1
|
Vollset SE, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbastabar H, Abd Al Magied AHA, Abd ElHafeez S, Abdelkader A, Abdelmasseh M, Abd-Elsalam S, Abdi P, Abdollahi M, Abdoun M, Abdullahi A, Abebe M, Abiodun O, Aboagye RG, Abolhassani H, Abouzid M, Aboye GB, Abreu LG, Absalan A, Abualruz H, Abubakar B, Abukhadijah HJJ, Addolorato G, Adekanmbi V, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adha R, Adhikary RK, Adnani QES, Adzigbli LA, Afrashteh F, Afzal MS, Afzal S, Agbozo F, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahlstrom AJ, Ahmad A, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmed A, Ahmed A, Ahmed H, Ahmed S, Ahmed SA, Akinosoglou K, Akkaif MA, Akrami AE, Akter E, Al Awaidy S, Al Hasan SM, Al Mosa AS, Al Ta'ani O, Al Zaabi OAM, Alahdab F, Alajlani MM, Al-Ajlouni Y, Alalalmeh SO, Al-Aly Z, Alam K, Alam N, Alam T, Alam Z, Al-amer RM, Alanezi FM, Alanzi TM, Albakri A, Aldhaleei WA, Aldridge RW, Alemohammad SY, Alemu YM, Al-Gheethi AAS, Al-Hanawi MK, Ali A, Ali A, Ali I, Ali MU, Ali R, Ali SSS, Ali VE, Ali W, Al-Ibraheem A, Alicandro G, Alif SM, Aljunid SM, Alla F, Almazan JU, Al-Mekhlafi HM, Alqutaibi AY, Alrawashdeh A, Alrousan SM, Al-Sabah SK, Alsabri MA, Altaany Z, Al-Tammemi AB, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Al-Wardat MS, Al-Worafi YM, Aly H, Alyahya MS, Alzoubi KH, Al-Zyoud W, Amani R, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Andrei T, Andrews EA, Anil A, Anil S, Anoushiravani A, Antony CM, Antriyandarti E, Anuoluwa BS, Anvari S, Anyasodor AE, Appiah F, Aquilano M, Arab JP, Arabloo J, Arafa EA, Arafat M, Aravkin AY, Ardekani A, Areda D, Aregawi BB, Aremu A, Ariffin H, Arkew M, Armani K, Artamonov AA, Arumugam A, Asghari-Jafarabadi M, Ashbaugh C, Astell-Burt T, Athari SS, Atorkey P, Atout MMW, Aujayeb A, Ausloos M, Awad H, Awotidebe AW, Ayatollahi H, Ayuso-Mateos JL, Azadnajafabad S, Azeez FK, Azevedo RMS, Badar M, Baghdadi S, Bagheri M, Bagheri N, Bai R, Baker JL, Bako AT, Balakrishnan S, Balcha WF, Baltatu OC, Barchitta M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barqawi HJ, Barteit S, Basiru A, Basso JD, Bastan MM, Basu S, Bauckneht M, Baune BT, Bayati M, Bayileyegn NS, Behnoush AH, Behzadi P, Beiranvand M, Bello OO, Belo L, Beloukas A, Bemanalizadeh M, Bensenor IM, Benzian H, Beran A, Berezvai Z, Bernstein RS, Bettencourt PJG, Beyene KA, Beyene MG, Bhagat DS, Bhagavathula AS, Bhala N, Bhandari D, Bharadwaj R, Bhardwaj N, Bhardwaj P, Bhargava A, Bhaskar S, Bhat V, Bhattacharjee NV, Bhatti GK, Bhatti JS, Bhatti MS, Bhuiyan MA, Bisignano C, Biswas B, Bjørge T, Bodolica V, Bodunrin AO, Bonakdar Hashemi M, Bora Basara B, Borhany H, Bosoka SA, Botero Carvajal A, Bouaoud S, Boufous S, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brauer M, Brazo-Sayavera J, Brenner H, Brown CS, Browne AJ, Brugha T, Bryazka D, Bulamu NB, Buonsenso D, Burkart K, Burns RA, Busse R, Bustanji Y, Butt ZA, Caetano dos Santos FL, Çakmak Barsbay M, Calina D, Campos LA, Cao S, Capodici A, Cárdenas R, Carreras G, Carugno A, Carvalho M, Castaldelli-Maia JM, Castelpietra G, Cattaruzza MS, Caye A, Cegolon L, Cembranel F, Cenko E, Cerin E, Chadban SJ, Chadwick J, Chakraborty C, Chakraborty S, Chalek J, Chan JSK, Chandika RM, Chandy S, Charan J, Chaudhary AA, Chaurasia A, Chen AT, Chen H, Chen MX, Chen S, Cherbuin N, Chi G, Chichagi F, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho DY, Cho WCS, Choi DW, Chong B, Chong CL, Chopra H, Chu DT, Chung E, Chutiyami M, Clayton JT, Cogen RM, Cohen AJ, Columbus A, Comfort H, Conde J, Connolly JT, Cooper EEK, Cortese S, Cruz-Martins N, da Silva AG, Dadras O, Dai X, Dai Z, Dalton BE, Damiani G, Dandona L, Dandona R, Das JK, Das S, Das S, Dash NR, Davletov K, De la Hoz FP, De Leo D, Debopadhaya S, Delgado-Enciso I, Denova-Gutiérrez E, Dervenis N, Desai HD, Devanbu VGC, Dewan SMR, Dhama K, Dhane AS, Dhingra S, Dias da Silva D, Diaz D, Diaz LA, Diaz MJ, Dima A, Ding DD, Do THP, do Prado CB, Dodangeh M, Dodangeh M, Doegah PT, Dohare S, Dong W, D'Oria M, Doshi R, Dowou RK, Dsouza HL, Dsouza V, Dube J, Dumith SC, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dushpanova A, Dutta S, Dzianach PA, Dziedzic AM, Eboreime E, Ebrahimi A, Ebrahimi Kalan M, Edinur HA, Efendi F, Eikemo TA, Eini E, Ekundayo TC, El Arab RA, El Sayed I, Elamin O, Elemam NM, ElGohary GMT, Elhadi M, Elmeligy OAA, Elmoselhi AB, Elshaer M, Elsohaby I, Eltahir ME, Emeto TI, Eshrati B, Eslami M, Esmaeili Z, Fabin N, Fagbamigbe AF, Fagbule OF, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faro A, Fasihi K, Fatehizadeh A, Fauk NK, Fazylov T, Feigin VL, Fekadu G, Feng X, Fereshtehnejad SM, Ferrara P, Ferreira N, Firew BS, Fischer F, Fitriana I, Flavel J, Flor LS, Folayan MO, Foley KM, Fonzo M, Force LM, Foschi M, Freitas A, Fridayani NKY, Fukutaki KG, Furtado JM, Fux B, Gaal PA, Gadanya MA, Gallus S, Ganesan B, Ganiyani MA, Gautam RK, Gebi TG, Gebregergis MW, Gebrehiwot M, Getacher L, Getahun GKA, Gething PW, Ghadimi DJ, Ghadirian F, Ghafarian S, Ghailan KY, Ghasemi M, Ghasempour Dabaghi G, Ghazy RM, Ghoba S, Gholami E, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghotbi E, Gil AU, Gill TK, Girmay A, Glasbey JC, Glushkova EV, Gnedovskaya EV, Göbölös L, Goldust M, Goleij P, Golinelli D, Gopalani SV, Goulart AC, Gouravani M, Goyal A, Grivna M, Grosso G, Guarducci G, Gubari MIM, Guicciardi S, Guimarães RA, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta R, Gupta R, Gupta R, Gupta S, Gupta VK, Haakenstad A, Hadi NR, Haep N, Hafiz A, Haghmorad D, Haile D, Hajj Ali A, Hajj Ali A, Haj-Mirzaian A, Halboub ES, Haller S, Halwani R, Hamagharib Abdullah K, Hamdy NM, Hamoudi R, Hanifi N, Hankey GJ, Haq ZA, Haque MR, Harapan H, Hargono A, Haro JM, Hasaballah AI, Hasan SMM, Hasanian M, Hasnain MS, Hassan A, Haubold J, Hay SI, Hebert JJ, Hegazi OE, Heidari M, Hemmati M, Henson CA, Herrera-Serna BY, Herteliu C, Heydari M, Hezam K, Hidayana I, Hiraike Y, Hoan NQ, Holla R, Hoogar P, Horita N, Hossain MM, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hu C, Huang J, Hultström M, Hundie TG, Hunt AJ, Hushmandi K, Hussain J, Hussain MA, Hussein NR, Huynh HH, Hwang BF, Ibitoye SE, Iftikhar PM, Ikiroma AI, Ikwegbue PC, Ilic IM, Ilic MD, Immurana M, Isa MA, Islam MR, Islam SMS, Ismail F, Ismail NE, Isola G, Iwagami M, Iyamu IO, Jacob L, Jacobsen KH, Jafarinia M, Jahankhani K, Jahanmehr N, Jain N, Jairoun AA, Jakhmola Mani DR, Jamil S, Jamora RDG, Jatau AI, Javadov S, Javaheri T, Jayaram S, Jee SH, Jeganathan J, Jiang H, Jokar M, Jonas JB, Joseph N, Joshua CE, Jürisson M, K V, Kabir A, Kabir Z, Kadashetti V, Kalankesh LR, Kalra S, Kamath A, Kamath R, Kamireddy A, Kanaan M, Kanchan T, Kanmiki EW, Kanmodi KK, Kansal SK, Karim A, Karkhah S, Kashoo FZ, Kasraei H, Kassel MB, Katikireddi SV, Kauppila JH, Kaur H, Kayode GA, Kazemi F, Kazemian S, Kebede F, Kendal ES, Kesse-Guyot E, Khademvatan S, Khajuria H, Khalaji A, Khalid A, Khalid N, Khalilian A, Khamesipour F, Khan F, Khan MJ, Khan MAB, Khanmohammadi S, Khatab K, Khatatbeh H, Khatatbeh MM, Khatib MN, Khayat Kashani HR, Kheirallah KA, Khokhar M, Khormali M, Khorrami Z, Khosla AA, Khosravi M, Khosrowjerdi M, Khubchandani J, Kifle ZD, Kim G, Kim JS, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Knibbs LD, Knudsen AKS, Kochhar S, Kolahi AA, Kompani F, Koren G, Korzh O, Krishan K, Krishna V, Krishnamoorthy V, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kujan O, Kulimbet M, Kulkarni V, Kumar GA, Kumar H, Kumar N, Kumar R, Kumar V, Kundu A, Kusuma D, Kyei-Arthur F, Kytö V, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lahariya C, Lai DTC, Lalloo R, Lallukka T, Lám J, Lan Q, Lan T, Landires I, Lanfranchi F, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lauriola P, Lawlor HR, Le HH, Le LKD, Le NHH, Le TTT, Le TDT, Leasher JL, Lee DW, Lee M, Lee PH, Lee SW, Lee SW, Lee SWH, Lee YH, Leigh J, Leong E, Li MC, Libra M, Ligade VS, Lim LL, Lim SS, Limenh LW, Lindholm D, Lindstedt PA, Listl S, Liu G, Liu S, Liu S, Liu X, Liu X, Llanaj E, López-Bueno R, López-Gil JF, Loreche AM, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Luo L, Lusk JB, Lv L, M Amin HI, Ma ZF, Maass KL, Machairas N, Machoy M, Madureira-Carvalho ÁM, Magdy Abd El Razek H, Maghazachi AA, Mahadeshwara Prasad D, Mahalleh M, Mahasha PW, Mahmoud MA, Mahmoudi E, Mahmoudvand G, Makama M, Malakan Rad E, Malhotra K, Malik AA, Malta DC, Manla Y, Mansour A, Mansouri MH, Mansouri P, Mansouri V, Mansourian M, Mansournia MA, Marasini BP, Marateb HR, Maravilla JC, Mardi P, Marjani A, Markazi Moghadam H, Marrugo Arnedo CA, Martinez G, Martinez-Piedra R, Martins-Melo FR, Martorell M, Marx W, Marzo RR, Masoudi S, Mathangasinghe Y, Mathioudakis AG, Mathur M, Mathur N, Mathur N, Matozinhos FP, Mattumpuram J, Maude RJ, Maugeri A, Mayeli M, Mazidi M, Mazzotti A, McGrath JJ, McKee M, McKowen ALW, McPhail MA, McPhail SM, Mehmood A, Mehrabani-Zeinabad K, Mehravar S, Mekene Meto T, Melese EB, Mendez-Lopez MAM, Mendoza W, Menezes RG, Mensah GA, Mensah LG, Mentis AFA, Meo SA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Mettananda KCD, Mettananda S, Mhlanga A, Mhlanga L, Miazgowski T, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Miller TR, Minh LHN, Mirahmadi A, Mirijello A, Mirrakhimov EM, Mirzaei R, Mitchell PB, Mittal C, Moberg ME, Moghadam Fard A, Mohajelin S, Mohamadkhani A, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad AM, Mohammadi S, Mohammed H, Mohammed M, Mohammed S, Mokdad AH, Molokhia M, Momani SM, Momtazmanesh S, Monasta L, Mondello S, Moni MA, Montazeri F, Moodi Ghalibaf A, Moradi M, Moradi Y, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Mosapour A, Mosser JF, Mossialos E, Motappa R, Mougin V, Mousavi P, Mrejen M, Mubarik S, Mueller UO, Mulita F, Munjal K, Murillo-Zamora E, Musallam KM, Musina AM, Mustafa G, Myung W, Nafei A, Nagarajan AJ, Naghavi P, Naik GR, Naik G, Nainu F, Najdaghi S, Nakhostin Ansari N, Nangia V, Narasimha Swamy S, Nargus S, Narimani Davani D, Nascimento BR, Nascimento GG, Naser AY, Nashwan AJ, Natto ZS, Nauman J, Navaratna SNK, Naveed M, Nawsherwan, Nayak BP, Nayak VC, Negash H, Negoi I, Negoi RI, Nejadghaderi SA, Nejjari C, Nematollahi S, Netsere HB, Ng M, Nguefack-Tsague G, Ngunjiri JW, Nguyen AH, Nguyen DH, Nguyen DH, Nguyen HTH, Nguyen N, Nguyen NNY, Nguyen PT, Nguyen QP, Nguyen VT, Nguyen Tran Minh D, Niazi RK, Nigatu YT, Niknam M, Nikoobar A, Nikpoor AR, Nikravangolsefid N, Noman EA, Nomura S, Noor STA, Noroozi N, Nouri M, Nozari M, Nri-Ezedi CA, Ntaios G, Nunemo MH, Nurrika D, Nutor JJ, Nzoputam CI, Nzoputam OJ, Oancea B, Obamiro KO, Odetokun IA, Oduro MS, Ogundijo OA, Ogunfowokan AA, Ogunkoya A, Oguntade AS, Oh IH, Ojo-Akosile TR, Okati-Aliabad H, Okekunle AP, Okonji OC, Olagunju AT, Olatubi MI, Oliveira GMM, Olusanya BO, Olusanya JO, Oluwafemi YD, Omar HA, Omer GL, Ong S, Onie S, Onwujekwe OE, Opejin AO, Ordak M, Orish VN, Ortiz A, Ortiz-Prado E, Osman WMS, Ostojic SM, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov SS, Ouyahia A, Owolabi MO, Oyeyemi OT, Ozair A, P A MP, Padron-Monedero A, Padubidri JR, Pal PK, Palicz T, Pan F, Pan HF, Panda-Jonas S, Pandey A, Pando-Robles V, Pangaribuan HU, Panos GD, Panos LD, Pantazopoulos I, Pantea Stoian AM, Parikh RR, Park EK, Park S, Park S, Parsons N, Parthasarathi A, Pasovic M, Passera R, Patel J, Pathan AR, Patil S, Patoulias D, Pawar S, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Pensato U, Pepito VCF, Peprah P, Pereira M, Pereira MO, Perianayagam A, Perico N, Perna S, Pesudovs K, Petermann-Rocha FE, Pham HT, Philip AK, Phillips MR, Pigeolet M, Piradov MA, Pisoni E, Plotnikov E, Poddighe D, Polibin RV, Poluru R, Ponkilainen VT, Popovic DS, Postma MJ, Pour-Rashidi A, Prabhu D, Prada SI, Pradhan J, Pradhan PMS, Prashant A, Prates EJS, Priscilla T, Purnobasuki H, Purohit BM, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Rabiee Rad M, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raggi C, Raheem N, Rahim F, Rahim MJ, Rahimibarghani S, Rahman MMMR, Rahman M, Rahman MA, Rahman T, Rahmani AM, Rahmanian M, Rahmanian N, Rahmati R, Rahmawaty S, Raimondo D, Raja A, Rajput P, Ramadan M, Ramasamy SK, Ramazanu S, Ramteke PW, Rana K, Rana RK, Ranabhat CL, Rane A, Rao CR, Rao M, Rasella D, Rashedi V, Rashid AM, Rasouli-Saravani A, Rastogi P, Rasul A, Rathish D, Rathnaiah Babu G, Rauniyar SK, Ravangard R, Rawaf DL, Rawaf S, Raza RZ, Redwan EMM, Reifels L, Reitsma MB, Remuzzi G, Rengasamy KRR, Reshmi B, Resnikoff S, Restaino S, Reyes LF, Rezaei N, Rezaei N, Rezaei ZS, Rezaeian M, Rhee TG, Rickard J, Robalik T, Robinson-Oden HE, Rocha HAL, Rodrigues M, Rodriguez JAB, Roever L, Romadlon DS, Ronfani L, Rony MKK, Roshandel G, Rotimi K, Rout HS, Roy B, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Russo M, Saad AMA, Saber K, Saber-Ayad MM, Sabet CJ, Sabour S, Sachdev PS, Saddler A, Sadee BA, Sadeghi M, Saeb MR, Saeed U, Safi SZ, Sagar R, Saghafi A, Sagoe D, Sahebkar A, Sahoo PM, Sajid MR, Salam N, Salamati P, Salami AA, Saleh MA, Salehi L, Salem MR, Salemcity AJ, Salimi S, Samadi Kafil H, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santric-Milicevic MM, Sao Jose BP, Saraswathy SYI, Saravanan A, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sartorius B, Satpathy M, Sayeed A, Scarmeas N, Schaarschmidt BM, Schinckus C, Schuermans A, Schumacher AE, Schutte AE, Schwebel DC, Schwendicke F, Selvaraj S, Semreen MH, Senapati S, Sengupta P, Senthilkumaran S, Serban D, Sethi Y, Seylani A, Shafie M, Shah PA, Shahbandi A, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh MA, Shalash AS, Shamekh A, Shamim MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma A, Sharma M, Sharma S, Sharma V, Shastry RP, Shayan M, Shekhar S, Shenoy RR, Shetty M, Shetty PH, Shetty PK, Shi P, Shiani A, Shigematsu M, Shimels T, Shiri R, Shittu A, Shiue I, Shivakumar KM, Shool S, Shorofi SA, Shrestha S, Shuval K, Si Y, Siddig EE, Sidhu JK, Silva JP, Silva LMLR, Silva S, Silva TPR, Simpson CR, Simpson KE, Singh A, Singh BB, Singh B, Singh H, Singh J, Singh P, Singh P, Skou ST, Smith G, Sobia F, Socea B, Solanki S, Soleimani H, Soliman SSM, Song Y, Soyiri IN, Spartalis M, Spearman S, Sreeramareddy CT, Stanaway JD, Stanikzai MH, Starodubova AV, Stein DJ, Steiner C, Steiropoulos P, Stockfelt L, Stokes MA, Straif K, Subedi N, Suliankatchi Abdulkader R, Sultana A, Sun J, Sundström J, Swain CK, Szarpak L, Szeto MD, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabche C, Tabish M, Taheri Abkenar Y, Taheri Soodejani M, Taiba J, Talaat IM, Tamuzi JL, Tan KK, Tang H, Tat NY, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tbakhi A, Tehrani H, Temsah MH, Teramoto M, Tesfaye BT, Teye-Kwadjo E, Thangaraju P, Thankappan KR, Thapar R, Thayakaran R, Thirunavukkarasu S, Thomas N, Thygesen LC, Ticoalu JHV, Timalsena D, Tiruye TY, Tiwari K, Tomo S, Tonelli M, Topor-Madry R, Touvier M, Tovani-Palone MR, Tran AT, Tran JT, Tran NM, Tran TH, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsermpini EE, Tumurkhuu M, Turnock ST, Udoh A, Ullah A, Ullah S, Ullah S, Umakanthan S, Umar M, Umar SS, Unim B, Unnikrishnan B, Upadhyay E, Usman JS, Vahdati S, Vaithinathan AG, Vakili O, Valizadeh R, Van den Eynde J, Vart P, Varthya SB, Vasankari TJ, Vasic M, Venketasubramanian N, Veroux M, Verras GI, Vervoort D, Vijayageetha M, Villafañe JH, Vinayak M, Violante FS, Vladimirov SK, Vlassov V, Vo B, Vohra K, Vos T, Wadood AW, Waheed Y, Wang F, Wang S, Wang S, Wang Y, Wang Y, Wang YP, Wanjau MN, Waqas M, Ward P, Waris A, Wassie EG, Watson S, Weaver MR, Weerakoon KG, Weintraub RG, Weldetinsaa HLL, Wells KM, Wen YF, Westerman R, Wiangkham T, Wickramasinghe DP, Widowati E, Wojewodzic MW, Woldeyes DH, Wolf AW, Wolfe CDA, Wu C, Wu D, Wu F, Wu J, Wu Z, Wulf Hanson S, Xiao H, Xu S, Yadav R, Yamagishi K, Yang D, Yano Y, Yarahmadi A, Yazdani Nia I, Ye P, Yesodharan R, Yesuf SA, Yezli S, Yiğit A, Yiğit V, Yigzaw ZA, Yin D, Yip P, Yonemoto N, You Y, Younis MZ, Yu C, Yu EA, Yu Y, Yuan CW, Yusuf H, Zafar U, Zafari N, Zahid MH, Zakham F, Zaki N, Zerfu TA, Zhang H, Zhang J, Zhang L, Zhang Y, Zhang Z, Zhao XJG, Zhao Y, Zhao Z, Zhong C, Zhou B, Zhou J, Zhou S, Zhu B, Zhumagaliuly A, Zielińska M, Zoghi G, Zumla A, Zyoud SH, Zyoud SH, Smith AE, Murray CJL. Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2204-2256. [PMID: 38762325 DOI: 10.1016/s0140-6736(24)00685-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. METHODS Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. FINDINGS In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8-63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0-45·0] in 2050) and south Asia (31·7% [29·2-34·1] to 15·5% [13·7-17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4-40·3) to 41·1% (33·9-48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6-25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5-43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5-17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7-11·3) in the high-income super-region to 23·9% (20·7-27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5-6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2-26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [-0·6 to 3·6]). INTERPRETATION Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
2
|
Brauer M, Roth GA, Aravkin AY, Zheng P, Abate KH, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasi MA, Abbasian M, Abbasifard M, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Elsalam S, Abdi P, Abdollahi M, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abedi A, Abedi A, Abegaz TM, Abeldaño Zuñiga RA, Abiodun O, Abiso TL, Aboagye RG, Abolhassani H, Abouzid M, Aboye GB, Abreu LG, Abualruz H, Abubakar B, Abu-Gharbieh E, Abukhadijah HJJ, Aburuz S, Abu-Zaid A, Adane MM, Addo IY, Addolorato G, Adedoyin RA, Adekanmbi V, Aden B, Adetunji JB, Adeyeoluwa TE, Adha R, Adibi A, Adnani QES, Adzigbli LA, Afolabi AA, Afolabi RF, Afshin A, Afyouni S, Afzal MS, Afzal S, Agampodi SB, Agbozo F, Aghamiri S, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad N, Ahmad S, Ahmad T, Ahmed A, Ahmed A, Ahmed A, Ahmed LA, Ahmed MB, Ahmed S, Ahmed SA, Ajami M, Akalu GT, Akara EM, Akbarialiabad H, Akhlaghi S, Akinosoglou K, Akinyemiju T, Akkaif MA, Akkala S, Akombi-Inyang B, Al Awaidy S, Al Hasan SM, Alahdab F, AL-Ahdal TMA, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Alam N, Alanezi FM, Alanzi TM, Albakri A, AlBataineh MT, Aldhaleei WA, Aldridge RW, Alemayohu MA, Alemu YM, Al-Fatly B, Al-Gheethi AAS, Al-Habbal K, Alhabib KF, Alhassan RK, Ali A, Ali A, Ali BA, Ali I, Ali L, Ali MU, Ali R, Ali SSS, Ali W, Alicandro G, Alif SM, Aljunid SM, Alla F, Al-Marwani S, Al-Mekhlafi HM, Almustanyir S, Alomari MA, Alonso J, Alqahtani JS, Alqutaibi AY, Al-Raddadi RM, Alrawashdeh A, Al-Rifai RH, Alrousan SM, Al-Sabah SK, Alshahrani NZ, Altaany Z, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Alvis-Zakzuk NJ, Alwafi H, Al-Wardat MS, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Al-Zyoud W, Amaechi UA, Aman Mohammadi M, Amani R, Amiri S, Amirzade-Iranaq MH, Ammirati E, Amu H, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Anderson JA, Andrade PP, Andrei CL, Andrei T, Anenberg SC, Angappan D, Angus C, Anil A, Anil S, Anjum A, Anoushiravani A, Antonazzo IC, Antony CM, Antriyandarti E, Anuoluwa BS, Anvari D, Anvari S, Anwar S, Anwar SL, Anwer R, Anyabolo EE, Anyasodor AE, Apostol GLC, Arabloo J, Arabzadeh Bahri R, Arafat M, Areda D, Aregawi BB, Aremu A, Armocida B, Arndt MB, Ärnlöv J, Arooj M, Artamonov AA, Artanti KD, Aruleba IT, Arumugam A, Asbeutah AM, Asgary S, Asgedom AA, Ashbaugh C, Ashemo MY, Ashraf T, Askarinejad A, Assmus M, Astell-Burt T, Athar M, Athari SS, Atorkey P, Atreya A, Aujayeb A, Ausloos M, Avila-Burgos L, Awoke AA, Ayala Quintanilla BP, Ayatollahi H, Ayestas Portugal C, Ayuso-Mateos JL, Azadnajafabad S, Azevedo RMS, Azhar GS, Azizi H, Azzam AY, Backhaus IL, Badar M, Badiye AD, Bagga A, Baghdadi S, Bagheri N, Bagherieh S, Bahrami Taghanaki P, Bai R, Baig AA, Baker JL, Bakkannavar SM, Balasubramanian M, Baltatu OC, Bam K, Bandyopadhyay S, Banik B, Banik PC, Banke-Thomas A, Bansal H, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrero LH, Barrow A, Barteit S, Basharat Z, Basiru A, Basso JD, Bastan MM, Basu S, Batchu S, Batra K, Batra R, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Behnoush AH, Beiranvand M, Béjot Y, Bekele A, Belgaumi UI, Bell AW, Bell ML, Bello MB, Bello OO, Belo L, Beloukas A, Bendak S, Bennett DA, Bennitt FB, Bensenor IM, Benzian H, Beran A, Berezvai Z, Bernabe E, Bernstein RS, Bettencourt PJG, Bhagavathula AS, Bhala N, Bhandari D, Bhardwaj N, Bhardwaj P, Bhaskar S, Bhat AN, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhuiyan MA, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Biswas A, Biswas B, Biswas RK, Bjørge T, Boachie MK, Boakye H, Bockarie MJ, Bodolica V, Bodunrin AO, Bogale EK, Bolla SR, Boloor A, Bonakdar Hashemi M, Boppana SH, Bora Basara B, Borhany H, Botero Carvajal A, Bouaoud S, Boufous S, Bourne R, Boxe C, Braithwaite D, Brant LC, Brar A, Breitborde NJK, Breitner S, Brenner H, Briko AN, Britton G, Brown CS, Browne AJ, Brunoni AR, Bryazka D, Bulamu NB, Bulto LN, Buonsenso D, Burkart K, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Cagney J, Cahuana-Hurtado L, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao F, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Caye A, Cederroth CR, Cegolon L, Cenderadewi M, Cercy KM, Cerin E, Chadwick J, Chakraborty C, Chakraborty PA, Chakraborty S, Chan JSK, Chan RNC, Chandan JS, Chandika RM, Chaturvedi P, Chen AT, Chen CS, Chen H, Chen MX, Chen M, Chen S, Cheng CY, Cheng ETW, Cherbuin N, Chi G, Chichagi F, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho WCS, Chong B, Chopra H, Chowdhury R, Christopher DJ, Chu DT, Chukwu IS, Chung E, Chung SC, Chutiyami M, Cioffi I, Cogen RM, Cohen AJ, Columbus A, Conde J, Corlateanu A, Cortese S, Cortesi PA, Costa VM, Costanzo S, Criqui MH, Cruz JA, Cruz-Martins N, Culbreth GT, da Silva AG, Dadras O, Dai X, Dai Z, Daikwo PU, Dalli LL, Damiani G, D'Amico E, D'Anna L, Darwesh AM, Das JK, Das S, Dash NR, Dashti M, Dávila-Cervantes CA, Davis Weaver N, Davitoiu DV, De la Hoz FP, de la Torre-Luque A, De Leo D, Debopadhaya S, Degenhardt L, Del Bo' C, Delgado-Enciso I, Delgado-Saborit JM, Demoze CK, Denova-Gutiérrez E, Dervenis N, Dervišević E, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhane AS, Dhimal ML, Dhimal M, Dhingra S, Dhulipala VR, Dhungana RR, Dias da Silva D, Diaz D, Diaz LA, Diaz MJ, Dima A, Ding DD, Dinu M, Djalalinia S, Do TC, Do THP, do Prado CB, Dodangeh M, Dohare S, Dokova KG, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza AC, Dsouza HL, Dumith SC, Duncan BB, Duraes AR, Duraisamy S, Dushpanova A, Dzianach PA, Dziedzic AM, Ebrahimi A, Echieh CP, Ed-Dra A, Edinur HA, Edvardsson D, Edvardsson K, Efendi F, Eftekharimehrabad A, Eini E, Ekholuenetale M, Ekundayo TC, El Arab RA, El Sayed Zaki M, El-Dahiyat F, Elemam NM, Elgar FJ, ElGohary GMT, Elhabashy HR, Elhadi M, Elmehrath AO, Elmeligy OAA, Elshaer M, Elsohaby I, Emeto TI, Esfandiari N, Eshrati B, Eslami M, Esmaeili SV, Estep K, Etaee F, Fabin N, Fagbamigbe AF, Fagbule OF, Fahimi S, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faris PS, Faro A, Fasina FO, Fatehizadeh A, Fauk NK, Fazylov T, Feigin VL, Feng X, Fereshtehnejad SM, Feroze AH, Ferrara P, Ferrari AJ, Ferreira N, Fetensa G, Feyisa BR, Filip I, Fischer F, Fitriana I, Flavel J, Flohr C, Flood D, Flor LS, Foigt NA, Folayan MO, Force LM, Fortuna D, Foschi M, Franklin RC, Freitas A, Friedman SD, Fux B, G S, Gaal PA, Gaihre S, Gajdács M, Galali Y, Gallus S, Gandhi AP, Ganesan B, Ganiyani MA, Garcia V, Gardner WM, Garg RK, Gautam RK, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremariam TBB, Gebremeskel TG, Gerema U, Getacher L, Getahun GKA, Getie M, Ghadirian F, Ghafarian S, Ghaffari Jolfayi A, Ghailan KY, Ghajar A, Ghasemi M, Ghasempour Dabaghi G, Ghasemzadeh A, Ghassemi F, Ghazy RM, Gholami A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Gil AU, Gil GF, Gilbertson NM, Gill PS, Gill TK, Gindaba EZ, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golechha M, Goleij P, Golinelli D, Gomes NGM, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Gouravani M, Goyal A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Guha A, Guicciardi S, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta B, Gupta M, Gupta R, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Habibzadeh F, Habibzadeh P, Hadaro TS, Hadian Z, Haep N, Haghi-Aminjan H, Haghmorad D, Hagins H, Haile D, Hailu A, Hajj Ali A, Halboub ES, Halimi A, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hamdy NM, Hameed S, Hamidi S, Hammoud A, Hanif A, Hanifi N, Haq ZA, Haque MR, Harapan H, Hargono A, Haro JM, Hasaballah AI, Hasan I, Hasan MJ, Hasan SMM, Hasani H, Hasanian M, Hashmeh N, Hasnain MS, Hassan A, Hassan I, Hassan Zadeh Tabatabaei MS, Hassani S, Hassanipour S, Hassankhani H, Haubold J, Havmoeller RJ, Hay SI, Hebert JJ, Hegazi OE, Hegena TY, Heidari G, Heidari M, Helfer B, Hemmati M, Henson CA, Herbert ME, Herteliu C, Heuer A, Hezam K, Hinneh TK, Hiraike Y, Hoan NQ, Holla R, Hon J, Hoque ME, Horita N, Hossain S, Hosseini SE, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hoven H, Hsairi M, Hsu JM, Hu C, Huang J, Huda MN, Hulland EN, Hultström M, Hushmandi K, Hussain J, Hussein NR, Huynh CK, Huynh HH, Ibitoye SE, Idowu OO, Ihler AL, Ikeda N, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Inbaraj LR, Irham LM, Isa MA, Islam MR, Ismail F, Ismail NE, Iso H, Isola G, Iwagami M, Iwu CCD, Iwu-Jaja CJ, J V, Jaafari J, Jacob L, Jacobsen KH, Jadidi-Niaragh F, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jaiswal A, Jakovljevic M, Jalilzadeh Yengejeh R, Jamora RDG, Jatau AI, Javadov S, Javaheri T, Jayaram S, Jeganathan J, Jeswani BM, Jiang H, Johnson CO, Jokar M, Jomehzadeh N, Jonas JB, Joo T, Joseph A, Joseph N, Joshi V, Joshua CE, Jozwiak JJ, Jürisson M, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kahn EM, Kalani R, Kaliyadan F, Kalra S, Kamath R, Kanagasabai T, Kanchan T, Kandel H, Kanmiki EW, Kanmodi KK, Kansal SK, Kapner DJ, Kapoor N, Karagiannidis E, Karajizadeh M, Karakasis P, Karanth SD, Karaye IM, Karch A, Karim A, Karimi H, Karmakar S, Kashoo FZ, Kasraei H, Kassahun WD, Kassebaum NJ, Kassel MB, Katikireddi SV, Kauppila JH, Kawakami N, Kaydi N, Kayode GA, Kazemi F, Keiyoro PN, Kemmer L, Kempen JH, Kerr JA, Kesse-Guyot E, Khader YS, Khafaie MA, Khajuria H, Khalaji A, Khalil M, Khalilian A, Khamesipour F, Khan A, Khan MN, Khan M, Khan MJ, Khan MAB, Khanmohammadi S, Khatab K, Khatatbeh H, Khatatbeh MM, Khatib MN, Khavandegar A, Khayat Kashani HR, Khidri FF, Khodadoust E, Khormali M, Khorrami Z, Khosla AA, Khosrowjerdi M, Khreis H, Khusun H, Kifle ZD, Kim K, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Knibbs LD, Knudsen AKS, Koh DSQ, Kolahi AA, Kompani F, Kong J, Koren G, Korja M, Korshunov VA, Korzh O, Kosen S, Kothari N, Koul PA, Koulmane Laxminarayana SL, Krishan K, Krishnamoorthy V, Krishnamoorthy Y, Krishnan B, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kuddus MA, Kuddus M, Kugbey N, Kuitunen I, Kulimbet M, Kulkarni V, Kumar A, Kumar N, Kumar V, Kundu S, Kurmi OP, Kusnali A, Kusuma D, Kutluk T, La Vecchia C, Ladan MA, Laflamme L, Lahariya C, Lai DTC, Lal DK, Lallukka T, Lám J, Lan Q, Lan T, Landires I, Lanfranchi F, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lauriola P, Le HH, Le LKD, Le NHH, Le TTT, Leasher JL, Ledda C, Lee M, Lee PH, Lee SW, Lee SWH, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Lescinsky H, Leung J, Li MC, Li WZ, Li W, Li Y, Li Z, Ligade VS, Lim LL, Lim SS, Lin RT, Lin S, Liu C, Liu G, Liu J, Liu J, Liu RT, Liu S, Liu W, Liu X, Liu X, Livingstone KM, Llanaj E, Lohiya A, López-Bueno R, Lopukhov PD, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Luo L, lv H, M Amin HI, Ma ZF, Maass KL, Mabrok M, Machairas N, Machoy M, Mafhoumi A, Magdy Abd El Razek M, Maghazachi AA, Mahadeshwara Prasad DR, Maharaj SB, Mahmoud MA, Mahmoudi E, Majeed A, Makram OM, Makris KC, Malasala S, Maled V, Malhotra K, Malik AA, Malik I, Malinga LA, Malta DC, Mamun AA, Manda AL, Manla Y, Mansour A, Mansouri B, Mansouri P, Mansourian M, Mansournia MA, Mantovani LG, Manu E, Marateb HR, Maravilla JC, Marsh E, Martinez G, Martinez-Piedra R, Martini S, Martins-Melo FR, Martorell M, Marx W, Maryam S, Mathangasinghe Y, Mathioudakis AG, Matozinhos FP, Mattumpuram J, Maugeri A, Maulik PK, Mayeli M, Mazidi M, Mazzotti A, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail MA, McPhail SM, Mechili EA, Mehmood A, Mehmood K, Mehrabani-Zeinabad K, Mehrabi Nasab E, Meier T, Mejia-Rodriguez F, Mekene Meto T, Mekonnen BD, Menezes RG, Mengist B, Mensah GA, Mensah LG, Mentis AFA, Meo SA, Meretoja A, Meretoja TJ, Mersha AM, Mesfin BA, Mestrovic T, Mettananda KCD, Mettananda S, Miazgowski T, Micha G, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mirarefin M, Mirghafourvand M, Mirica A, Mirijello A, Mirrakhimov EM, Mirshahi A, Mirzaei M, Mishra AK, Mishra V, Mitchell PB, Mithra P, Mittal C, Moazen B, Moberg ME, Mocciaro G, Mohamadkhani A, Mohamed AZ, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammadi E, Mohammadi S, Mohammadian-Hafshejani A, Mohammadifard N, Mohammed H, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Monasta L, Mondello S, Moni MA, Moodi Ghalibaf A, Moore CE, Moradi M, Moradi Y, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosaddeghi Heris R, Mossialos E, Motappa R, Mougin V, Mousavi