatric operation, but postoperative reflux symptoms can sometimes necessitate revisional surgery. Roux-en-Y gastric bypass is the preferred operation in morbidly obese patients with gastro-oesophageal reflux disease. In 2011, we introduced preoperative endoscopy to assess for hiatus hernia or evidence of oesophagitis in conjunction with an assessment of gastro-oesophageal reflux symptoms for all patients undergoing bariatric surgery with a view to avoid sleeve gastrectomy for these patients. A prospectively maintained database was used to identify patients who underwent sleeve gastrectomy before and after we changed the unit policy. The need for revisional surgery in patients with troublesome gastro-oesophageal reflux disease was examined. Prior to 2011, 130 patients underwent sleeve gastrectomy, and 11 (8.5%) of them required conversion to Roux-en-Y gastric bypass for symptomatic reflux disease. Following the policy change, 284 patients underwent sleeve gastrectomy, and to date, only five (1.8%) have required revisional surgery (p = 0.001). Baseline demographics were comparable between the groups, and average follow-up period was 47 and 33 months, respectively, for each group. Preoperative endoscopy and a detailed clinical history regarding gastro-oesophageal reflux symptoms may improve patient selection for sleeve gastrectomy. Avoiding sleeve gastrectomy in patients with reflux disease and/or hiatus hernia may reduce the incidence of revisional surgery.
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Affiliation(s)
- B M Madhok
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - W R J Carr
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - C McCormack
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - M Boyle
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - N Jennings
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - N Schroeder
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - S Balupuri
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - P K Small
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom
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17
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Mahawar KK, Parmar C, Carr WRJ, Jennings N, Schroeder N, Balupuri S, Small PK. Preoperative Interventions for Patients Being Considered for Bariatric Surgery: Separating the Fact from Fiction. Obes Surg 2016; 25:1527-33. [PMID: 25994780 DOI: 10.1007/s11695-015-1738-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Preoperative interventions aimed at patients referred for bariatric surgery continue to divide funders, commissioners, and practitioners alike. A number of preoperative interventions and variables have been used to influence patient selection. Many of these are believed to lead to better postoperative outcomes by helping target a limited resource (bariatric surgery) at those most likely to benefit. Inevitably, this leads to competition amongst patients and some being denied benefits of surgery. There is a risk that these strategies for resource allocation may actually deprive the most vulnerable and those most in need. This review examines evidence and justification behind popular preoperative interventions for patients being considered for bariatric surgery patients in the light of published English language scientific literature.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK,
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18
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Parmar CD, Mahawar KK, Boyle M, Carr WRJ, Jennings N, Schroeder N, Balupuri S, Small PK. Mini Gastric Bypass: first report of 125 consecutive cases from United Kingdom. Clin Obes 2016; 6:61-7. [PMID: 26781603 DOI: 10.1111/cob.12124] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/27/2015] [Accepted: 10/04/2015] [Indexed: 11/27/2022]
Abstract
Mini Gastric Bypass is a promising bariatric procedure with multiple apparent benefits. Ours is the first unit within the National Health Service of the United Kingdom to be routinely performing this procedure. This retrospective cohort study reports our experience with first 125 procedures. Data were retrospectively analysed from a prospective database. Information was further supplemented by interviewing team members, contacting patients' general practitioners and telephonic follow-up. The mean follow-up was 11.4 months. There were 86 (68.8%) females and the mean age was 45 (range 20-70) years. Mean weight and body mass index was 135.8 (range 85-244) kilograms and 48.1 (range 34.5-73.8) kg m(-2) , respectively. The mean operating time was 92.4 (range 45-150) minutes and the mean post-operative hospital stay was 2.2 (range 2-17) days. There was no leak, one 30-day reoperation and no mortality in this study. Three patients required late reoperations and four patients developed marginal ulcers. At 6 months follow-up (n = 114), 27.5 (range 11.4-47.4) % total body weight loss and 60.1 (range 23.2-117.5) % excess body weight loss was seen. The figures at 12 months follow-up (n = 65) were 36.8 (range 23.7-55.4) % and 79.5 (range 44.9-138.3) %, respectively. This study demonstrates early safety and efficacy of Mini Gastric Bypass in a carefully selected British obese population in a high-volume centre.
