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Browning MHEM, Locke DH, Konijnendijk C, Labib SM, Rigolon A, Yeager R, Bardhan M, Berland A, Dadvand P, Helbich M, Li F, Li H, James P, Klompmaker J, Reuben A, Roman LA, Tsai WL, Patwary M, O'Neil-Dunne J, Ossola A, Wang R, Yang B, Yi L, Zhang J, Nieuwenhuijsen M. Measuring the 3-30-300 rule to help cities meet nature access thresholds. Sci Total Environ 2024; 907:167739. [PMID: 37832672 PMCID: PMC11090249 DOI: 10.1016/j.scitotenv.2023.167739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
The 3-30-300 rule offers benchmarks for cities to promote equitable nature access. It dictates that individuals should see three trees from their dwelling, have 30 % tree canopy in their neighborhood, and live within 300 m of a high-quality green space. Implementing this demands thorough measurement, monitoring, and evaluation methods, yet little guidance is currently available to pursue these actions. To overcome this gap, we employed an expert-based consensus approach to review the available ways to measure 3-30-300 as well as each measure's strengths and weaknesses. We described seven relevant data and processes: vegetation indices, street level analyses, tree inventories, questionnaires, window view analyses, land cover maps, and green space maps. Based on the reviewed strengths and weaknesses of each measure, we presented a suitability matrix to link recommended measures with each component of the rule. These recommendations included surveys and window-view analyses for the '3 component', high-resolution land cover maps for the '30 component', and green space maps with network analyses for the '300 component'. These methods, responsive to local situations and resources, not only implement the 3-30-300 rule but foster broader dialogue on local desires and requirements. Consequently, these techniques can guide strategic investments in urban greening for health, equity, biodiversity, and climate adaptation.
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Affiliation(s)
- M H E M Browning
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC 29631, USA.
| | - D H Locke
- USDA Forest Service, Northern Research Station, Baltimore Field Station, Suite 350, 5523 Research Park Drive, Baltimore, MD 21228, USA.
| | - C Konijnendijk
- Nature Based Solutions Institute - Dutch Office, Zeist, the Netherlands
| | - S M Labib
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
| | - A Rigolon
- Department of City and Metropolitan Planning, The University of Utah, Salt Lake City, UT 84112, USA
| | - R Yeager
- Division of Environmental Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - M Bardhan
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC 29631, USA; Environment and Sustainability Research Initiative, Khulna 9208, Bangladesh
| | - A Berland
- Department of Geography and Meteorology, Ball State University, Muncie, IN 47306, USA
| | - P Dadvand
- ISGlobal, Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029 Madrid, Spain
| | - M Helbich
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
| | - F Li
- Virtual Reality and Nature Lab, Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC 29631, USA
| | - H Li
- College of Physical Education, Southwest University, Chongqing 400715, China
| | - P James
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - J Klompmaker
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - A Reuben
- Department of Psychology & Neuroscience, Duke University, Durham, NC, 27705, USA
| | - L A Roman
- USDA Forest Service, Pacific Southwest Research Station & Northern Research Station, 4995 Canyon Crest Dr., Riverside, CA 92507, USA
| | - W-L Tsai
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - M Patwary
- Environment and Sustainability Research Initiative, Khulna 9208, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna 9208, Bangladesh
| | - J O'Neil-Dunne
- Spatial Analysis Lab, Rubenstein School of Environment and Natural Resources, University of Vermont, Burlington, VT, USA
| | - A Ossola
- Department of Plant Sciences, University of California Davis, Davis, CA, 95616, USA; School of Ecosystem and Forest Science, University of Melbourne, VIC, Australia
| | - R Wang
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - B Yang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - L Yi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J Zhang
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, China
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Kent S, Adatia A, James P, Bains K, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P. Risk factors associated with short-term complications in mandibular fractures: the MANTRA study-a Maxillofacial Trainee Research Collaborative (MTReC). Oral Maxillofac Surg 2023; 27:609-616. [PMID: 35788932 PMCID: PMC10684408 DOI: 10.1007/s10006-022-01096-5] [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: 03/14/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Complications following mandibular fractures occur in 9-23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. METHODS The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. RESULTS Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. DISCUSSION We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.