P, Msherghi A, Mubarik S, Muccioli L, Mueller UO, Mulita F, Mullany EC, Munjal K, Murillo-Zamora E, Murlimanju BV, Musina AM, Mustafa G, Muthu S, Muthupandian S, Muthusamy R, Muzaffar M, Myung W, Nafei A, Nagarajan AJ, Nagaraju SP, Nagel G, Naghavi M, Naghavi P, Naik GR, Naik G, Nainu F, Nair TS, Najdaghi S, Nakhostin Ansari N, Nanavaty DP, Nangia V, Narasimha Swamy S, Narimani Davani D, Nascimento BR, Nascimento GG, Nashwan AJ, Natto ZS, Nauman J, Navaratna SNK, Naveed M, Nayak BP, Nayak VC, Ndejjo R, Nduaguba SO, Negash H, Negoi I, Negoi RI, Nejadghaderi SA, Nejjari C, Nematollahi MH, Nepal S, Neupane S, Ng M, Nguefack-Tsague G, Ngunjiri JW, Nguyen DH, Nguyen NNY, Nguyen PT, Nguyen PT, Nguyen VT, Nguyen Tran Minh D, Niazi RK, Nicholson SI, Nie J, Nikoobar A, Nikpoor AR, Ningrum DNA, Nnaji CA, Noman EA, Nomura S, Noroozi N, Norrving B, Noubiap JJ, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nunemo MH, Nurrika D, Nutor JJ, Oancea B, O'Connell EM, Odetokun IA, O'Donnell MJ, Oduro MS, Ogunfowokan AA, Ogunkoya A, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olasupo OO, Olatubi MI, Oliveira AB, Oliveira GMM, Olorukooba AA, Olufadewa II, Olusanya BO, Olusanya JO, Oluwafemi YD, Omar HA, Omar Bali A, Omer GL, Ong KL, Ong S, Onwujekwe OE, Onyedibe KI, Oppong AF, Ordak M, Orish VN, Ornello R, Orpana HM, Ortiz A, Ortiz-Prado E, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Owolabi MO, Oyeyemi IT, Oyeyemi OT, P A MP, Pacheco-Barrios K, Padron-Monedero A, Padubidri JR, Pal PK, Palicz T, Pan F, Pan HF, Pana A, Panda SK, Panda-Jonas S, Pandey A, Pandi-Perumal SR, Pangaribuan HU, Pantazopoulos I, Pantea Stoian AM, Papadopoulou P, Parent MC, Parija PP, Parikh RR, Park S, Park S, Parsons N, Pashaei A, Pasovic M, Passera R, Patil S, Patoulias D, Patthipati VS, Paudel U, Pawar S, Pazoki Toroudi H, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah EK, Peprah P, Peres MFP, Perianayagam A, Perico N, Perna S, Pesudovs K, Petcu IR, Petermann-Rocha FE, Pham HT, Philip AK, Phillips MR, Pickering BV, Pierannunzio D, Pigeolet M, Pigott DM, Piracha ZZ, Piradov MA, Pisoni E, Piyasena MP, Plass D, Plotnikov E, Poddighe D, Polkinghorne KR, Poluru R, Pond CD, Popovic DS, Porru F, Postma MJ, Poudel GR, Pour-Rashidi A, Pourshams A, Pourtaheri N, Prabhu D, Prada SI, Pradhan J, Pradhan PMS, Prasad M, Prates EJS, Purnobasuki H, Purohit BM, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Qiu S, Rabiee Rad M, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Rafiei A, Raggi A, Raghav PR, Raheem N, Rahim F, Rahim MJ, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahmani AM, Rahmani B, Rahmanian M, Rahmanian N, Rahmanian V, Rahmati M, Rahmawaty S, Raimondo D, Rajaa S, Rajendran V, Rajput P, Ramadan MM, Ramasamy SK, Ramasubramani P, Ramazanu S, Ramteke PW, Rana J, Rana K, Ranabhat CL, Rane A, Rani U, Ranta A, Rao CR, Rao M, Rao PC, Rao SJ, Rasella D, Rashedi S, Rashedi V, Rashidi M, Rashidi MM, Rasouli-Saravani A, Ratan ZA, Rathnaiah Babu G, Rauniyar SK, Rautalin I, Rawaf DL, Rawaf S, Rawassizadeh R, Razo C, Reda ZFF, Reddy MMRK, Redwan EMM, Reifels L, Reitsma MB, Remuzzi G, Reshmi B, Resnikoff S, Restaino S, Reyes LF, Rezaei M, Rezaei N, Rezaei N, Rezaeian M, Rhee TG, Riaz MA, Ribeiro ALP, Rickard J, Robinson-Oden HE, Rodrigues CF, Rodrigues M, Rodriguez JAB, Roever L, Romadlon DS, Ronfani L, Rosauer JJ, Roshandel G, Rostamian M, Rotimi K, Rout HS, Roy B, Roy N, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Russo M, Ruzzante SW, S N C, Saad AMA, Saber K, Saber-Ayad MM, Sabour S, Sacco S, Sachdev PS, Sachdeva R, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi M, Sadeghi Majd E, Saeb MR, Saeed U, Safari M, Safi S, Safi SZ, Sagar R, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahu M, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salamati P, Salami AA, Salaroli LB, Salehi L, Salehi S, Salem MR, Salem MZY, Salihu D, Salimi S, Salum GA, Samadi Kafil H, Samadzadeh S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanjeev RK, Sanna F, Santomauro DF, Santric-Milicevic MM, Sarasmita MA, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sartorius B, Sarveazad A, Sathian B, Sattin D, Sawhney M, Saya GK, Sayeed A, Sayeed MA, Sayyah M, Schinckus C, Schmidt MI, Schuermans A, Schumacher AE, Schutte AE, Schwarzinger M, Schwebel DC, Schwendicke F, Selvaraj S, Semreen MH, Senthilkumaran S, Serban D, Serre ML, Sethi Y, Shafie M, Shah H, Shah NS, Shah PA, Shah SM, Shahbandi A, Shaheen AA, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh MA, Shaikh SZ, Shalash AS, Sham S, Shamim MA, Shams-Beyranvand M, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma M, Sharma U, Sharma V, Shastry RP, Shavandi A, Shehabeldine AME, Shehzadi S, Sheikh A, Shen J, Shetty A, Shetty BSK, Shetty PH, Shiani A, Shiferaw D, Shigematsu M, Shin MJ, Shiri R, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shool S, Shorofi SA, Shrestha R, Shrestha S, Shuja KH, Shuval K, Si Y, Siddig EE, Silva DAS, Silva LMLR, Silva S, Silva TPR, Simpson CR, Singh A, Singh BB, Singh B, Singh G, Singh H, Singh JA, Singh M, Singh NP, Singh P, Singh S, Sinto R, Sivakumar S, Siwal SS, Skhvitaridze N, Skou ST, Sleet DA, Sobia F, Soboka M, Socea B, Solaimanian S, Solanki R, Solanki S, Soliman SSM, Somayaji R, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Spearman S, Spencer CN, Sreeramareddy CT, Stachteas P, Stafford LK, Stanaway JD, Stanikzai MH, Stein C, Stein DJ, Steinbeis F, Steiner C, Steinke S, Steiropoulos P, Stockfelt L, Stokes MA, Straif K, Stranges S, Subedi N, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sundström J, Sunkersing D, Sunnerhagen KS, Suresh V, Swain CK, Szarpak L, Szeto MD, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabche C, Tabish M, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Takahashi K, Talaat IM, Tamuzi JL, Tan KK, Tang H, Tat NY, Taveira N, Tefera YM, Tehrani-Banihashemi A, Temesgen WA, Temsah MH, Teramoto M, Terefa DR, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Thapar R, Thayakaran R, Thirunavukkarasu S, Thomas N, Thomas NK, Tian J, Tichopad A, Ticoalu JHV, Tiruye TY, Tobe-Gai R, Tolani MA, Tolossa T, Tonelli M, Topor-Madry R, Topouzis F, Touvier M, Tovani-Palone MR, Trabelsi K, Tran JT, Tran MTN, Tran NM, Trico D, Trihandini I, Troeger CE, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsermpini EE, Tumurkhuu M, Udoakang AJ, Udoh A, Ullah A, Ullah S, Ullah S, Umair M, Umakanthan S, Unim B, Unnikrishnan B, Upadhyay E, Urso D, Usman JS, Vaithinathan AG, Vakili O, Valenti M, Valizadeh R, Van den Eynde J, van Donkelaar A, Varga O, Vart P, Varthya SB, Vasankari TJ, Vasic M, Vaziri S, Venketasubramanian N, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Villalobos-Daniel VE, Villani L, Villanueva GI, Vinayak M, Violante FS, Vlassov V, Vo B, Vollset SE, Volovat SR, Vos T, Vujcic IS, Waheed Y, Wang C, Wang F, Wang S, Wang Y, Wang YP, Wanjau MN, Waqas M, Ward P, Waris A, Wassie EG, Weerakoon KG, Weintraub RG, Weiss DJ, Weiss EJ, Weldetinsaa HLL, Wells KM, Wen YF, Wiangkham T, Wickramasinghe ND, Wilkerson C, Willeit P, Wilson S, Wong YJ, Wongsin U, Wozniak S, Wu C, Wu D, Wu F, Wu Z, Xia J, Xiao H, Xu S, Xu X, Xu YY, Yadav MK, Yaghoubi S, Yamagishi K, Yang L, Yano Y, Yaribeygi H, Yasufuku Y, Ye P, Yesodharan R, Yesuf SA, Yezli S, Yi S, Yiğit A, Yigzaw ZA, Yin D, Yip P, Yismaw MB, Yon DK, Yonemoto N, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Zadey S, Zadnik V, Zakham F, Zaki N, Zakzuk J, Zamagni G, Zaman SB, Zandieh GGZ, Zanghì A, Zar HJ, Zare I, Zarimeidani F, Zastrozhin MS, Zeng Y, Zhai C, Zhang AL, Zhang H, Zhang L, Zhang M, Zhang Y, Zhang Z, Zhang ZJ, Zhao H, Zhao JT, Zhao XJG, Zhao Y, Zhao Y, Zhong C, Zhou J, Zhou J, Zhou S, Zhu B, Zhu L, Zhu Z, Ziaeian B, Ziafati M, Zielińska M, Zimsen SRM, Zoghi G, Zoller T, Zumla A, Zyoud SH, Zyoud SH, Murray CJL, Gakidou E. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2162-2203. [PMID: 38762324 DOI: 10.1016/s0140-6736(24)00933-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/11/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. METHODS The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk-outcome pairs. Pairs were included on the basis of data-driven determination of a risk-outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk-outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk-outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. FINDINGS Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7-9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4-9·2]), smoking (5·7% [4·7-6·8]), low birthweight and short gestation (5·6% [4·8-6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8-6·0]). For younger demographics (ie, those aged 0-4 years and 5-14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9-27·7]) and environmental and occupational risks (decrease of 22·0% [15·5-28·8]), coupled with a 49·4% (42·3-56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9-21·7] for high BMI and 7·9% [3·3-12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6-1·9) for high BMI and 1·3% (1·1-1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4-78·8) for child growth failure and 66·3% (60·2-72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). INTERPRETATION Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
3
|
Poudel GR, Sharma P, Lorenzetti V, Parsons N, Cerin E. Network Representation of fMRI Data Using Visibility Graphs: The Impact of Motion and Test-Retest Reliability. Neuroinformatics 2024; 22:107-118. [PMID: 38332409 PMCID: PMC11021232 DOI: 10.1007/s12021-024-09652-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
Visibility graphs provide a novel approach for analysing time-series data. Graph theoretical analysis of visibility graphs can provide new features for data mining applications in fMRI. However, visibility graphs features have not been used widely in the field of neuroscience. This is likely due to a lack of understanding of their robustness in the presence of noise (e.g., motion) and their test-retest reliability. In this study, we investigated visibility graph properties of fMRI data in the human connectome project (N = 1010) and tested their sensitivity to motion and test-retest reliability. We also characterised the strength of connectivity obtained using degree synchrony of visibility graphs. We found that strong correlation (r > 0.5) between visibility graph properties, such as the number of communities and average degrees, and motion in the fMRI data. The test-retest reliability (Intraclass correlation coefficient (ICC)) of graph theoretical features was high for the average degrees (0.74, 95% CI = [0.73, 0.75]), and moderate for clustering coefficient (0.43, 95% CI = [0.41, 0.44]) and average path length (0.41, 95% CI = [0.38, 0.44]). Functional connectivity between brain regions was measured by correlating the visibility graph degrees. However, the strength of correlation was found to be moderate to low (r < 0.35). These findings suggest that even small movement in fMRI data can strongly influence robustness and reliability of visibility graph features, thus, requiring robust motion correction strategies prior to data analysis. Further studies are necessary for better understanding of the potential application of visibility graph features in fMRI.
Collapse
Affiliation(s)
- Govinda R Poudel
- Mary Mackillop Institute for Health Research, Australian Catholic University, 215 Spring Street, Melbourne, 3000, Australia.
- Braincast Neurotechnologies, Melbourne, Australia.
| | - Prabin Sharma
- Department of Computer Science, University of Massachusetts, Boston, MA, USA.
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, The Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.
| | - Nicholas Parsons
- School of Psychological Sciences, Monash University, Melbourne, Australia.
- Braincast Neurotechnologies, Melbourne, Australia.
| | - Ester Cerin
- Mary Mackillop Institute for Health Research, Australian Catholic University, 215 Spring Street, Melbourne, 3000, Australia.
| |
Collapse
|
4
|
Younger E, Ellis EG, Parsons N, Pantano P, Tommasin S, Caeyenberghs K, Benito-León J, Romero JP, Joutsa J, Corp DT. Mapping Essential Tremor to a Common Brain Network Using Functional Connectivity Analysis. Neurology 2023; 101:e1483-e1494. [PMID: 37596042 PMCID: PMC10585696 DOI: 10.1212/wnl.0000000000207701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The cerebello-thalamo-cortical circuit plays a critical role in essential tremor (ET). However, abnormalities have been reported in multiple brain regions outside this circuit, leading to inconsistent characterization of ET pathophysiology. Here, we test whether these mixed findings in ET localize to a common functional network and whether this network has therapeutic relevance. METHODS We conducted a systematic literature search to identify studies reporting structural or metabolic brain abnormalities in ET. We then used 'coordinate network mapping,' which leverages a normative connectome (n = 1,000) of resting-state fMRI data to identify regions commonly connected to findings across all studies. To assess whether these regions may be relevant for the treatment of ET, we compared our network with a therapeutic network derived from lesions that relieved ET. Finally, we investigated whether the functional connectivity of this ET symptom network is abnormal in an independent cohort of patients with ET as compared with healthy controls. RESULTS Structural and metabolic brain abnormalities in ET were located in heterogeneous regions throughout the brain. However, these coordinates were connected to a common functional brain network, including the cerebellum, thalamus, motor cortex, precuneus, inferior parietal lobe, and insula. The cerebellum was identified as the hub of this network because it was the only brain region that was both functionally connected to the findings of over 90% of studies and significantly different in connectivity compared with a control data set of other movement disorders. This network was strikingly similar to the therapeutic network derived from lesions improving ET, with key regions aligning in the thalamus and cerebellum. Furthermore, positive functional connectivity between the cerebellar network hub and the sensorimotor cortices was significantly reduced in patients with ET compared with healthy controls, and connectivity within this network was correlated with tremor severity and cognitive functioning. DISCUSSION These findings suggest that the cerebellum is the central hub of a network commonly connected to structural and metabolic abnormalities in ET. This network may have therapeutic utility in refining and informing new targets for neuromodulation of ET.