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Affiliation(s)
- C D Parmar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - K K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - M Boyle
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - W R J Carr
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - N Jennings
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - N Schroeder
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - S Balupuri
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - P K Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
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19
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Byrne J, Rogers C, Welbourn R, David Mahon, Noble H, Kelly J, Byrom R, Davies N, Hayden J, Sarela A, Dexter S, Jennings N, Blazeby J. The By-Band-Sleeve Study: A Pragmatic Multicentre Randomised (Controlled) Trial to Examine The Effectiveness and Cost-Effectiveness of Adjustable Gastric Band, Roux-En-Y Gastric Bypass And Sleeve Gastrectomy for Severe and Complex Obesity. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.142] [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: 12/01/2022]
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20
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK,
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21
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Mahawar KK, Parmar C, Graham Y, Abouleid A, Carr WRJ, Jennings N, Schroeder N, Small PK. Routine Liver Biopsy During Bariatric Surgery: an Analysis of Evidence Base. Obes Surg 2015; 26:177-81. [DOI: 10.1007/s11695-015-1916-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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22
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Abstract
Sleeve gastrectomy is rapidly becoming popular as a standalone bariatric operation. At the same time, there are valid concerns regarding its long-term durability and postoperative gastro-oesophageal reflux disease. Though gastric bypass remains the gold standard bariatric operation, it is not suitable for all patients. Sleeve gastrectomy is sometimes the only viable option. Patients with inflammatory bowel disease, liver cirrhosis, significant intra-abdominal adhesions involving small bowel and those reluctant to undergo gastric bypass could fall in this category. It is widely recognised that some patients report worsening of their gastro-oesophageal reflux disease after sleeve gastrectomy. Still, others develop de novo reflux. This review examines if it is possible to identify these patients prior to surgery and thus prevent postoperative gastro-oesophageal reflux disease after sleeve gastrectomy.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
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23
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Jennings N, Boyle M, Mahawar K, Balupuri S, Small P. The relationship of distance from the surgical centre on attendance and weight loss after laparoscopic gastric bypass surgery in the United Kingdom. Clin Obes 2013; 3:180-4. [PMID: 25586734 DOI: 10.1111/cob.12031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 06/19/2013] [Accepted: 06/22/2013] [Indexed: 12/01/2022]
Abstract
Obesity remains a significant worldwide health problem and is currently increasing. Surgery remains the only proven long-term intervention and has been shown to be cost-effective. Evidence suggests that regular follow-up following laparoscopic adjustable gastric banding is related to improved outcome, such evidence is lacking for laparoscopic gastric bypass surgery (laparoscopic Roux-en-Y gastric bypass [LRYGB]). This study examines the effect of distance on attendance at post-operative clinics and subsequent weight loss following surgery. A prospectively maintained database was interrogated to analyze patients undergoing LRYGB before August 2010. Patient demographics, percentage excess weight loss (%EWL), compliance with out-patient clinic attendances and the distance the patients lived from the hospital were examined. Perfect clinic attendees were compared with non-attendees and the distances patients lived from the hospital evaluated. There was a significantly greater %EWL at 1 year post-op observed in the perfect attendees group (65.5 vs. 59.5, P = 0.01). Increased %EWL was also evident at 2 years post-op but did not reach statistical significance (66.9 vs. 59.5, P = 0.06). There was a negative correlation observed between post-operative weight loss and distance from the bariatric centre (R = -0.21, P = 0.04). Close follow-up following LRYGB is essential to optimize outcomes. Increased frequency of out-patient clinic visits was associated with improved post-operative weight loss. Increasing distance between the patient's home and the bariatric centre was associated with worse post-operative weight loss.