Collapse
Affiliation(s)
- Ellen Younger
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Elizabeth G Ellis
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nicholas Parsons
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrizia Pantano
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Silvia Tommasin
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karen Caeyenberghs
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julián Benito-León
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Juan Pablo Romero
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Juho Joutsa
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Daniel T Corp
- From the Cognitive Neuroscience Unit (E.Y., E.G.E., N.P., K.C., D.T.C.), School of Psychology, Deakin University, Geelong, Australia; Human Neuroscience (P.P., S.T.), Sapienza University of Rome; IRCCS NEUROMED (P.P.), Pozzilli, Italy; Department of Neurology (J.B.-L.) and Research Institute (i+12), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine (J.B.-L.), Complutense University; Facultad de Ciencias Experimentales (J.P.R.), Universidad Francisco de Vitoria; Brain Damage Unit (J.P.R.), Hospital Beata María Ana, Madrid, Spain; Turku Brain and Mind Center (J.J.), Clinical Neurosciences, University of Turku; Turku PET Centre (J.J.), Neurocenter, Turku University Hospital, Finland; and Center for Brain Circuit Therapeutics (D.T.C.), Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
Tabu I, Goh EL, Appelbe D, Parsons N, Lekamwasam S, Lee JK, Amphansap T, Pandey D, Costa M. Service availability and readiness for hip fracture care in low- and middle-income countries in South and Southeast Asia. Bone Jt Open 2023; 4:676-681. [PMID: 37666496 PMCID: PMC10477024 DOI: 10.1302/2633-1462.49.bjo-2023-0075.r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Aims The aim of this study was to describe the current pathways of care for patients with a fracture of the hip in five low- and middle-income countries (LMIC) in South Asia (Nepal and Sri Lanka) and Southeast Asia (Malaysia, Thailand, and the Philippines). Methods The World Health Organization Service Availability and Readiness Assessment tool was used to collect data on the care of hip fractures in Malaysia, Thailand, the Philippines, Sri Lanka, and Nepal. Respondents were asked to provide details about the current pathway of care for patients with hip fracture, including pre-hospital transport, time to admission, time to surgery, and time to weightbearing, along with healthcare professionals involved at different stages of care, information on discharge, and patient follow-up. Results Responses were received from 98 representative hospitals across the five countries. Most hospitals were publicly funded. There was consistency in clinical pathways of care within country, but considerable variation between countries. Patients mostly travel to hospital via ambulance (both publicly- and privately-funded) or private transport, with only half arriving at hospital within 12 hours of their injury. Access to surgery was variable and time to surgery ranged between one day and more than five days. The majority of hospitals mobilized patients on the first or second day after surgery, but there was notable variation in postoperative weightbearing protocols. Senior medical input was variable and specialist orthogeriatric expertise was unavailable in most hospitals. Conclusion This study provides the first step in mapping care pathways for patients with hip fracture in LMIC in South Asia. The previous lack of data in these countries hampers efforts to identify quality standards (key performance indicators) that are relevant to each different healthcare system.
Collapse
Affiliation(s)
- Irewin Tabu
- Department of Orthopedics, University of the Philippines Manila, Manila, Philippines
- Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - En L. Goh
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Duncan Appelbe
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Sarath Lekamwasam
- University of Ruhuna, Matara, Sri Lanka
- Department of Medicine, University of Ruhuna, Matara, Sri Lanka
| | | | | | | | - Matthew Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - On behalf of FERMAT collaborators and the Global Fragility Fracture Network Hip Fracture Audit Special Interest Group
- Department of Orthopedics, University of the Philippines Manila, Manila, Philippines
- Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University of Warwick Faculty of Medicine, Coventry, UK
- University of Ruhuna, Matara, Sri Lanka
- Department of Medicine, University of Ruhuna, Matara, Sri Lanka
- Beacon Hospital, Petaling Jaya, Malaysia
- Police General Hospital, Bangkok, Thailand
- National Trauma Center, Kathmandu, Nepal
| |
Collapse
|
6
|
Hawkes CA, Staniszewska S, Vlaev I, Perkins GD, Howe D, Khalifa E, Mustafa Y, Parsons N, Lin YL, Rycroft-Malone J. Facilitating cardiopulmonary resuscitation training in high-risk areas of England: A study protocol. Resusc Plus 2023; 15:100407. [PMID: 37363123 PMCID: PMC10285558 DOI: 10.1016/j.resplu.2023.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Introduction Bystanders' interventions improve chances of survival from out-of-hospital cardiac arrest (OHCA) before Emergency Medical Services arrive. Some areas in England are of concern. These high-risk areas have a higher incidence of cardiac arrest combined with lower-than-average bystander CPR rates and are characterised by higher proportions of minority ethnic group residents and deprivation.Collaborating with people from the Black African and Caribbean and South Asian minority communities in deprived areas of England, we aim to develop and evaluate the implementation of theoretically informed intervention(s) to address factors contributing to lower bystander intervention rates. Methods The study is a collaborative realist enquiry, informed by the Theoretical Domains Framework and associated Behaviour Change Wheel. It consists of 1) a realist evidence synthesis to produce initial program theories developed from primary workshop data and published evidence. It will include identifying factors contributing to the issue and potential interventions to address them; 2) theoretically informed intervention development, using the initial program theories and behaviour change theory and 3) a realist mixed methods implementation evaluation with embedded feasibility.Public involvement (PPI) as study team and public advisory group members is key to this study.We will conduct realist evidence synthesis, qualitative and statistical analyses appropriate to the various methods used. Dissemination We will develop a dissemination plan and materials targeted to members of the public in high-risk areas as well as academic outputs. We will hold an event for participating community groups and stakeholders to share findings and seek advice on next steps. Study registration ISRCTN90350842. Registration date 28.03.2023. The study was registered after its start date.
Collapse
Affiliation(s)
- Claire A Hawkes
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8AW, UK
| | | | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Birmingham, Birmingham, UK
| | - Deska Howe
- Public Involvement Team Member, West Bromwich African Caribbean Resource Centre
| | | | | | | | - Yin-Ling Lin
- Warwick Medical School, University of Warwick, Coventry, UK
| | | |
Collapse
|
7
|
Parsons N, Irimia A, Amgalan A, Ugon J, Morgan K, Shelyag S, Hocking A, Poudel G, Caeyenberghs K. Structural-functional connectivity bandwidth predicts processing speed in mild traumatic brain Injury: A multiplex network analysis. Neuroimage Clin 2023; 38:103428. [PMID: 37167841 PMCID: PMC10196722 DOI: 10.1016/j.nicl.2023.103428] [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: 01/10/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
An emerging body of work has revealed alterations in structural (SC) and functional (FC) brain connectivity following mild TBI (mTBI), with mixed findings. However, these studies seldom integrate complimentary neuroimaging modalities within a unified framework. Multilayer network analysis is an emerging technique to uncover how white matter organization enables functional communication. Using our novel graph metric (SC-FC Bandwidth), we quantified the information capacity of synchronous brain regions in 53 mild TBI patients (46 females; age mean = 40.2 years (y), σ = 16.7 (y), range: 18-79 (y). Diffusion MRI and resting state fMRI were administered at the acute and chronic post-injury intervals. Moreover, participants completed a cognitive task to measure processing speed (30 Seconds and Counting Task; 30-SACT). Processing speed was significantly increased at the chronic, relative to the acute post-injury intervals (p = <0.001). Nonlinear principal components of direct (t = -1.84, p = 0.06) and indirect SC-FC Bandwidth (t = 3.86, p = <0.001) predicted processing speed with a moderate effect size (R2 = 0.43, p < 0.001), while controlling for age. A subnetwork of interhemispheric edges with increased SC-FC Bandwidth was identified at the chronic, relative to the acute mTBI post-injury interval (pFDR = 0.05). Increased interhemispheric SC-FC Bandwidth of this network corresponded with improved processing speed at the chronic post-injury interval (partial r = 0.32, p = 0.02). Our findings revealed that mild TBI results in complex reorganization of brain connectivity optimized for maximum information flow, supporting improved cognitive performance as a compensatory mechanism. Moving forward, this measurement may complement clinical assessment as an objective marker of mTBI recovery.
Collapse
Affiliation(s)
- Nicholas Parsons
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia; BrainCast Neurotechnologies, Australia; School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Julien Ugon
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Kerri Morgan
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Sergiy Shelyag
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Alex Hocking
- School of Information Technology, Faculty of Science Engineering Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Govinda Poudel
- BrainCast Neurotechnologies, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia
| |
Collapse
|
8
|
Lei II, Tompkins K, White E, Watson A, Parsons N, Noufaily A, Segui S, Wenzek H, Badreldin R, Conlin A, Arasaradnam RP. Study of capsule endoscopy delivery at scale through enhanced artificial intelligence-enabled analysis (the CESCAIL study). Colorectal Dis 2023. [PMID: 37272471 DOI: 10.1111/codi.16575] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/05/2023] [Accepted: 03/21/2023] [Indexed: 06/06/2023]
Abstract
AIM Lower gastrointestinal (GI) diagnostics have been facing relentless capacity constraints for many years, even before the COVID-19 era. Restrictions from the COVID pandemic have resulted in a significant backlog in lower GI diagnostics. Given recent developments in deep neural networks (DNNs) and the application of artificial intelligence (AI) in endoscopy, automating capsule video analysis is now within reach. Comparable to the efficiency and accuracy of AI applications in small bowel capsule endoscopy, AI in colon capsule analysis will also improve the efficiency of video reading and address the relentless demand on lower GI services. The aim of the CESCAIL study is to determine the feasibility, accuracy and productivity of AI-enabled analysis tools (AiSPEED) for polyp detection compared with the 'gold standard': a conventional care pathway with clinician analysis. METHOD This multi-centre, diagnostic accuracy study aims to recruit 674 participants retrospectively and prospectively from centres conducting colon capsule endoscopy (CCE) as part of their standard care pathway. After the study participants have undergone CCE, the colon capsule videos will be uploaded onto two different pathways: AI-enabled video analysis and the gold standard conventional clinician analysis pathway. The reports generated from both pathways will be compared for accuracy (sensitivity and specificity). The reading time can only be compared in the prospective cohort. In addition to validating the AI tool, this study will also provide observational data concerning its use to assess the pathway execution in real-world performance. RESULTS The study is currently recruiting participants at multiple centres within the United Kingdom and is at the stage of collecting data. CONCLUSION This standard diagnostic accuracy study carries no additional risk to patients as it does not affect the standard care pathway, and hence patient care remains unaffected.
Collapse
Affiliation(s)
- Ian Io Lei
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Katie Tompkins
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Angus Watson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | - Santi Segui
- Department of Maths and Computer Science, University of Barcelona, Barcelona, Spain
| | - Hagen Wenzek
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rawya Badreldin
- Department of Gastroenterology, James Paget University Hospitals NHS Foundation Trust, Lowestoft, UK
| | - Abby Conlin
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Leicester Cancer Centre, University of Leicester, Leicester, UK
| |
Collapse
|
9
|
Dharan AL, Bowden SC, Peterson A, Lai A, Seneviratne U, Dabscheck G, Nurse E, Loughman A, Parsons N, D'Souza WJ. A cross-sectional investigation of cognition and epileptiform discharges in juvenile absence epilepsy. Epilepsia 2023; 64:742-753. [PMID: 36625418 DOI: 10.1111/epi.17505] [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: 09/25/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Despite the prevalence of cognitive symptoms in the idiopathic generalized epilepsies (IGEs), cognitive dysfunction in juvenile absence epilepsy (JAE), a common yet understudied IGE subtype, remains poorly understood. This descriptive study provides a novel, comprehensive characterization of cognitive functioning in a JAE sample and examines the relationship between cognition and 24-h epileptiform discharge load. METHOD Forty-four individuals diagnosed with JAE underwent cognitive assessment using Woodcock Johnson III Test of Cognitive Abilities with concurrent 24-h ambulatory EEG monitoring. Generalized epileptiform discharges of any length, and prolonged generalized discharges ≥3 s were quantified across wakefulness and sleep. The relationship between standardized cognitive scores and epileptiform discharges was assessed through regression models. RESULTS Cognitive performances in overall intellectual ability, acquired comprehension-knowledge, processing speed, long-term memory storage and retrieval, and executive processes were 0.63-1.07 standard deviation (SD) units lower in the JAE group compared to the population reference mean, adjusted for educational attainment. Prolonged discharges (≥3 s) were recorded in 20 patients (47.6%) from 42 available electroencephalography (EEG) studies and were largely unreported. Duration and number of prolonged discharges were associated with reduced processing speed and long-term memory storage and retrieval. SIGNIFICANCE Cognitive dysfunction is seen in patients with JAE across various cognitive abilities, including those representing more stable processes like general intellect. During 24-h EEG, prolonged epileptiform discharges are common yet underreported in JAE despite treatment, and they show moderate effects on cognitive abilities. If epileptiform burden is a modifiable predictor of cognitive dysfunction, therapeutic interventions should consider quantitative 24-h EEG with routine neuropsychological screening. The growing recognition of the spectrum of neuropsychological comorbidities of IGE highlights the value of multidisciplinary approaches to explore the causes and consequences of cognitive deficits in epilepsy.
Collapse
Affiliation(s)
- Anita L Dharan
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andre Peterson
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash Medical Centre Clayton, Melbourne, Victoria, Australia
| | - Gabriel Dabscheck
- Department of Neurology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neurosciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ewan Nurse
- Seer Medical Inc Research, Melbourne, Victoria, Australia
| | - Amy Loughman
- Food & Mood Centre, Institute of Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Nicholas Parsons
- Deakin University, Cognitive Neuroscience Unit, School of Psychology, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| |
Collapse
|
10
|
Sharma K, Berry L, Vryonis E, Ali A, Lara B, Noufaily A, Parsons N, Bradley C, Haley B, Tabuso M, Arasaradnam RP. Prospective, randomised, parallel-group, open-label study to evaluate the effectiveness and safety of IMU-838, in combination with oseltamivir, in adults with COVID-19: the IONIC trial protocol. BMJ Open 2022; 12:e055205. [PMID: 36396307 PMCID: PMC9676417 DOI: 10.1136/bmjopen-2021-055205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, there is a scarcity of effective treatments for SARS-CoV-2 infections (causing COVID-19). Repurposing existing medications may offer the best hope for treating patients with COVID-19 to curb the pandemic. IMU-838 is a dihydroorotate dehydrogenase inhibitor, which is an effective mechanism for antiviral effects against respiratory viruses. When used synergistically with oseltamivir, therapeutic effects have been observed against influenza and SARS-CoV-2 in rodents. The IMU-838 and Oseltamivir in the Treatment of COVID-19 (IONIC) trial is a randomised controlled trial that will investigate whether time to clinical improvement in patients with COVID-19 is improved following a 14-day course of IMU-838+oseltamivir versus oseltamivir alone. METHODS IONIC trial is an open-label study in which participants will be randomised 1:1 in two parallel arms: the intervention arm (IMU-838+oseltamivir) and the control arm (oseltamivir only). The primary outcome is time to clinical improvement; defined as the time from randomisation to a two-point improvement on WHO ordinal scale; discharge from hospital, or death (whichever occurs first). The study is sponsored by the University Hospitals Coventry and Warwickshire NHS Trust and funded by LifeArc. DISCUSSION The IONIC protocol describes an overarching trial design to provide reliable evidence on the effectiveness of IMU-838 (vidofludimus calcium) when delivered in combination with an antiviral therapy (oseltamivir) (IONIC intervention) for confirmed or suspected COVID-19 infection in adult patients receiving usual standard of care. ETHICS AND DISSEMINATION This study has been independently reviewed and approved by Wales Research Ethics Committee. In addition, required regulatory approvals were received from Medicines and Healthcare products Regulatory Agency. TRIAL REGISTRATION NUMBER EudraCT 2020-001805-21, ISRCTN53038326, NCT04516915.
Collapse
Affiliation(s)
- Kavi Sharma
- Research & Development, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
- Division of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Lisa Berry
- R&D, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Evangelos Vryonis
- R&D, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Asad Ali
- R&D, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Beatriz Lara
- Department of Cardiology and Respiratory, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Angela Noufaily
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicholas Parsons
- Statistics and Epidemiology, Warwick Medical School, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Becky Haley
- R&D, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria Tabuso
- R&D, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ramesh P Arasaradnam
- Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- University of Warwick, Coventry, UK
| |
Collapse
|
11
|
Ahmed I, Dhaif F, Khatri C, Parsons N, Hutchinson C, Staniszewska S, Price A, Metcalfe A. The meniscal tear outcome (METRO) review: A systematic review summarising the clinical course and outcomes of patients with a meniscal tear. Knee 2022; 38:117-131. [PMID: 36041240 DOI: 10.1016/j.knee.2022.07.002] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes. METHOD A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints. RESULTS 35 studies were included, 28 reported outcomes following APM; four following meniscal repair and three following meniscal transplant. Graphical plots demonstrated a sustained improvement for all treatment interventions. A moderate to very strong correlation was reported between baseline and three-month outcomes. In the medium term, there was small significant difference in outcome between APM and non-operative measures (SMD 0.17; 95 % CI 0.04, 0.29), however, this was not clinically significant. CONCLUSIONS Patients with a meniscal tear demonstrated a sustained initial improvement in function scores, which was true of all treatments examined. APM may have little benefit in older people, however, previous trials did not include patients who meet the current indications for surgery as a result the findings should not be generalised to all patients with a meniscal tear. Further trials are required in patients who meet current operative indications.
Collapse
Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Fatema Dhaif
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Chetan Khatri
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Nicholas Parsons
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV47AL, United Kingdom.
| | - Charles Hutchinson
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Sophie Staniszewska
- Warwick Medical School, University of Warwick, Coventry CV47AL, United Kingdom.
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Headington, Oxford OX3 7LD, United Kingdom.
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| |
Collapse
|
12
|
Png ME, Petrou S, Fernandez MA, Achten J, Parsons N, McGibbon A, Gould J, Griffin XL, Costa ML. Erratum. Bone Joint J 2022; 104-B:1190. [PMID: 36177647 DOI: 10.1302/0301-620x.104b9.bjj-2022-00025] [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: 11/05/2022]
|
13
|
Parsons N, Ugon J, Morgan K, Shelyag S, Hocking A, Chan SY, Poudel G, Domìnguez D JF, Caeyenberghs K. Structural-Functional Connectivity Bandwidth of the Human Brain. Neuroimage 2022; 263:119659. [PMID: 36191756 DOI: 10.1016/j.neuroimage.2022.119659] [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] [Received: 03/25/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The human brain is a complex network that seamlessly manifests behaviour and cognition. This network comprises neurons that directly, or indirectly mediate communication between brain regions. Here, we show how multilayer/multiplex network analysis provides a suitable framework to uncover the throughput of structural connectivity (SC) to mediate information transfer-giving rise to functional connectivity (FC). METHOD We implemented a novel method to reconcile SC and FC using diffusion and resting-state functional MRI connectivity data from 484 subjects (272 females, 212 males; age = 29.15 ± 3.47) from the Human Connectome Project. First, we counted the number of direct and indirect structural paths that mediate FC. FC nodes with indirect SC paths were then weighted according to their least restrictive SC path. We refer to this as SC-FC Bandwidth. We then mapped paths with the highest SC-FC Bandwidth across 7 canonical resting-state networks. FINDINGS We found that most pairs of FC nodes were connected by SC paths of length two and three (SC paths of length >5 were virtually non-existent). Direct SC-FC connections accounted for only 10% of all SC-FC connections. The majority of FC nodes without a direct SC path were mediated by a proportion of two (44%) or three SC path lengths (39%). Only a small proportion of FC nodes were mediated by SC path lengths of four (5%). We found high-bandwidth direct SC-FC connections show dense intra- and sparse inter-network connectivity, with a bilateral, anteroposterior distribution. High bandwidth SC-FC triangles have a right superomedial distribution within the somatomotor network. High-bandwidth SC-FC quads have a superoposterior distribution within the default mode network. CONCLUSION Our method allows the measurement of indirect SC-FC using undirected, weighted graphs derived from multimodal MRI data in order to map the location and throughput of SC to mediate FC. An extension of this work may be to explore how SC-FC Bandwidth changes over time, relates to cognition/behavior, and if this measure reflects a marker of neurological injury or psychiatric disorders.
Collapse
Affiliation(s)
- Nicholas Parsons
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia.
| | - Julien Ugon
- School of Information Technology, Faculty of Science Engineering & Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Kerri Morgan
- School of Information Technology, Faculty of Science Engineering & Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Sergiy Shelyag
- School of Information Technology, Faculty of Science Engineering & Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Alex Hocking
- School of Information Technology, Faculty of Science Engineering & Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Su Yuan Chan
- School of Information Technology, Faculty of Science Engineering & Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Govinda Poudel
- School of Information Technology, Faculty of Science Engineering & Built Environment, Deakin University, Melbourne, VIC, Australia
| | - Juan F Domìnguez D
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
14
|
Parsons N, Steward T, Clohesy R, Almgren H, Duehlmeyer L. A systematic review of resting-state functional connectivity in obesity: Refining current neurobiological frameworks and methodological considerations moving forward. Rev Endocr Metab Disord 2022; 23:861-879. [PMID: 34159504 DOI: 10.1007/s11154-021-09665-x] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/07/2023]
Abstract
Obesity is the second most common cause of preventable morbidity worldwide. Resting-state functional magnetic resonance imaging (fMRI) has been used extensively to characterise altered communication between brain regions in individuals with obesity, though findings from this research have not yet been systematically evaluated within the context of prominent neurobiological frameworks. This systematic review aggregated resting-state fMRI findings in individuals with obesity and evaluated the contribution of these findings to current neurobiological models. Findings were considered in relation to a triadic model of problematic eating, outlining disrupted communication between reward, inhibitory, and homeostatic systems. We identified a pattern of consistently increased orbitofrontal and decreased insula cortex resting-state functional connectivity in individuals with obesity in comparison to healthy weight controls. BOLD signal amplitude was also increased in people with obesity across studies, predominantly confined to subcortical regions, including the hippocampus, amygdala, and putamen. We posit that altered orbitofrontal cortex connectivity may be indicative of a shift in the valuation of food-based rewards and that dysfunctional insula connectivity likely contributes to altered homeostatic signal processing. Homeostatic violation signals in obesity may be maintained despite satiety, thereby 'hijacking' the executive system and promoting further food intake. Moving forward, we provide a roadmap for more reliable resting-state and task-based functional connectivity experiments, which must be reconciled within a common framework if we are to uncover the interplay between psychological and biological factors within current theoretical frameworks.
Collapse
Affiliation(s)
- Nicholas Parsons
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne Burwood Campus, VIC, Australia
| | - Trevor Steward
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Rebecca Clohesy
- School of Psychology, Deakin University, Melbourne Burwood Campus, VIC, Australia
| | - Hannes Almgren
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Data Analysis, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | | |
Collapse
|
15
|
Png ME, Petrou S, Fernandez MA, Achten J, Parsons N, McGibbon A, Gould J, Griffin XL, Costa ML. Cost-utility analysis of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures : the World Hip Trauma Evaluation 5 (WHiTE 5) trial. Bone Joint J 2022; 104-B:922-928. [PMID: 35909375 DOI: 10.1302/0301-620x.104b8.bjj-2022-0417.r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare the cost-effectiveness of cemented hemiarthroplasty (HA) versus hydroxyapatite-coated uncemented HA for the treatment of displaced intracapsular hip fractures in older adults. METHODS A within-trial economic evaluation was conducted based on data collected from the World Hip Trauma Evaluation 5 (WHiTE 5) multicentre randomized controlled trial in the UK. Resource use was measured over 12 months post-randomization using trial case report forms and participant-completed questionnaires. Cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY) gained from the NHS and personal social service perspective. Methodological uncertainty was addressed using sensitivity analysis, while decision uncertainty was represented graphically using confidence ellipses and cost-effectiveness acceptability curves. RESULTS The base-case analysis showed that cemented implants were cost-saving (mean cost difference -£961 (95% confidence interval (CI) -£2,292 to £370)) and increased QALYs (mean QALY difference 0.010 (95% CI 0.002 to 0.017)) when compared to uncemented implants. The probability of the cemented implant being cost-effective approximated between 95% and 97% at alternative cost-effectiveness thresholds held by decision-makers, and its net monetary benefit was positive. The findings remained robust against all the pre-planned sensitivity analyses. CONCLUSION This study shows that cemented HA is cost-effective compared with hydroxyapatite-coated uncemented HA in older adults with displaced intracapsular hip fractures. Cite this article: Bone Joint J 2022;104-B(8):922-928.
Collapse
Affiliation(s)
- May E Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Miguel A Fernandez
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Trauma and Orthopaedics, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Xavier L Griffin
- Bone and Joint Health, Blizard Institute, Queen Mary University London, London, UK.,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, London, UK
| | - Matthew L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
16
|
Parsons N, D’Aprano F, Parish A, Hughes ME, Outsikas A. Use of video self-modelling to teach combined vocational and social skills to an adult with autism spectrum disorder. JVR 2022. [DOI: 10.3233/jvr-221197] [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: 11/15/2022]
Abstract
BACKGROUND: Autistic adults have difficulty in learning vocational and social skills, which often translates into low employment rates. Video self-modelling (VSM) is an effective educational technique for high-support-needs autistic adults, with the ability to teach challenging vocational skills as well as basic social skills. OBJECTIVE: The present study examined the use of video self-modelling to teach vocational and social skills to a 22-year-old autistic adult. Target behaviours categories included (1) reading order forms, (2) transporting goods, and (3) engaging with customers. METHODS: A multiple baseline design was used to evaluate the effectiveness of the videos in teaching these target behaviours. The dependent variables were the percentage of tasks completed correctly, and quantitative prompt dependency, using a least-to-most prompting strategy. RESULTS: Results showed that VSM modestly improved reading order forms and transporting goods, and moderately improved engagement with customers. CONCLUSION: This intervention resulted in the successful employment of an autistic adult in a job that he desired, whilst teaching him skills he specifically struggled with. As such, VSM should be considered for others wanting to learn combined social and vocational skills.
Collapse
Affiliation(s)
- Nicholas Parsons
- Cognitive Neuroscience Unit, Deakin University, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Fiore D’Aprano
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Annie Parish
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Matthew E. Hughes
- Australian National Imaging Facility, Swinburne University, Melbourne, VIC, Australia
| | | |
Collapse
|
17
|
Dickenson E, Griffin XL, Achten J, Mironov K, O'Connor H, Parsons N, Murphy M, Wyse M, Mason J, Appelbe D, Athwal A, Griffin D. Randomised controlled trial comparing intraoperative cell salvage and autotransfusion with standard care in the treatment of hip fractures: a protocol for the WHITE 9 study. BMJ Open 2022; 12:e062338. [PMID: 35676006 PMCID: PMC9185657 DOI: 10.1136/bmjopen-2022-062338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION People who sustain a hip fracture are typically elderly, frail and require urgent surgery. Hip fracture and the urgent surgery is associated with acute blood loss, compounding patients' pre-existing comorbidities including anaemia. Approximately 30% of patients require a donor blood transfusion in the perioperative period. Donor blood transfusions are associated with increased rates of infections, allergic reactions and longer lengths of stay. Furthermore, there is a substantial cost associated with the use of donor blood. Cell salvage and autotransfusion is a technique that recovers, washes and transfuses blood lost during surgery back to the patient. The objective of this study is to determine the clinical and cost effectiveness of intraoperative cell salvage, compared with standard care, in improving health related quality-of-life of patients undergoing hip fracture surgery. METHODS AND ANALYSIS Multicentre, parallel group, two-arm, randomised controlled trial. Patients aged 60 years and older with a hip fracture treated with surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either undergo cell salvage and autotransfusion or they will follow the standard care pathway. Otherwise, all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: EuroQol-5D-5L HRQoL at 4 months post injury. Secondary outcomes will include complications, postoperative delirium, residential status, mobility, allogenic blood use, mortality and resource use. ETHICS AND DISSEMINATION NHS ethical approval was provided on 14 August 2019 (19/WA/0197) and the trial registered (ISRCTN15945622). After the conclusion of this trial, a manuscript will be prepared for peer-review publication. Results will be disseminated in lay form to participants and the public. TRIAL REGISTRATION NUMBER ISRCTN15945622.
Collapse
Affiliation(s)
| | - Xavier Luke Griffin
- Bone and Joint Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Honorary Trauma and Orthopaedic Surgeon, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Juul Achten
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katy Mironov
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Heather O'Connor
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Mike Murphy
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - Matthew Wyse
- Consultant Anaesthetist, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Duncan Appelbe
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amrita Athwal
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Damian Griffin
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
18
|
Nwankwo H, Mason J, Costa ML, Parsons N, Redmond A, Parsons H, Haque A, Kearney RS. Cost-utility analysis of cast compared to removable brace in the management of adult patients with ankle fractures. Bone Jt Open 2022; 3:455-462. [PMID: 35658671 PMCID: PMC9233419 DOI: 10.1302/2633-1462.36.bjo-2022-0036] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims To compare the cost-utility of removable brace compared with cast in the management of adult patients with ankle fracture. Methods A within-trial economic evaluation conducted from the UK NHS and personnel social services (PSS) perspective. Health resources and quality-of-life data were collected as part of the Ankle Injury Rehabilitation (AIR) multicentre, randomized controlled trial over a 12-month period using trial case report forms and patient-completed questionnaires. Cost-utility analysis was estimated in terms of the incremental cost per quality adjusted life year (QALY) gained. Estimate uncertainty was explored by bootstrapping, visualized on the incremental cost-effectiveness ratio plane. Net monetary benefit and probability of cost-effectiveness were evaluated at a range of willingness-to-pay thresholds and visualized graphically. Results The incremental cost and QALYs of using brace over a 12-month period were £46.73 (95% confidence interval (CI) £-9 to £147) and 0.0141 (95% CI -0.005 to 0.033), respectively. The cost per QALY gained was £3,318. The probability of brace being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 88%. The results remained robust to a range of sensitivity analyses. Conclusion This within-trial economic evaluation found that it is probable that using a removable brace provides good value to the NHS when compared to cast, in the management of adults with ankle fracture. Cite this article: Bone Jt Open 2022;3(6):455–462.
Collapse
Affiliation(s)
- Henry Nwankwo
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - James Mason
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Matthew L. Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Rheumatology, Musculoskeletal and Orthopaedic Sciences, University of Oxford, Oxford, UK
| | | | - Anthony Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Aminul Haque
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | |
Collapse
|
19
|
Metcalfe A, Parsons H, Parsons N, Brown J, Fox J, Gemperlé Mannion E, Haque A, Hutchinson C, Kearney R, Khan I, Lawrence T, Mason J, Stallard N, Underwood M, Drew S. Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): a group-sequential, double-blind, multicentre randomised controlled trial. Lancet 2022; 399:1954-1963. [PMID: 35461618 DOI: 10.1016/s0140-6736(22)00652-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears. METHODS We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590. FINDINGS Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design -4·2 [95% CI -8·2 to -0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups. INTERPRETATION In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears. FUNDING Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership.
Collapse
Affiliation(s)
- Andrew Metcalfe
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK.
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Aminul Haque
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Charles Hutchinson
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Rebecca Kearney
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Iftekhar Khan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tom Lawrence
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Drew
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
20
|
Costa ML, Achten J, Ooms A, Png ME, Cook J, Dritsaki M, Lamb SE, Lerner R, Draper K, Campolier M, Dakin H, McGibbon A, Parsons N, Hedley H, Dias J. Moulded cast compared with K-wire fixation after manipulation of an acute dorsally displaced distal radius fracture: the DRAFFT 2 RCT. Health Technol Assess 2022; 26:1-80. [PMID: 35152940 DOI: 10.3310/rlcf6332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with a displaced fracture of the distal radius are frequently offered surgical fixation. Manipulation of the fracture and moulded plaster casting is an alternative treatment that avoids metal implants, but evidence of its effectiveness is lacking. OBJECTIVE To compare functional outcomes, quality-of-life outcomes, complications and resource use among patients with a dorsally displaced fracture of the distal radius treated with manipulation and surgical fixation with Kirschner wires (K-wires) and those treated with manipulation and moulded cast. DESIGN Pragmatic, superiority, multicentre, randomised controlled trial with a health economic evaluation. SETTING A total of 36 orthopaedic trauma centres in the UK NHS. PARTICIPANTS Patients (aged ≥ 16 years) treated for an acute dorsally displaced fracture of the distal radius were potentially eligible. Patients were excluded if their injury had occurred > 2 weeks previously, if the fracture was open, if it extended > 3 cm from the radiocarpal joint or if it required open reduction, or if the participant was unable to complete questionnaires. INTERVENTIONS Participants were randomly assigned in theatre (1 : 1) to receive a moulded cast (i.e. the cast group) or surgical fixation with K-wires (i.e. the K-wire group) after fracture manipulation. MAIN OUTCOME MEASURES The primary outcome measure was the Patient-Rated Wrist Evaluation score at 12 months, analysed on an intention-to-treat basis. Health-related quality of life was recorded using the EuroQol-5 Dimensions, five-level version, and resource use was recorded from a health and personal social care perspective. RESULTS Between January 2017 and March 2019, 500 participants (mean age 60 years, 83% women) were randomly allocated to receive a moulded cast (n = 255) or surgical fixation with K-wire (n = 245) following a manipulation of their fracture. A total of 395 (80%) participants were included in the primary analysis at 12 months. There was no difference in the Patient-Rated Wrist Evaluation score at 1 year post randomisation [cast group: n = 200, mean score 21.2 (standard deviation 23.1); K-wire group: n = 195, mean score 20.7 (standard deviation 22.3); adjusted mean difference -0.34 (95% confidence interval -4.33 to 3.66); p = 0.87]. A total of 33 (13%) participants in the cast group required surgical fixation for loss of fracture position in the first 6 weeks, compared with one participant in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10). The base-case cost-effectiveness analysis showed that manipulation and surgical fixation with K-wires had a higher mean cost than manipulation and a moulded cast, despite similar mean effectiveness. The use of K-wires is unlikely to be cost-effective, and sensitivity analyses found this result to be robust. LIMITATIONS Because the interventions were identifiable, neither patients nor clinicians could be blind to their treatment. CONCLUSIONS Surgical fixation with K-wires was not found to be superior to moulded casting following manipulation of a dorsally displaced fracture of the distal radius, as measured by Patient-Rated Wrist Evaluation score. However, one in eight participants treated in a moulded cast required surgery for loss of fracture reduction in the first 6 weeks. After a successful closed reduction, clinicians may consider a moulded cast as a safe and cost-effective alternative to surgical fixation with K-wires. FUTURE WORK Further research should focus on optimal techniques for immobilisation and manipulation of this type of fracture, including optimal analgesia, and for rehabilitation of the patient after immobilisation. TRIAL REGISTRATION This trial is registered as ISRCTN11980540 and UKCRN Portfolio 208830. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 11. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Matthew L Costa
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Cook
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,College of Medicine and Health, St Luke's Campus, University of Exeter, Exeter, UK
| | - Robin Lerner
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Blizard Institute, Queen Mary University of London, London, UK
| | - Kylea Draper
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Marta Campolier
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Helen Dakin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alwin McGibbon
- Patient and public involvement group member, Wimbourne, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Hedley
- Department of Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Joseph Dias
- AToMS Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | |
Collapse
|
21
|
Abstract
BACKGROUND Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available. METHODS We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075). RESULTS A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups. CONCLUSIONS Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).