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Affiliation(s)
- N Jennings
- Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, UK
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24
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White D, Jennings N, Kanellakis P, Bobik A, Morand E, Dart A, Du X, Gao X. Macrophage Migration Inhibitory Factor Regulates Acute Inflammatory Responses Following Myocardial Infarction. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Kiriazis H, Jennings N, Davern P, Lambert G, Su Y, Pang T, Du X, La Greca L, Head G, Hannan A, Du X. Enhanced Parasympathetic Nervous Activity in Huntington's Disease Transgenic Mice. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Graham J, Hackett CA, Smith K, Woodhead M, MacKenzie K, Tierney I, Cooke D, Bayer M, Jennings N. Towards an understanding of the nature of resistance to Phytophthora root rot in red raspberry. Theor Appl Genet 2011; 123:585-601. [PMID: 21573956 DOI: 10.1007/s00122-011-1609-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 04/26/2011] [Indexed: 05/20/2023]
Abstract
A mapping population segregating for root rot resistance was screened under both field and glasshouse conditions over a number of seasons. Few correlations between field and glasshouse scores were significant. Final root rot scores were significantly negatively correlated with measures of root vigour. Two QTL associated with resistance were identified as were overlapping QTL for root vigour assessments. Markers significantly associated with the traits were used to identify BAC clones, which were subsequently sequenced to examine gene content. A number of genes were identified including those associated with stem cell identity, cell proliferation and elongation in the root zone, control of meristematic activity and organisation, cell signalling, stress response, sugar sensing and control of gene expression as well as a range of transcription factors including those known to be associated with defence. For marker-assisted breeding, the SSR marker Rub118b 110 bp allele from Latham was found in resistant germplasm but was not found in any of the susceptible germplasm tested.
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Affiliation(s)
- J Graham
- Genetics Department, Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, Scotland, UK.
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27
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Nick A, Stone R, Bottsford-Miller J, Spannuth W, Jennings N, Bagri A, Coleman R, Sood A. Neuropilin-1 blockade in the tumor microenvironment reduces tumor growth. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Kiriazis H, Jennings N, Davern P, Su Y, Pang T, Du X, Lambert G, Head G, Hannan A, Du X. Autonomic Neurocardiac Dysregulation in R6/1 Huntington's Disease Transgenic Mice. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Ritchie R, Love J, Kiriazis H, Huynh K, Cemerlang N, Tan J, Julius T, Jennings N, Jandeleit-Dahm K, Du X, McMullen J. Cardiac-Specific Activation of Phosphoinositide 3-Kinase p110á (PI3Ká) Protects Against Diabetes-Induced Diastolic Dysfunction In Vivo: Role for ROS Suppression? Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.761] [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: 10/19/2022]
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30
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Xu Q, Jennings N, Kiriazis H, Dart A, Du X. Cardiac Angiogenesis Promoted by β2-adrenergic Activation is Crucially Involved in Maintaining Cardiac Function. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.821] [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: 10/19/2022]
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31
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Jennings N, Luo W, Aagren M. Treatment pattern and outcome changes for type 2 patients on basal therapy with insulin aspart add-on in a real-world managed care setting in the US. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33304-3] [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: 11/28/2022]
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32
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Jennings N, Parsons S, Pocock MJ. Human vs. machine: identification of bat species from their echolocation calls by humans and by artificial neural networks. CAN J ZOOL 2008. [DOI: 10.1139/z08-009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Automated remote ultrasound detectors allow large amounts of data on bat presence and activity to be collected. Processing of such data involves identifying bat species from their echolocation calls. Automated species identification has the potential to provide more consistent, predictable, and potentially higher levels of accuracy than identification by humans. In contrast, identification by humans permits flexibility and intelligence in identification, as well as the incorporation of features and patterns that may be difficult to quantify. We compared humans with artificial neural networks (ANNs) in their ability to classify short recordings of bat echolocation calls of variable signal to noise ratios; these sequences are typical of those obtained from remote automated recording systems that are often used in large-scale ecological studies. We presented 45 recordings (1–4 calls) produced by known species of bats to ANNs and to 26 human participants with 1 month to 23 years of experience in acoustic identification of bats. Humans correctly classified 86% of recordings to genus and 56% to species; ANNs correctly identified 92% and 62%, respectively. There was no significant difference between the performance of ANNs and that of humans, but ANNs performed better than about 75% of humans. There was little relationship between the experience of the human participants and their classification rate. However, humans with <1 year of experience performed worse than others. Currently, identification of bat echolocation calls by humans is suitable for ecological research, after careful consideration of biases. However, improvements to ANNs and the data that they are trained on may in future increase their performance to beyond those demonstrated by humans.