Collapse
Affiliation(s)
- Miguel A Fernandez
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Juul Achten
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Nicholas Parsons
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Xavier L Griffin
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - May-Ee Png
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Jenny Gould
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Alwin McGibbon
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Matthew L Costa
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| |
Collapse
|
22
|
Kearney R, McKeown R, Parsons N, Parsons H, Haque A, Brown J, Kefford S, Underwood M, Redmond A, Mason J, Nwankwo H, Costa M. Ankle Injury Rehabilitation (AIR): A multicentre randomised controlled trial and economic evaluation. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Duehlmeyer L, Parsons N, Malpas CB, Hester R. Functional connectivity during feedback learning in smokers. Addict Biol 2022; 27:e13109. [PMID: 34734457 DOI: 10.1111/adb.13109] [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: 03/04/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although it has been traditionally assumed that dysregulation of psychological processes in smokers results from activity within specific brain regions, an emerging view regards such dysregulation as attributable to aberrant communication between distinct brain regions. These processes can be measured during appropriate task paradigms such as the learning from errors task. This study aims to elucidate interactions between brain regions underlying the process of learning from errors, punishment and sensitivity to reward in dependent smokers. METHODS Functional MRI data from 23 age-matched dependent smokers (8 females, mean age = 25.48, SD = 4.46) and 23 controls (13 females, mean age = 24.83, SD = 5.99) were analysed during a feedback-based associative learning task. Functional connectivity between the dorsal anterior cingulate cortex, nucleus accumbens and reward/sensorimotor areas was investigated during a feedback learning task. RESULTS Behaviourally, smokers exhibited lower error correction rates and were less sensitive to punishment magnitude. Smokers showed increased functional connectivity between dorsal anterior cingulate cortex/nucleus accumbens seed regions and numerous reward-related target regions including the putamen, anterior cingulate and orbitofrontal cortex. CONCLUSIONS Reduced learning from errors and widespread aberrant functional connectivity contribute to the emerging functional characterisation of dependent smokers and may bear significant implications when considering the efficacy of smoking interventions.
Collapse
Affiliation(s)
- Leonie Duehlmeyer
- School of Psychological Sciences University of Melbourne Parkville Victoria Australia
| | - Nicholas Parsons
- Cognitive Neuroscience Unit, School of Psychology Deakin University Melbourne Victoria Australia
| | - Charles B. Malpas
- School of Psychological Sciences University of Melbourne Parkville Victoria Australia
- Department of Medicine, Royal Melbourne Hospital The University of Melbourne Melbourne Victoria Australia
- Department of Neurology Royal Melbourne Hospital Parkville Victoria Australia
| | - Robert Hester
- School of Psychological Sciences University of Melbourne Parkville Victoria Australia
| |
Collapse
|
24
|
Morant N, Milton A, Gilbert E, Johnson S, Parsons N, Singh S, Marwaha S. Vocational rehabilitation via social firms: a qualitative investigation of the views and experiences of employees with mental health problems, social firm managers and clinicians. BMC Psychiatry 2021; 21:566. [PMID: 34772380 PMCID: PMC8590221 DOI: 10.1186/s12888-021-03577-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Employment within social firms in the UK is under-developed and under-researched, but a potentially beneficial route to vocational rehabilitation for people with mental health problems. This study explores the views and experiences of employees with mental ill-health, managers of social firms and mental health clinicians, in order to understand the potential value of social firms for the vocational rehabilitation, employment and well-being of people with mental health problems. METHODS Semi-structured interviews were conducted with 23 employees with mental health problems in 11 social firms in England. A focus group and individual interviews were conducted with 12 managers of social firms. Two focus groups were held with 16 mental health clinicians. Data were analysed using thematic analysis. RESULTS Most employees expressed very positive views about working in a social firm. In responses from both employees and social firm managers, an overarching theme regarding the supportive ethos of social firms encompassed several related features: openness about mental health issues; peer, team and management support; flexibility; and support to progress and develop skills over time. Managers identified benefits of employing people with mental health problems who were sufficiently recovered. Knowledge of social firms within clinician focus groups was very limited, although clinicians thought they could be a welcome additional vocational resource. CONCLUSIONS High levels of job satisfaction among social firm employees may be explained by the supportive ethos of these working environments. Social firms have potential to be a helpful addition to the range of vocational pathways available for people with mental ill-health. Further mixed methods investigations of experiences and outcomes in order to understand who engages with and benefits from this form of vocational rehabilitation would be valuable in informing decisions about scaling up the model.
Collapse
Affiliation(s)
- Nicola Morant
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, W1T 7NF, London, UK.
| | - Alyssa Milton
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, W1T 7NF, London, UK
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Eleanor Gilbert
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, W1T 7NF, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Birmingham and Solihull Mental Health Trust, Birmingham, UK
| |
Collapse
|
25
|
Poudel GR, Hawes S, Innes CRH, Parsons N, Drummond SPA, Caeyensberghs K, Jones RD. RoWDI: rolling window detection of sleep intrusions in the awake brain using fMRI. J Neural Eng 2021; 18. [PMID: 34592721 DOI: 10.1088/1741-2552/ac2bb9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022]
Abstract
Objective.Brief episodes of sleep can intrude into the awake human brain due to lack of sleep or fatigue-compromising the safety of critical daily tasks (i.e. driving). These intrusions can also introduce artefactual activity within functional magnetic resonance imaging (fMRI) experiments, prompting the need for an objective and effective method of removing them.Approach.We have developed a method to track sleep-like events in awake humans via rolling window detection of intrusions (RoWDI) of fMRI signal template. These events can then be used in voxel-wise event-related analysis of fMRI data. To test this approach, we generated a template of fMRI activity associated with transition to sleep via simultaneous fMRI and electroencephalogram (EEG) (N= 10). RoWDI was then used to identify sleep-like events in 20 individuals performing a cognitive task during fMRI after a night of partial sleep deprivation. This approach was further validated in an independent fMRI dataset (N= 56).Main results.Our method (RoWDI) was able to infer frequent sleep-like events during the cognitive task performed after sleep deprivation. The sleep-like events were associated with on average of 20% reduction in pupil size and prolonged response time. The blood-oxygen-level-dependent activity during the sleep-like events covered thalami-cortical regions, which although spatially distinct, co-existed with, task-related activity. These key findings were validated in the independent dataset.Significance.RoWDI can reliably detect spontaneous sleep-like events in the human brain. Thus, it may also be used as a tool to delineate and account for neural activity associated with wake-sleep transitions in both resting-state and task-related fMRI studies.
Collapse
Affiliation(s)
- Govinda R Poudel
- Mary Mackillop Institute for Health Research, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Stephanie Hawes
- Mary Mackillop Institute for Health Research, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Carrie R H Innes
- New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nicholas Parsons
- Cognitive Neuroscience Unit, School of Psychology, Deakins University, Melbourne, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Karen Caeyensberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakins University, Melbourne, Australia
| | - Richard D Jones
- New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,Department of Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand.,School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
26
|
Groff D, Sun A, Ssentongo AE, Ba DM, Parsons N, Poudel GR, Lekoubou A, Oh JS, Ericson JE, Ssentongo P, Chinchilli VM. Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review. JAMA Netw Open 2021; 4:e2128568. [PMID: 34643720 PMCID: PMC8515212 DOI: 10.1001/jamanetworkopen.2021.28568] [Citation(s) in RCA: 533] [Impact Index Per Article: 177.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/05/2021] [Indexed: 12/15/2022] Open
Abstract
Importance Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region. Objective To estimate organ system-specific frequency and evolution of PASC. Evidence Review PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility. Findings From a total of 2100 studies identified, 57 studies with 250 351 survivors of COVID-19 met inclusion criteria. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC was 54.0% (45.0%-69.0%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term). Most prevalent pulmonary sequelae, neurologic disorders, mental health disorders, functional mobility impairments, and general and constitutional symptoms were chest imaging abnormality (median [IQR], 62.2% [45.8%-76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), general functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]), respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders. Conclusions and Relevance In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.
Collapse
Affiliation(s)
- Destin Groff
- Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ashley Sun
- Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Anna E. Ssentongo
- Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Nicholas Parsons
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Govinda R. Poudel
- Mary Mackillop Institute for Health Research, Department of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alain Lekoubou
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Neurology, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John S. Oh
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jessica E. Ericson
- Division of Infectious Disease, Department of Pediatrics, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, State College
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
27
|
Kearney RS, Ji C, Warwick J, Parsons N, Brown J, Harrison P, Young J, Costa ML. Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial. JAMA 2021; 326:137-144. [PMID: 34255009 PMCID: PMC8278266 DOI: 10.1001/jama.2021.6986] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Platelet-rich plasma injections are used as a treatment for chronic midportion Achilles tendinopathy, but evidence for this treatment is limited. OBJECTIVE In adults with midportion Achilles tendinopathy, to assess the effects of a single platelet-rich plasma injection, compared with sham injection, on the outcome of the Victorian Institute of Sport Assessment-Achilles (VISA-A) score (a single composite measure of Achilles tendinopathy severity). DESIGN, SETTING, AND PARTICIPANTS A participant-blinded, multicenter randomized clinical trial that included 240 people from 24 sites assigned to either a platelet-rich plasma injection or a sham injection between April 2016 and February 2020. Final follow-up was July 2020. Participants were older than 18 years with midportion Achilles tendon pain for more than 3 months as confirmed by ultrasound, magnetic resonance imaging, or both. INTERVENTIONS A single intratendinous platelet-rich plasma injection (n = 121) or a single sham injection (insertion of a subcutaneous dry needle not entering the tendon) (n = 119). MAIN OUTCOMES AND MEASURES The primary outcome was the VISA-A score, measured 6 months after treatment allocation. The VISA-A score contains 8 questions that cover 3 domains of pain, function, and activity, analyzed as a composite score (range, 0 [worst symptoms] to 100 [no symptoms]; minimal clinically important difference in score, 12 points). The primary analysis was adjusted for laterality, age, sex, and baseline VISA-A score. RESULTS Among 240 patients assigned to a platelet-rich plasma or sham injection (mean age, 52 years; 138 [58%] women), 221 (92%) completed the trial. At 6-month follow-up, mean VISA-A score values in the plasma-rich plasma group vs the sham injection group were 54.4 vs 53.4 (adjusted mean difference, -2.7 [95% CI, -8.8 to 3.3]). The most common adverse events compared between patients in the platelet-rich plasma group vs the sham group were injection site discomfort (97 vs 73 patients), swelling (56 vs 52 patients) and bruising (48 vs 49 patients). CONCLUSIONS AND RELEVANCE Among patients with chronic midportion Achilles tendinopathy, treatment with a single injection of intratendinous platelet-rich plasma, compared with insertion of a subcutaneous dry needle, did not reduce Achilles tendon dysfunction at 6 months. These findings do not support the use of this treatment for chronic midportion Achilles tendinopathy. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN13254422.
Collapse
Affiliation(s)
- Rebecca S. Kearney
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- University Hospitals of Coventry and Warwickshire, Coventry, United Kingdom
| | - Chen Ji
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jane Warwick
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nicholas Parsons
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Paul Harrison
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Young
- University Hospitals of Coventry and Warwickshire, Coventry, United Kingdom
| | - Matthew L. Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Rheumatology, Musculoskeletal and Orthopaedic Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
28
|
Parsons N, Outsikas A, Parish A, Clohesy R, D'Aprano F, Toomey F, Advani S, Poudel GR. Modelling the Anatomic Distribution of Neurologic Events in Patients with COVID-19: A Systematic Review of MRI Findings. AJNR Am J Neuroradiol 2021; 42:1190-1195. [PMID: 33888458 DOI: 10.3174/ajnr.a7113] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurologic events have been reported in patients with coronavirus disease 2019 (COVID-19). However, a model-based evaluation of the spatial distribution of these events is lacking. PURPOSE Our aim was to quantitatively evaluate whether a network diffusion model can explain the spread of small neurologic events. DATA SOURCES The MEDLINE, EMBASE, Scopus, and LitCovid data bases were searched from January 1, 2020, to July 19, 2020. STUDY SELECTION Thirty-five case series and case studies reported 317 small neurologic events in 123 unique patients with COVID-19. DATA ANALYSIS Neurologic events were localized to gray or white matter regions of the Illinois Institute of Technology (gray-matter and white matter) Human Brain Atlas using radiologic images and descriptions. The total proportion of events was calculated for each region. A network diffusion model was implemented, and any brain regions showing a significant association (P < .05, family-wise error-corrected) between predicted and measured events were considered epicenters. DATA SYNTHESIS Within gray matter, neurologic events were widely distributed, with the largest number of events (∼10%) observed in the bilateral superior temporal, precentral, and lateral occipital cortices, respectively. Network diffusion modeling showed a significant association between predicted and measured gray matter events when the spread of pathology was seeded from the bilateral cerebellum (r = 0.51, P < .001, corrected) and putamen (r = 0.4, P = .02, corrected). In white matter, most events (∼26%) were observed within the bilateral corticospinal tracts. LIMITATIONS The risk of bias was not considered because all studies were either case series or case studies. CONCLUSIONS Transconnectome diffusion of pathology via the structural network of the brain may contribute to the spread of neurologic events in patients with COVID-19.
Collapse
Affiliation(s)
- N Parsons
- From the Cognitive Neuroscience Unit (N.P.).,School of Psychology (N.P., A.O., A.P., R.C.)
| | - A Outsikas
- School of Psychology (N.P., A.O., A.P., R.C.)
| | - A Parish
- School of Psychology (N.P., A.O., A.P., R.C.)
| | - R Clohesy
- School of Psychology (N.P., A.O., A.P., R.C.)
| | - F D'Aprano
- Melbourne School of Psychological Sciences (F.D.), The University of Melbourne, Melbourne, Australia.,Department of Neurology (F.D.), Royal Melbourne Hospital, Melbourne, Australia
| | - F Toomey
- School of Medicine (F.T.), Deakin University, Melbourne, Australia
| | - S Advani
- Social Behavioural Research Branch (S.A.), National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - G R Poudel
- Department of Health Sciences (G.R.P.), Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| |
Collapse
|
29
|
Freeman K, Ryan R, Parsons N, Taylor-Phillips S, Willis BH, Clarke A. The incidence and prevalence of inflammatory bowel disease in UK primary care: a retrospective cohort study of the IQVIA Medical Research Database. BMC Gastroenterol 2021; 21:139. [PMID: 33771127 PMCID: PMC8004426 DOI: 10.1186/s12876-021-01716-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 09/23/2020] [Accepted: 03/10/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Our knowledge of the incidence and prevalence of inflammatory bowel disease (IBD) is uncertain. Recent studies reported an increase in prevalence. However, they excluded a high proportion of ambiguous cases from general practice. Estimates are needed to inform health care providers who plan the provision of services for IBD patients. We aimed to estimate the IBD incidence and prevalence in UK general practice. METHODS We undertook a retrospective cohort study of routine electronic health records from the IQVIA Medical Research Database covering 14 million patients. Adult patients from 2006 to 2016 were included. IBD was defined as an IBD related Read code or record of IBD specific medication. Annual incidence and 12-month period prevalence were calculated. RESULTS The prevalence of IBD increased between 2006 and 2016 from 106.2 (95% CI 105.2-107.3) to 142.1 (95% CI 140.7-143.5) IBD cases per 10,000 patients which is a 33.8% increase. Incidence varied across the years. The incidence across the full study period was 69.5 (95% CI 68.6-70.4) per 100,000 person years. CONCLUSIONS In this large study we found higher estimates of IBD incidence and prevalence than previously reported. Estimates are highly dependent on definitions of disease and previously may have been underestimated.
Collapse
Affiliation(s)
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
30
|
Trompeter AJ, Knight R, Parsons N, Costa ML. Corrigenda. Bone Joint J 2021; 103-B:204. [PMID: 33380208 DOI: 10.1302/0301-620x.103b1.bjj-2020-00014] [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: 11/05/2022]
|
31
|
Ahmed I, Radhakrishnan A, Khatri C, Staniszewska S, Hutchinson C, Parsons N, Price A, Metcalfe A. Meniscal tears are more common than previously identified, however, less than a quarter of people with a tear undergo arthroscopy. Knee Surg Sports Traumatol Arthrosc 2021; 29:3892-3898. [PMID: 33521890 PMCID: PMC8514344 DOI: 10.1007/s00167-021-06458-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/18/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE The management of meniscal tears is a widely researched and evolving field. Previous studies reporting the incidence of meniscal tears are outdated and not representative of current practice. The aim of this study was to report the current incidence of MRI confirmed meniscal tears in patients with a symptomatic knee and the current intervention rate in a large NHS trust. METHODS Radiology reports from 13,358 consecutive magnetic resonance imaging scans between 2015 and 2017, performed at a large UK hospital serving a population of 470,000, were assessed to identify patients with meniscal tears. The hospital database was interrogated to explore the subsequent treatment undertaken by the patient. A linear regression model was used to identify if any factors predicted subsequent arthroscopy. RESULTS 1737 patients with isolated meniscal tears were identified in patients undergoing an MRI for knee pain, suggesting a rate of 222 MRI confirmed tears per 100,000 of the population aged 18 to 55 years old. 47% attended outpatient appointments and 22% underwent arthroscopy. Root tears [odds ratio (95% CI) 2.24 (1.0, 4.49); p = 0.049] and bucket handle tears were significantly associated with subsequent surgery, with no difference between the other types of tears. The presence of chondral changes did not significantly affect the rate of surgery [0.81 (0.60, 1.08); n.s]. CONCLUSION Meniscal tears were found to be more common than previously described. However, less than half present to secondary care and only 22% undergo arthroscopy. These findings should inform future study design and recruitment strategies. In agreement with previous literature, bucket handle tears and root tears were significant predictors of subsequent surgery. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX, UK.
| | - Anand Radhakrishnan
- grid.412570.50000 0004 0400 5079Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX UK
| | - Chetan Khatri
- grid.412570.50000 0004 0400 5079Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX UK
| | - Sophie Staniszewska
- grid.412570.50000 0004 0400 5079Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX UK
| | - Charles Hutchinson
- grid.412570.50000 0004 0400 5079Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX UK
| | - Nicholas Parsons
- grid.412570.50000 0004 0400 5079Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX UK
| | - Andrew Price
- grid.412570.50000 0004 0400 5079Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX UK
| | - Andrew Metcalfe
- grid.412570.50000 0004 0400 5079Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV22DX UK
| |
Collapse
|
32
|
Png ME, Fernandez MA, Achten J, Parsons N, McGibbon A, Gould J, Griffin X, Costa ML. Economic evaluation plan of a RCT of hydroxyapatite-coated uncemented hemiarthroplasty versus cemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: the WHiTE5 trial. Bone Jt Open 2020; 1:13-18. [PMID: 33215102 PMCID: PMC7659688 DOI: 10.1302/2633-1462.13.bjo-2020-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim This paper describes the methods applied to assess the cost-effectiveness of cemented versus uncemented hemiarthroplasty among hip fracture patients in the World Hip Trauma Evaluation Five (WHiTE5) trial. Methods A within-trial cost-utility analysis (CUA) will be conducted at four months postinjury from a health system (National Health Service and personal social services) perspective. Resource use pertaining to healthcare utilization (i.e. inpatient care, physiotherapy, social care, and home adaptations), and utility measures (quality-adjusted life years) will be collected at one and four months (primary outcome endpoint) postinjury; only treatment of complications will be captured at 12 months. Sensitivity analysis will be conducted to assess the robustness of the results. Conclusion The planned analysis strategy described here records our intent to conduct a within-trial CUA alongside the WHiTE5 trial.
Collapse
Affiliation(s)
- May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Miguel A Fernandez
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK; Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Juul Achten
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alwin McGibbon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Oxford Trauma, NDORMS, University of Oxford, Oxford, UK; Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Oxford Trauma, NDORMS, University of Oxford, Oxford, UK.,Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | - Jenny Gould
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Oxford Trauma, NDORMS, University of Oxford, Oxford, UK; Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Oxford Trauma, NDORMS, University of Oxford, Oxford, UK.,Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | | | | |
Collapse
|
33
|
Kearney RS, Dhanjal G, Parsons N, Ellard D, Parsons H, Haque A, Karasouli E, Mason J, Nwankwo H, Brown J, Liew Z, Drew S, Modi C, Bush H, Torgerson D, Underwood M. Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial. BMJ Open 2020; 10:e040623. [PMID: 33444204 PMCID: PMC7678365 DOI: 10.1136/bmjopen-2020-040623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION First-time traumatic anterior shoulder dislocation (TASD) is predominantly managed non-operatively. People sustaining TASD have ongoing pain, disability and future risk of redislocation. There are no published randomised controlled trials (RCTs) comparing different non-operative rehabilitation strategies to ascertain the optimum clinically effective approach after TASD. METHODS AND ANALYSIS In this multicentre adaptive RCT, with internal pilot, adults with a radiologically confirmed first time TASD treated non-surgically will be screened at a minimum of 30 sites. People with neurovascular complications, bilateral dislocations or are unable to attend physiotherapy will be excluded.Randomisation will be on a 1:1 treatment allocation, stratified by age, hand dominance and site. Participants will receive a single session of advice; or a single session of advice plus offer of further physiotherapy (maximum 4 months). The primary analysis will be the difference in Oxford Shoulder Instability Score at 6 months. A sample size of a minimum of 478 participants will allow us to show a four point difference with 90% power.An embedded qualitative study will explore the participants' experiences of the trial interventions. ETHICS, REGISTRATION AND DISSEMINATION Funded by NIHR HTA (16/167/56), 1 June 2018; National Research Ethic Committee approved (18/WA/0236), 26 July 2018. First site opened 5 November 2018 and final results will be updated on trial registries and submitted to a peer-reviewed journal and will inform rehabilitation strategies after a TASD. Study Within A Trial (SWAT) funded by MRC (MR/R013748/1), 1 May 2019; registered on the MRC-HTMR All-Ireland Hub (reference number SWAT 121). TRIAL REGISTRATION NUMBER ISRCTN63184243. (Trial stage: Pre-results).
Collapse
Affiliation(s)
| | - Gurmit Dhanjal
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Aminul Haque
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Henry Nwankwo
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | - ZiHeng Liew
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Drew
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chetan Modi
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Howard Bush
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | |
Collapse
|
34
|
Parsons N, Outsikas A, Parish A, Clohesy R, Thakkar N, D'Aprano F, Toomey F, Advani S, Poudel G. Modelling the Anatomical Distribution of Neurological Events in COVID-19 Patients: A Systematic Review. medRxiv 2020. [PMID: 33106811 DOI: 10.1101/2020.10.21.20215640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Neuropathology caused by the coronavirus disease 2019 (COVID-19) has been reported across several studies. The characterisation of the spatial distribution of these pathology remains critical to assess long and short-term neurological sequelae of COVID-19. To this end, Mathematical models can be used to characterise the location and aetiologies underlying COVID-19-related neuropathology. Method We performed a systematic review of the literature to quantify the locations of small neurological events identified with magnetic resonance imaging (MRI) among COVID-19 patients. Neurological events were localised into the Desikan-Killiany grey and white matter atlases. A mathematical network diffusion model was then used to test whether the spatial distribution of neurological events could be explained via a linear spread through the structural connectome of the brain. Findings We identified 35 articles consisting of 123 patients that assessed the spatial distribution of small neurological events among COVID-19 patients. Of these, 91 patients had grey matter changes, 95 patients had white matter changes and 72 patients had confirmed cerebral microbleeds. White matter events were observed within 14 of 42 white matter bundles from the IIT atlas. The highest proportions (26%) of events were observed within the bilateral corticospinal tracts. The splenium and middle of the corpus callosum were affected in 14% and 9% of the cases respectively. Grey matter events were spatially distributed in the 41 brain regions within the Desikan-Killiany atlas. The highest proportions (∼10%) of the events were observed in areas including the bilateral superior temporal, precentral, and lateral occipital cortices. Sub-cortical events were most frequently identified in the Pallidum. The application of a mathematical network diffusion model suggested that the spatial pattern of the small neurological events in COVID-19 can be modelled with a linear diffusion of spread from epicentres in the bilateral cerebellum and basal ganglia (Pearson's r =0.41, p <0.001, corrected). Interpretation To our knowledge, this is the first study to systematically characterise the spatial distribution of small neurological events in COVID-19 patients and test whether the spatial distribution of these events can be explained by a linear diffusion spread model. The location of neurological events is consistent with commonly identified neurological symptoms including alterations in conscious state among COVID-19 patients that require brain imaging. Given the prevalence and severity of these manifestations, clinicians should carefully monitor neurological symptoms within COVID-19 patients and their potential long-term sequelae .
Collapse
|
35
|
Griffin XL, Costa ML, Phelps E, Parsons N, Dritsaki M, Png ME, Achten J, Tutton E, Lerner R, McGibbon A, Baird J. Retrograde intramedullary nail fixation compared with fixed-angle plate fixation for fracture of the distal femur: the TrAFFix feasibility RCT. Health Technol Assess 2020; 23:1-132. [PMID: 31549959 DOI: 10.3310/hta23510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/19/2022] Open
Abstract
BACKGROUND Fractures of the distal femur are an increasingly common injury; the optimal management of these injuries remains controversial. The two interventions used in UK practice are intramedullary fixation, with a locked retrograde nail, and extramedullary fixation, with a fixed angle plate. OBJECTIVES This study assessed the feasibility of a definitive trial and included a process evaluation to understand the generalisability and likely success of a future trial. DESIGN A multicentre, parallel, two-arm, randomised controlled feasibility trial with an embedded process evaluation. Treatment with a plate or nail was allocated in a 1 : 1 ratio, stratified by centre and chronic cognitive impairment. Surgeons were not blinded, but participants were not told their allocation. SETTING Seven NHS hospitals. PARTICIPANTS Patients aged ≥ 18 years with a fracture of the distal femur who the attending surgeon believed would benefit from internal fixation were potentially eligible. Patients were excluded if they had a loose arthroplasty requiring revision or a femoral deformity or arthroplasty that precluded nail fixation. The sample was recruited between 29 September 2016 and 31 August 2017. Consent was obtained from the patient or appropriate consultee before enrolment. INTERVENTIONS Patients were randomised to receive fixation of their distal femur fracture with either a proximally and distally locked retrograde nail that spanned the diaphysis of the femur or an anatomical distal femoral locking plate with at least one locked screw distal to the fracture. Reduction and supplemental fixation were at the surgeon's discretion. OUTCOMES The primary outcome measures for this study were the recruitment rate and the completion rate of the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), at 6 weeks and 4 months. Additional measurements included baseline characteristics, measures of social support and self-efficacy, disability rating index, dementia quality-of-life measures and a radiographical assessment of any malunion. Participants' and staff views were obtained, at interview, for the process evaluation. RESULTS The process evaluation showed that surgeon-related factors, principally confidence with both technologies and a lack of individual equipoise, were key barriers to recruitment. A total of 23 participants were randomised and analysed (nail, n = 11; plate, n = 12). The recruitment rate was estimated as 0.42 [95% confidence interval (CI) 0.27 to 0.62] participants per centre per month, lower than the prespecified feasibility threshold of 1.0 participants per centre per month. Data completeness of the EQ-5D-5L was estimated at 65% (95% CI 43% to 83%). CONCLUSIONS This feasibility study has challenged many of the assumptions that underpinned the development of proposed definitive trial protocol. A modified protocol is proposed that would be feasible given the recruitment rate observed here, which is equal to that reported in the similar FixDT trial [Health Technology Assessment (HTA) 11/136/04: Costa ML, Achten J, Hennings S, Boota N, Griffin J, Petrou S, et al. Intramedullary nail fixation versus locking plate fixation for adults with a fracture of the distal tibia: the UK FixDT RCT. Health Technol Assess 2018;22(25)], which delivered to target and budget. FUTURE WORK A definitive trial with a modified design is recommended, including an internal pilot to confirm initial recruitment rate assumptions. REGISTRATION Current Controlled Trials ISRCTN92089567. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 51. See the NIHR Journals Library website for further project information. Funding was also supported by the NIHR Oxford Biomedical Research Centre.
Collapse
Affiliation(s)
- Xavier L Griffin
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Emma Phelps
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - May Ee Png
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK
| | - Elizabeth Tutton
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Robin Lerner
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Kadoorie Centre, University of Oxford, Oxford, UK
| | | | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
36
|
Ahmed I, Khatri C, Parsons N, Hutchinson CE, Staniszewska S, Price AJ, Metcalfe A. Meniscal Tear Outcome (METRO) review: a protocol for a systematic review summarising the clinical course and patient experiences of meniscal tears in the current literature. BMJ Open 2020; 10:e036247. [PMID: 32753448 PMCID: PMC7406020 DOI: 10.1136/bmjopen-2019-036247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Meniscal tears are a common knee injury with an incidence of 60 per 100 000. Management of meniscal tears can include either non-operative measures or operative procedures such as arthroscopic partial meniscectomy (APM). Despite substantial research evaluating the effectiveness of APM in the recent past, little is known about the clinical course or the experiences of patients with a meniscal tear. AIM To summarise the short to long-term patterns of variability in outcome in patients with a meniscal tear.To summarise the evidence on patient experiences of meniscal tears. In particular, we will focus on patient experiences of treatment options, treatment pathways and their views of the outcomes used in meniscal tear research. METHODS AND ANALYSIS Two search strategies will be developed to identify citations from EMBASE, MEDLINE, AMED, CENTRAL, Web of Science and Sociofile. The date of our planned search is 14 August 2020. For the quantitative review we will identify studies reporting patient-reported outcome measures in patients after a meniscal tear. The standardised mean change will be used to assess the variation in size of response and summarise the overall response to each treatment option. All studies will undergo quality assessment using either the Cochrane risk of bias or the Newcastle-Ottawa tool.A qualitative systematic review will be used to identify studies reporting views and experiences of patients with a meniscal tear. All studies will be assessed using the Critical Appraisal Skills Programme tool and if sufficient data are present a meta-synthesis will be performed to identify first, second and third-order constructs. ETHICS AND DISSEMINATION Given the nature of this study, no formal ethical approval will be sought. Results from the review will be disseminated at national conferences and will be submitted to a peer-reviewed journal for publication. Lay summaries will be freely available via the study Twitter page. PROSPERO REGISTRATION NUMBER CRD42019122179.
Collapse
Affiliation(s)
- Imran Ahmed
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Chetan Khatri
- Trauma and Orthopaedics, --University Hospital Coventry and Warwickshire, Coventry, West Midlands, UK
| | | | | | | | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
37
|
Ahmed I, Bowes M, Hutchinson CE, Parsons N, Staniszewska S, Price AJ, Metcalfe A. Meniscal tear outcome Study (METRO Study): a study protocol for a multicentre prospective cohort study exploring the factors which affect outcomes in patients with a meniscal tear. BMJ Open 2020; 10:e038681. [PMID: 32660954 PMCID: PMC7359070 DOI: 10.1136/bmjopen-2020-038681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION This study is designed to explore the baseline characteristics of patients under 55 years of age with a meniscal tear, and to describe the relationship between the baseline characteristics and patient-reported outcome measures (PROMs) over 12 months. Research has highlighted the need for a trial to investigate the effectiveness of arthroscopic meniscectomy in younger patients. Before this trial, we need to understand the patient population in greater detail. METHODS AND ANALYSIS This is a multicentre prospective cohort study. Participants aged between 18 and 55 years with an MRI confirmed meniscal tear are eligible for inclusion. Baseline characteristics including age, body mass index, gender, PROMs duration of symptoms and MRI will be collected. The primary outcome measure is the Western Ontario Meniscal Evaluation Tool at 12 months. Secondary outcome measures will include PROMs such as EQ5D, Knee Injury and Osteoarthritis Outcome Score and patient global impression of change score at 3, 6 and 12 months. ETHICS AND DISSEMINATION The study obtained approval from the National Research Ethics Committee West Midlands-Black Country research ethics committee (19/WM/0079) on 12 April 2019. The study is sponsored by the University of Warwick. The results will be disseminated via peer-reviewed publication. TRIAL REGISTRATION NUMBER UHCW R&D Reference: IA428119. University of Warwick Sponsor ID: SC.08/18-19.
Collapse
Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
| | | | | | - Nicholas Parsons
- Warwick Medical School, University of Warwick, Coventry, Coventry, UK
| | | | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
38
|
Metcalfe A, Gemperle Mannion E, Parsons H, Brown J, Parsons N, Fox J, Kearney R, Lawrence T, Bush H, McGowan K, Khan I, Mason J, Hutchinson C, Gates S, Stallard N, Underwood M, Drew S. Protocol for a randomised controlled trial of Subacromial spacer for Tears Affecting Rotator cuff Tendons: a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS). BMJ Open 2020; 10:e036829. [PMID: 32444433 PMCID: PMC7247380 DOI: 10.1136/bmjopen-2020-036829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Shoulder pain due to irreparable rotator cuff tears can cause substantial disability, but treatment options are limited. A balloon spacer is a relatively simple addition to a standard arthroscopic debridement procedure, but it is costly and there is no current randomised trial evidence to support its use. This trial will evaluate the clinical and cost-effectiveness of a subacromial balloon spacer for individuals undergoing arthroscopic debridement for irreparable rotator cuff tears.New surgical procedures can provide substantial benefit to patients. Good quality randomised controlled trials (RCTs) are needed, but trials in surgery are typically long and expensive, exposing patients to risk and the healthcare system to substantial costs. One way to improve the efficiency of trials is with an adaptive sample size. Such methods are well established in drug trials but have rarely, if ever, been used in surgical trials. METHODS AND ANALYSIS Subacromial spacer for Tears Affecting Rotator cuff Tendons: a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS) is a participant and assessor blinded, adaptive, multicentre RCT comparing arthroscopic debridement with the InSpace balloon (Stryker, USA) to arthroscopic debridement alone for people with a symptomatic irreparable rotator cuff tear. It uses a group sequential adaptive design where interim analyses are performed using all of the 3, 6 and 12-month data that are available at each time point. A maximum of 221 participants will be randomised (1:1 ratio), this will provide 90% power (at the 5% level) for a 6 point difference in the primary outcome; the Oxford Shoulder Score at 12 months. A substudy will use deltoid-active MRI scans in 56 participants to assess the function of the balloon. Analysis will be on an intention-to-treat basis and reported according to principles established in the Consolidated Standards of Reporting Trials statement. ETHICS AND DISSEMINATION NRES number 18/WM/0025. The results will be disseminated via peer-reviewed publications, presentations at conferences, lay summaries and social media. TRIAL REGISTRATION NUMBER ISRCTN17825590.
Collapse
Affiliation(s)
- Andrew Metcalfe
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Rebecca Kearney
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Tom Lawrence
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Howard Bush
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kerri McGowan
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Iftekhar Khan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Simon Gates
- Warwick Medical School, University of Warwick, Coventry, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stephen Drew
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
39
|
Friede T, Stallard N, Parsons N. Adaptive seamless clinical trials using early outcomes for treatment or subgroup selection: Methods, simulation model and their implementation in R. Biom J 2020; 62:1264-1283. [PMID: 32118317 PMCID: PMC8614126 DOI: 10.1002/bimj.201900020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 11/12/2022]
Abstract
Adaptive seamless designs combine confirmatory testing, a domain of phase III trials, with features such as treatment or subgroup selection, typically associated with phase II trials. They promise to increase the efficiency of development programmes of new drugs, for example, in terms of sample size and/or development time. It is well acknowledged that adaptive designs are more involved from a logistical perspective and require more upfront planning, often in the form of extensive simulation studies, than conventional approaches. Here, we present a framework for adaptive treatment and subgroup selection using the same notation, which links the somewhat disparate literature on treatment selection on one side and on subgroup selection on the other. Furthermore, we introduce a flexible and efficient simulation model that serves both designs. As primary endpoints often take a long time to observe, interim analyses are frequently informed by early outcomes. Therefore, all methods presented accommodate interim analyses informed by either the primary outcome or an early outcome. The R package asd, previously developed to simulate designs with treatment selection, was extended to include subgroup selection (so‐called adaptive enrichment designs). Here, we describe the functionality of the R package asd and use it to present some worked‐up examples motivated by clinical trials in chronic obstructive pulmonary disease and oncology. The examples both illustrate various features of the R package and provide insights into the operating characteristics of adaptive seamless studies.
Collapse
Affiliation(s)
- Tim Friede
- Department of Medical StatisticsUniversity Medical Center GöttingenGöttingen Germany
| | - Nigel Stallard
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventry UK
| | - Nicholas Parsons
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventry UK
| |
Collapse
|
40
|
Png ME, Fernandez MA, Achten J, Parsons N, McGibbon A, Gould J, Griffin X, Costa ML. Economic evaluation plan of a RCT of hydroxyapatite-coated uncemented hemiarthroplasty versus cemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures. Bone Jt Open 2020. [DOI: 10.1302/2046-3758.13.bjo-2020-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim This paper describes the methods applied to assess the cost-effectiveness of cemented versus uncemented hemiarthroplasty among hip fracture patients in the World Hip Trauma Evaluation Five (WHiTE5) trial. Methods A within-trial cost-utility analysis (CUA) will be conducted at four months postinjury from a health system (National Health Service and personal social services) perspective. Resource use pertaining to healthcare utilization (i.e. inpatient care, physiotherapy, social care, and home adaptations), and utility measures (quality-adjusted life years) will be collected at one and four months (primary outcome endpoint) postinjury; only treatment of complications will be captured at 12 months. Sensitivity analysis will be conducted to assess the robustness of the results. Conclusion The planned analysis strategy described here records our intent to conduct a within-trial CUA alongside the WHiTE5 trial.