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Affiliation(s)
- N. Jennings
- School of Biological Sciences, University of Bristol, Woodland Road, Bristol BS8 1UG, UK
- School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - S. Parsons
- School of Biological Sciences, University of Bristol, Woodland Road, Bristol BS8 1UG, UK
- School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - M. J.O. Pocock
- School of Biological Sciences, University of Bristol, Woodland Road, Bristol BS8 1UG, UK
- School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
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33
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Kumar SR, Masood R, Spannuth WA, Singh J, Scehnet J, Kleiber G, Jennings N, Deavers M, Krasnoperov V, Dubeau L, Weaver FA, Sood AK, Gill PS. The receptor tyrosine kinase EphB4 is overexpressed in ovarian cancer, provides survival signals and predicts poor outcome. Br J Cancer 2007; 96:1083-91. [PMID: 17353927 PMCID: PMC2360128 DOI: 10.1038/sj.bjc.6603642] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
EphB4 is a member of the largest family of transmembrane receptor tyrosine kinases and plays critical roles in axonal pathfinding and blood vessel maturation. We wanted to determine the biological role of EphB4 in ovarian cancer. We studied the expression of EphB4 in seven normal ovarian specimens and 85 invasive ovarian carcinomas by immunohistochemistry. EphB4 expression was largely absent in normal ovarian surface epithelium, but was expressed in 86% of ovarian cancers. EphB4 expression was significantly associated with advanced stage of disease and the presence of ascites. Overexpression of EphB4 predicted poor survival in both univariate and multivariate analyses. We also studied the biological significance of EphB4 expression in ovarian tumour cells lines in vitro and in vivo. All five malignant ovarian tumour cell lines tested expressed higher levels of EphB4 compared with the two benign cell lines. Treatment of malignant, but not benign, ovarian tumour cell lines with progesterone, but not oestrogen, led to a 90% reduction in EphB4 levels that was associated with 50% reduction in cell survival. Inhibition of EphB4 expression by specific siRNA or antisense oligonucleotides significantly inhibited tumour cell viability by inducing apoptosis via activation of caspase-8, and also inhibited tumour cell invasion and migration. Furthermore, EphB4 antisense significantly inhibited growth of ovarian tumour xenografts and tumour microvasculature in vivo. Inhibition of EphB4 may hence have prognostic and therapeutic utility in ovarian carcinoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Apoptosis
- Caspases/metabolism
- Cell Line, Tumor
- Cell Movement
- Cystadenocarcinoma, Serous/metabolism
- Cystadenocarcinoma, Serous/pathology
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Middle Aged
- Neoplasm Invasiveness
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/pathology
- Progesterone/pharmacology
- Progestins/pharmacology
- RNA, Small Interfering/therapeutic use
- Receptor, EphB4/antagonists & inhibitors
- Receptor, EphB4/metabolism
- Survival Rate
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Affiliation(s)
- S R Kumar
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - R Masood
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - W A Spannuth
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Singh
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J Scehnet
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - G Kleiber
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - N Jennings
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Deavers
- Department of Pathology and Laboratory Medicine, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - L Dubeau
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - F A Weaver
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - A K Sood
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Cancer Biology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P S Gill
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
- USC/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, NOR 6330, Los Angeles, CA 90033, USA. E-mail:
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Sultan J, Jennings N, Preston S, Karat D, Hayes N, Kirby J, Wilkinson P, Griffin S. 716 DO HIGH DOSE OPIOIDS PREDISPOSE TO POST-OPERATIVE INFECTIVE COMPLICATIONS FOLLOWING MAJOR UPPER GASTROINTESTINAL SURGERY? Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Watkins NA, O'Connor MN, Rankin A, Jennings N, Wilson E, Harmer IJ, Davies L, Smethurst PA, Dudbridge F, Farndale RW, Ouwehand WH. Definition of novel GP6 polymorphisms and major difference in haplotype frequencies between populations by a combination of in-depth exon resequencing and genotyping with tag single nucleotide polymorphisms. J Thromb Haemost 2006; 4:1197-205. [PMID: 16706959 DOI: 10.1111/j.1538-7836.2006.01937.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Common genetic variants of cell surface receptors contribute to differences in functional responses and disease susceptibility. We have previously shown that single nucleotide polymorphisms (SNPs) in platelet glycoprotein VI (GP6) determine the extent of response to agonist. In addition, SNPs in the GP6 gene have been proposed as risk factors for coronary artery disease. METHODS To completely characterize genetic variation in the GP6 gene we generated a high-resolution SNP map by sequencing the promoter, exons and consensus splice sequences in 94 non-related Caucasoids. In addition, we sequenced DNA encoding the ligand-binding domains of GP6 from non-human primates to determine the level of evolutionary conservation. RESULTS Eighteen SNPs were identified, six of which encoded amino acid substitutions in the mature form of the protein. The single non-synonymous SNP identified in the exons encoding the ligand-binding domains, encoding for a 103Leu > Val substitution, resulted in reduced ligand binding. Two common protein isoforms were confirmed in Caucasoid with frequencies of 0.82 and 0.15. Variation at the GP6 locus was characterized further by determining SNP frequency in over 2000 individuals from different ethnic backgrounds. CONCLUSIONS The SNPs were polymorphic in all populations studied although significant differences in allele frequencies were observed. Twelve additional GP6 protein isoforms were identified from the genotyping results and, despite extensive variation in GP6, the sequence of the ligand-binding domains is conserved. Sequences from non-human primates confirmed this observation. These data provide valuable information for the optimal selection of genetic variants for use in future association studies.