Collapse
Affiliation(s)
- May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Miguel A. Fernandez
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK; Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Juul Achten
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | | | | |
Collapse
|
41
|
Kearney RS, Parsons N, Ji C, Warwick J, Brown J, Young J, Costa ML. Platelet rich plasma versus placebo for the management of Achilles tendinopathy: protocol for the UK study of Achilles tendinopathy management (ATM) multi-centre randomised trial. BMJ Open 2020; 10:e034076. [PMID: 32051317 PMCID: PMC7044811 DOI: 10.1136/bmjopen-2019-034076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION In the UK, 150 000 people every year experience mid-substance Achilles tendinopathy. Typically patients are offered a range of treatment options such as exercise, electrotherapy, injections and surgery. With large variations in current practice, there is a pressing need to establish which treatments are effective and which are not. This is the protocol for a multi-centre randomised trial of platelet rich plasma (PRP) versus placebo injection for patients with Achilles tendinopathy. METHODS AND ANALYSIS Adult patients with mid-substance Achilles tendinopathy for longer than 3 months will be screened. Randomisation will be on a 1:1 basis, stratified by centre and bilateral presentation. Participants will be allocated to either a single PRP injection or placebo injection. A minimum of 240 patients will be recruited into the study; this number will provide 90% power to detect a difference of 12 points in Victorian Institute of Sport Assessment-Achilles score at 6 months. Quality of life, pain and complications data will be collected at baseline, 2-week, 3-month and 6-month post-randomisation. The differences between treatment groups will be assessed on an intention-to-treat basis. ETHICS, REGISTRATION AND DISSEMINATION This trial was funded by Versus Arthritis and commenced on 1 September 2015 (Versus Arthritis 20831). National Research Ethic Committee approved this study on 30 October 2015 (15/WM/0359). It was registered on the International Standard Randomised Controlled Trial Number (ISRCTN) registry with reference number ISRCTN 13254422 on 28 October 2015. The first site opened to recruitment on 27 April 2016 and the trial was in active recruitment at the point of submitting the protocol paper. The results of this trial will be submitted to a peer-reviewed journal and will inform clinical practice with regard to the treatment of Achilles tendinopathy.
Collapse
Affiliation(s)
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jaclyn Brown
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jonathan Young
- Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
42
|
Geevarghese R, Harding J, Parsons N, Hutchinson C, Parsons C. The relationship of embolic particle size to patient outcomes in prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-regression. Clin Radiol 2020; 75:366-374. [PMID: 32000985 DOI: 10.1016/j.crad.2019.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/24/2019] [Indexed: 01/06/2023]
Abstract
AIM To explore the relationship of embolic particle size used in prostate artery embolisation (PAE) to patient outcomes. MATERIALS AND METHODS A systematic review of PubMed, EMBASE, and the Cochrane database was undertaken to identify all existing studies using PAE for benign prostatic hyperplasia (BPH). Inclusion criteria included prospective studies reporting baseline and 12-month International Prostate Symptom Score (IPSS) and particle size. Exclusion criteria were overlapping studies, commentaries, abstracts, and letters. Data extraction from eligible studies included the size of embolic particle, particle material, and baseline and 12-month values for the following patient outcomes: IPSS, IPSS quality of life, urinary flow rate (Q-max), prostate volume, prostate specific antigen, and post-void residual volume. A meta-regression analysis was then undertaken to examine the relationship of particle size to patient outcome measures. RESULTS Six studies with a total of 687 patients were identified. Meta-regression analysis demonstrated particle size as a statistically significant (p<0.001) moderator of 12-month IPSS change following PAE. No statistically significant relationships were identified with other patient outcome measures. CONCLUSION Smaller embolic particle size is associated with a greater reduction in IPSS following PAE.
Collapse
Affiliation(s)
- R Geevarghese
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK.
| | - J Harding
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - N Parsons
- Department of Statistics and Epidemiology, Warwick Medical School, University of Warwick, Warwick, UK
| | - C Hutchinson
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK; Department of Population Evidence and Technologies, Warwick Medical School, University of Warwick, Warwick, UK
| | - C Parsons
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK
| |
Collapse
|
43
|
Parsons N, Bowden SC, Vogrin S, D’Souza WJ. Default mode network dysfunction in idiopathic generalised epilepsy. Epilepsy Res 2020; 159:106254. [DOI: 10.1016/j.eplepsyres.2019.106254] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/13/2019] [Accepted: 12/07/2019] [Indexed: 12/14/2022]
|
44
|
Fernandez MA, Achten J, Lerner RG, Mironov K, Parsons N, Dritsaki M, Png ME, McGibbon A, Gould J, Griffin X, Costa ML. Randomised controlled trial comparing hydroxyapatite coated uncemented hemiarthroplasty with cemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a protocol for the WHITE 5 study. BMJ Open 2019; 9:e033957. [PMID: 31822548 PMCID: PMC6924810 DOI: 10.1136/bmjopen-2019-033957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Hip fracture is a serious injury in adults, especially those aged over 60 years. The most common type of hip fracture (displaced intracapsular) is treated for the majority of patients with a partial hip replacement (hemiarthroplasty). The hemiarthroplasty implant can be fixed to the bone with or without bone cement. Cement is the current recommended technique but recently some risks have been identified, which could potentially be avoided by using uncemented implants. Controversy, therefore, remains about which type of hemiarthroplasty offers patients the best outcomes.This is the protocol for a multicentre randomised controlled trial comparing cemented hemiarthroplasty versus uncemented hemiarthroplasty for patients 60 years and over with a displaced intracapsular hip fracture. METHODS AND ANALYSIS Multicentre (a minimum of seven UK hospitals), multisurgeon, parallel group, two-arm, superiority, randomised controlled trial. Patients aged 60 years and older with a displaced intracapsular hip fracture treated with hemiarthroplasty surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either a cemented hemiarthroplasty or a modern hydroxyapatite coated uncemented hemiarthroplasty. Otherwise all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: health-related quality of life (EuroQol 5 dimensions 5 levels) at 4 months postinjury. The treatment effect will be estimated using a two-sided t-test adjusted for age, gender and cognitive impairment based on an intention-to-treat analysis. Secondary outcomes include mortality, complications including revision surgery and cause, mobility status, residential status, health-related quality of life at 1 and 12 months and health resource use. A within-trial economic analysis will be conducted. ETHICS, DISSEMINATION AND FUNDING Wales Research Ethics Committee 5 approved the feasibility phase on 2 December 2016 (16/WA/0351) and the definitive trial on 22 November 2017 (17/WA/0383). This study is sponsored by the University of Oxford and funded by the National Institute for Health Research, Research for Patient Benefit (PB-PG-0215-36043 and PB-PG-1216-20021). A manuscript for a peer-reviewed journal will be prepared and the results shared with patients via local mechanisms at participating centres. TRIAL REGISTRATION NUMBER ISRCTN18393176.
Collapse
Affiliation(s)
- Miguel Antonio Fernandez
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
- Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Juul Achten
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | | | - Katy Mironov
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Oxford Clinical Trial Unit, NDORMS, University of Oxford, Oxford, UK
| | - May E Png
- Oxford Clinical Trial Unit, NDORMS, University of Oxford, Oxford, UK
| | | | | | | | | |
Collapse
|
45
|
Parsons N, Bowden SC, Vogrin S, D'Souza WJ. Single-subject manual independent component analysis and resting state fMRI connectivity outcomes in patients with juvenile absence epilepsy. Magn Reson Imaging 2019; 66:42-49. [PMID: 31734272 DOI: 10.1016/j.mri.2019.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/11/2019] [Revised: 10/17/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
Abstract
The quality of fMRI data impacts functional connectivity measures and consequently, the decisions that clinicians and researchers make regarding functional connectivity interpretation. The present study used resting state fMRI to investigate resting state network connectivity in a sample of patients with Juvenile Absence Epilepsy. Single-subject manual independent component analysis was used in two levels, whereby all noise components were removed, and cerebrospinal fluid pulsation components only were isolated and removed. Improved temporal signal to noise ratios and functional connectivity metrics were observed in each of the cleaning levels for both epilepsy and control cohorts. Results showed full, single-subject manual independent component analysis reduced the number of functional connectivity correlations and increased the strength of these correlations. Similar effects were also observed for the cerebrospinal fluid pulsation only cleaned data relative to the uncleaned, and fully cleaned data. Single-subject manual independent component analysis coupled with short TR multiband acquisition can significantly improve the validity of findings derived from fMRI data sets.
Collapse
Affiliation(s)
- Nicholas Parsons
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Medicine, St Vincent's Hospital, The University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Simon Vogrin
- Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Wendyl J D'Souza
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Medicine, St Vincent's Hospital, The University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| |
Collapse
|
46
|
Petrou S, Parker B, Masters J, Achten J, Bruce J, Lamb SE, Parsons N, Costa ML. Cost-effectiveness of negative-pressure wound therapy in adults with severe open fractures of the lower limb: evidence from the WOLLF randomized controlled trial. Bone Joint J 2019; 101-B:1392-1401. [DOI: 10.1302/0301-620x.101b11.bjj-2018-1228.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aims The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. Patients and Methods An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation. Results The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses. Conclusion This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb. Cite this article: Bone Joint J 2019;101-B:1392–1401.
Collapse
Affiliation(s)
- S. Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - B. Parker
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - J. Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Achten
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - S. E. Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N. Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - M. L. Costa
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | | |
Collapse
|
47
|
Williamson SZ, Johnson R, Sandhu HK, Parsons N, Jenkins J, Casey M, Kearins O, Taylor-Phillips S. Communicating benign biopsy results by telephone in the NHS Breast Screening Programme: a protocol for a cluster randomised crossover trial. BMJ Open 2019; 9:e028679. [PMID: 31377704 PMCID: PMC6687008 DOI: 10.1136/bmjopen-2018-028679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/11/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION One of the main harms from breast cancer screening is the anxiety caused by false positive results. Various factors may be associated with false-positive anxiety. One modifiable factor may be the method of communication used to deliver results. The aim of this study is to measure the effect on anxiety of receiving benign biopsy results in-person or by telephone. METHODS AND ANALYSIS This is a multi-centre cluster randomised crossover trial in the English National Health Service Breast Screening Programme (NHSBSP) involving repeated survey measures at four time points. Participants will be women of screening age who have a biopsy following a suspicious mammography result, who ultimately receive a benign or normal (B1) result. Centres will trial both telephone and in-person results on a month-by-month basis, being randomised to which communication method will be trialled first. Women will be blinded to the method of communication they will receive. The analysis will compare women who have received telephone results and women who have received in-person results. The primary outcome measure will be anxiety (measured by the Psychological Consequences Questionnaire) after receiving results, while controlling for baseline anxiety. Secondary outcome measures will include anxiety at 3 and 6 months post-results, understanding of results and patient preferences for how results are communicated. Qualitative telephone interviews will also be conducted to further explore women's reasons for communication preferences. Qualitative and quantitative data will be integrated after initial separate analysis using the pillar integration process. ETHICS AND DISSEMINATION This study has been approved by the Public Health England Breast Screening Programme Research Advisory Committee, (BSPRAC_0013, ODR1718_040) and the National Health Service Health Research Authority (HRA) West Midlands-Coventry & Warwickshire Research Ethics Committee (17/WM/0313). The findings from this study will be disseminated to key stakeholders within the NHSBSP and via academic publications. TRIAL REGISTRATION NUMBER ISRCTN36997684 TRIAL SPONSOR: This research is part of a PhD award and is funded by the Economic and Social Research Council Doctoral Training Centre at the University of Warwick and Public Health England. The sponsor for this research is Jane Prewett (sponsorship@warwick.ac.uk).
Collapse
Affiliation(s)
- Sian Zena Williamson
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rebecca Johnson
- Faculty of Health & Life Sciences, University of Warwick, Coventry, UK
| | | | - Nicholas Parsons
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jacquie Jenkins
- National Programme Manager-NHS Breast Screening Programme, Public Health England, Sheffield, UK
| | - Margaret Casey
- Clinical Nurse Specialist Breast Care, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Olive Kearins
- National Lead Breast Screening QA, Public Health England, Birmingham, UK
| | - Sian Taylor-Phillips
- Population Evidence and Technologies, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
48
|
Palinska-Rudzka KE, Ghobara T, Parsons N, Milner J, Lockwood G, Hartshorne GM. Five-year study assessing the clinical utility of anti-Müllerian hormone measurements in reproductive-age women with cancer. Reprod Biomed Online 2019; 39:712-720. [PMID: 31471141 DOI: 10.1016/j.rbmo.2019.06.001] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/03/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION An important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve? DESIGN A prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18-43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up. RESULTS After adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancer patients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis). CONCLUSIONS Reproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy.
Collapse
Affiliation(s)
- K E Palinska-Rudzka
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - T Ghobara
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - N Parsons
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK
| | - J Milner
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G Lockwood
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G M Hartshorne
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK.
| |
Collapse
|
49
|
Griffin XL, Costa ML, Phelps E, Parsons N, Dritsaki M, Achten J, Tutton E, Lerner RG, McGibbon A, Baird J. Intramedullary nails versus distal locking plates for fracture of the distal femur: results from the Trial of Acute Femoral Fracture Fixation (TrAFFix) randomised feasibility study and process evaluation. BMJ Open 2019; 9:e026810. [PMID: 31061043 PMCID: PMC6502051 DOI: 10.1136/bmjopen-2018-026810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This feasibility study and process evaluation assessed the likely success of a definitive trial of intramedullary fixation with locked retrograde nails versus extramedullary fixation with fixed angle plates for fractures of the distal femur. DESIGN & SETTING A multicentre, parallel, two-arm, randomised controlled feasibility study with an embedded process evaluation was conducted at seven NHS hospitals in England. Treatment was randomly allocated in 1:1 ratio, stratified by centre and chronic cognitive impairment. Participants, but not surgeons or research staff, were blinded to the allocation. PARTICIPANTS Patients 18 years and older with a fracture of the distal femur, who their surgeon believed would benefit from internal fixation, were eligible to take part.Participants were allocated to receive either a retrograde intramedullary nail or an anatomical locking plate. OUTCOMES The primary outcomes for this feasibility study were the recruitment rate and completion rate of the EQ-5D-5L at 4 months post-randomisation. Baseline characteristics, disability rating index, quality of life scores, measurements of social support and self-efficacy, resource use and radiographic assessments were also collected. The views of patients and staff were collected during interviews. RESULTS Recruitment and data completion were lower than expected. 23 of 82 eligible patients were recruited (nail, 11; plate, 12). The recruitment rate was estimated as 0.42 (95% CI 0.27 to 0.62) participants per centre-month. Data completeness of the EQ-5D-5L at 4 months was 61 per cent (95% CI 43% to 83%). The process evaluation demonstrated that the main barriers to recruitment were variation in treatment pathways across centres, lack of surgeon equipoise and confidence in using both interventions and newly formed research cultures that lacked cohesion. CONCLUSIONS A modified trial design, with embedded recruitment support intervention, comparing functional outcome in cognitively intact adults who have sustained a fragility fracture of the distal femur is feasible. ETHICS APPROVAL The Wales Research Ethics Committee 5 approved the study (ref: 16/WA/0225). TRIAL REGISTRATION NUMBER ISRCTN92089567; Pre-results.
Collapse
Affiliation(s)
- Xavier L Griffin
- Oxford Trauma, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew L Costa
- Oxford Trauma, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emma Phelps
- Oxford Trauma, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Juul Achten
- Oxford Trauma, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Elizabeth Tutton
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Robin Gillmore Lerner
- Kadoorie Centre, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | | | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
50
|
Kearney RS, McKeown R, Stevens S, Parsons N, Parsons H, Wells P, Brown J, Underwood M, Redmond A, Mason J, Costa ML. Cast versus functional brace in the rehabilitation of patients treated for an ankle fracture: protocol for the UK study of ankle injury rehabilitation (AIR) multicentre randomised trial. BMJ Open 2018; 8:e027242. [PMID: 30567826 PMCID: PMC6303686 DOI: 10.1136/bmjopen-2018-027242] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Each year in the UK over 120 000 people fracture their ankle. It is not known what the best rehabilitation strategy is for these people. Traditionally standard care has involved immobilisation in a plaster cast but an alternative is a functional brace, which can be removed to allow early movement. This paper details the protocol for a multicentre randomised trial of plaster cast immobilisation versus functional bracing for patients with an ankle fracture. METHODS AND ANALYSIS We will recruit adults with a fractured ankle, for which the treating clinician would consider plaster cast to be a reasonable management option. Randomisation will be on a 1:1 basis, stratified by centre, operative or non-operative management and age. Participants will be allocated to either plaster cast or a functional brace, both treatments are widely used. To have 90% power to detect a difference of 10 points on the primary outcome (Olerud and Molander Ankle Score) at the primary outcome time point (16 weeks), we need to randomise a minimum of 478 people. Quality of life and resource use will be collected at 6, 10, 16, 24 weeks and 12, 18, 24 months. The differences between treatment groups will be assessed on an intention-to-treat basis. The economic evaluation will adhere to the recommendations of the National Institute for Health and Care Excellence reference case. ETHICS, REGISTRATION AND DISSEMINATION National Research Ethic Committee approved this study on 4 July 2017 (17/WM/0239). The first site opened to recruitment 9 October 2017. The results of this trial will be submitted to a peer-reviewed journal and will inform clinical practice. TRIAL REGISTRATION NUMBER ISRCTN15537280; Pre-results.
Collapse
Affiliation(s)
| | | | | | | | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Philip Wells
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Anthony Redmond
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Matthew L Costa
- Orthopaedic Trauma, Oxford University, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|