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Affiliation(s)
- N A Watkins
- Department of Haematology, University of Cambridge and National Blood Service, Cambridge, UK.
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Kastelein RA, Jennings N, Verboom WC, de Haan D, Schooneman NM. Differences in the response of a striped dolphin (Stenella coeruleoalba) and a harbour porpoise (Phocoena phocoena) to an acoustic alarm. Mar Environ Res 2006; 61:363-78. [PMID: 16439011 DOI: 10.1016/j.marenvres.2005.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 11/24/2005] [Accepted: 11/25/2005] [Indexed: 05/06/2023]
Abstract
Small cetacean bycatch in gillnet fisheries may be reduced by deterring odontocetes from nets acoustically. However, different odontocete species may respond differently to acoustic signals from alarms. Therefore, in this study a striped dolphin and a harbour porpoise were subjected simultaneously to sounds produced by the XP-10 experimental acoustic alarm. The alarm produced 0.3s tonal signals randomly selected from a set of 16 with fundamental frequencies between 9 and 15kHz, with a constant pulse interval of 4.0s (duty cycle 8%) and a Source Level range of 133-163dB re 1muPa (rms). The effect of the alarm was judged by comparing the animals' respiration rate and position relative to the alarm during test periods with those during baseline periods. As in a previous study on two porpoises with the same alarm, the porpoise in the present study reacted strongly to the alarm by swimming away from it and increasing his respiration rate. The striped dolphin, however, showed no reaction to the active alarm. Based on harbour porpoise audiograms and the specific audiogram of the striped dolphin in the present study, and the low background noise levels during the experiment, both animals must have heard the alarm signals clearly. This study indicates that cetacean species are not equally sensitive to human-made noise disturbance. Therefore, source levels of acoustic alarms should be adapted to the species they are supposed to deter. In addition, alarms should be tested on each odontocete species for which they are intended to reduce bycatch.
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Affiliation(s)
- R A Kastelein
- Sea Mammal Research Company (SEAMARCO), Julianalaan 46, 3843 CC Harderwijk, The Netherlands.
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Ng T, Hathaway D, Jennings N, Champ D, Chiang YW, Chu HJ. Equine vaccine for West Nile virus. Dev Biol (Basel) 2003; 114:221-7. [PMID: 14677692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
To meet the urgent need of controlling West Nile virus (WNV) infection in the equine population, we have developed a killed WNV vaccine. A dose titration study in horses was first conducted to evaluate serum neutralization antibody responses against WNV in these animals. Horses were vaccinated intramuscularly twice with the test vaccine at low, medium and high dose, three weeks apart. Serum samples were collected periodically and were measured for serum neutralizing antibody using a plaque reduction neutralization test. Significant increases in serum neutralizing antibody were detected in all three dosage groups 14 days post the second vaccination. Twelve months after the second vaccination, horses vaccinated with the medium dose of WNV vaccine and non-vaccinated control horses were experimentally challenged with WNV. Nine out of 11 (81.8%) controls developed viraemia after challenge while only one out of 19 (5.3%) vaccinates had transient viraemia, representing a 94% preventable fraction. In a separate study, the safety of the killed WNV vaccine was demonstrated under field conditions. A total of 648 horses, including 32 pregnant mares, were enrolled in the study. During the two weeks post vaccination period, no local or systemic adverse reactions were observed following 96% of the vaccinations administered while mild, transient injection site reactions were noted in a small number of horses. These results indicate that the killed WNV vaccine developed by Fort Dodge Animal Health is safe and efficacious.
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Affiliation(s)
- T Ng
- Biological Research and Development, Fort Dodge Animal Health, Fort Dodge, Iowa 50501, USA.
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Harrop R, Jennings N, Mountford AP, Coulson PS, Wilson RA. Characterization, cloning and immunogenicity of antigens released by transforming cercariae of Schistosoma mansoni. Parasitology 2000; 121 ( Pt 4):385-94. [PMID: 11072901 DOI: 10.1017/s003118209900640x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A schistosome infection is initiated when the parasite penetrates the skin of a susceptible host. Relatively large quantities of protein are released by transforming cercariae compared to later larval stages. This represents the first parasite material to which the host's immune system is exposed, yet little is known about the proteins which are released during the first few hours post-transformation. We have shown that antiserum raised against such molecules was capable of imparting protection against a schistosome challenge infection upon passive transfer to naïve mice. By screening a cercarial cDNA library with this serum, 38 positive clones were identified. Sequence analysis showed these to represent 8 different molecules which included Schistosoma mansoni 21-7 kDa antigen, calcium-binding-protein and the vaccine candidate glutathione S-transferase (Sm28GST). In addition, 5 clones were isolated, 1 of which had significant homology to many cytochrome C proteins, another with leukocyte elastase inhibitors and 3 which represented novel molecules. Four clones were expressed in a prokaryotic high-level expression vector, sera produced against each purified recombinant protein and used subsequently to probe Western blots and parasite sections. The leukocyte elastase inhibitor homologue and 2 unknowns induced significant proliferation by lymph node cells recovered from mice vaccinated with irradiated cercariae. More strikingly, the 2 novel proteins stimulated very high levels of interferon gamma (IFNgamma) secretion both by lymph node cells and those recovered by broncho-alveolar lavage from the lungs of vaccinated mice. Such results will be discussed in the context of vaccine development.
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Affiliation(s)
- R Harrop
- Department of Biology, University of York.
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Wartella EA, Jennings N. Children and computers: new technology--old concerns. Future Child 2000; 10:31-43. [PMID: 11255707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Computer technology has ushered in a new era of mass media, bringing with it great promise and great concerns about the effect on children's development and well-being. Although we tend to see these issues as being new, similar promises and concerns have accompanied each new wave of media technology throughout the past century: films in the early 1900s, radio in the 1920s, and television in the 1940s. With the introduction of each of these technologies, proponents touted the educational benefits for children, while opponents voiced fears about exposure to inappropriate commercial, sexual, and violent content. This article places current studies on children and computers in a historical context, noting the recurrent themes and patterns in media research during the twentieth century. Initial research concerning each innovation has tended to focus on issues of access and the amount of time children were spending with the new medium. As use of the technology became more prevalent, research shifted to issues related to content and its effects on children. Current research on children's use of computers is again following this pattern. But the increased level of interactivity now possible with computer games and with the communication features of the Internet has heightened both the promise of greatly enriched learning and the concerns related to increased risk of harm. As a result, research on the effects of exposure to various types of content has taken on a new sense of urgency. The authors conclude that to help inform and sustain the creation of more quality content for children, further research is needed on the effects of media on children, and new partnerships must be forged between industry, academia, and advocacy groups.
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Affiliation(s)
- E A Wartella
- Walter Cronkite Regents Chair of the College of Communication at the University of Texas, Austin, USA
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Sierra C, Jennings N, Noriega P, Parsons S. Negociación mediante argumentación en sistemas multiagente. Int Artif 1998. [DOI: 10.4114/ia.v2i6.617] [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: 11/20/2022] Open
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Abstract
The Kilkenny Health Project, started in 1985, aims to reduce the level of risk factors in the community for coronary heart disease through health promotion. Dental disease and coronary heart disease share risk factors of tobacco use, alcohol consumption and poor dietary patterns. A baseline oral health survey demonstrated significant levels of dental disease in Kilkenny in the 429 adults and 523 children who were examined there in 1987. Seventy one per cent of adults required treatment for periodontal disease and 49% of children surveyed required treatment for dental decay. The Kilkenny Oral Health Project was developed as a community participation project aiming to reduce the level of common risk factors in the community for coronary heart disease and dental disease. It has run parallel with the main Kilkenny Health Project and is one of the first health promotion projects which has an integrated health message preventing dental disease and coronary heart disease.
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Affiliation(s)
- B Daly
- Department of Community Dental Health, Preventive Dentistry and General Practice, School of Dental Science, University of Dublin, Trinity College
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