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Affiliation(s)
- S Kent
- University Hospital of Wales, Cardiff, UK.
| | - A Adatia
- Aintree University Hospital, Liverpool, UK
| | - P James
- Aintree University Hospital, Liverpool, UK
| | - K Bains
- Aintree University Hospital, Liverpool, UK
| | - A Henry
- Swansea Bay University Health Board, Swansea, UK
| | - C Blore
- University Hospitals of North Midlands NHS Trust, Stafford, UK
| | - B Dawoud
- North Manchester General Hospital, Manchester , UK
| | - D Kumar
- Liverpool Medical School, Liverpool, UK
| | - C Jefferies
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Kyzas
- Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Ghazarian M, Leung KK, Yu LW, Sullivan K, Samman A, Deeb M, Steel A, James P. A67 RISK FACTORS ASSOCIATED WITH CRITICAL CARE AFTER INPATIENT GASTROINTESTINAL ENDOSCOPY: A 5-YEAR TERTIARY HOSPITAL STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991249 DOI: 10.1093/jcag/gwac036.067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background A subset of hospitalized patients will require critical care after their gastrointestinal endoscopy (GIE) and predicting which patients are at high risk of requiring critical care remains an important challenge. Purpose To identify protective and aggravating clinical risk factors associated with critical care involvement within 7 days of inpatient GIE in adults and to develop a tool that could assist in risk-stratifying patients at high risk of requiring critical care post-endoscopy. Method This was a single-centre retrospective case-control study of adult patients who underwent inpatient GIE while admitted to ward-level care at Toronto General Hospital from years 2015 to 2019. Cases were defined by inpatients who required critical care response team and/or critical care admission within 7 days of GIE, compared to control patients who did not require critical care throughout admission. Chart review and linked secondary sources were used with defined inclusion and exclusion criteria. Both univariate and multivariate analyses were performed comparing patient baseline, clinical history (including cardiovascular, respiratory, other co-morbidities) and endoscopy characteristics. Result(s) We identified a total of 275 patients with 302 endoscopies as cases and 2069 patient controls who satisfied inclusion criteria. Critical care involvement was most commonly due to cardiovascular-related complications (n=175, 58%) followed by respiratory complications (n=117, 39%). Amongst cases, death occurred in 9 (3%), 25 (9%) and 67 (22%) within 72 hours, 7 days and 30 days respectively post endoscopy. The strongest associations with critical care involvement within 7 days after GIE included a history of discharge from critical care (OR 2.29 CI 1.70-3.04) and/or recent mechanical ventilatory support (OR 2.27 CI 1.30-3.91) in the 30 days prior to endoscopy, having several co-morbidities involving major organ systems (elevated troponin OR 3.20 CI 2.26-4.52, cirrhosis OR 2.5 CI 1.80-3.46, renal dysfunction 2.09 CI 1.57-2.78) and patients admitted under surgical (OR 3.82 CI 2.54-5.71) or transplant services (OR 4.63 CI 2.94-7.26). The majority of adverse events among cases were not found to be complications directly related to GIE (64% unlikely, 20% possible, 9% probable, 7% definite). Patients with a history of pulmonary hypertension (OR 5.68 CI 0.53-60.70) and ASA score III/IV (OR 3.28 CI 1.01-10.73) had the highest odds of probable or definite endoscopy-related adverse events. Conclusion(s) This study is the largest to date to examine risk factors associated with critical care requirements post GIE in the tertiary care inpatient setting. The risk factors we have identified can be used to create a tool to determine which inpatients may benefit from anesthesia consultation and support during their endoscopic procedure. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | - K K Leung
- Division of Gastroenterology and Hepatology
| | | | | | | | - M Deeb
- Division of Gastroenterology and Hepatology
| | - A Steel
- Department of Anesthesiology, University Health Network, University of Toronto, Toronto, Canada
| | - P James
- Division of Gastroenterology and Hepatology
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James P, Gayowsky A, Salim M, Seow H, Sutradhar R, Tanuseputro P, Coburn N, Hallet J, Hsu A, Mahar A, Webber C. A56 DEVELOPMENT OF A PROGNOSTIC SURVIVAL MODEL FOR PATIENTS DIAGNOSED WITH PANCREATIC CANCER IN ONTARIO. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991217 DOI: 10.1093/jcag/gwac036.056] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Pancreatic adenocarcinoma (PAC) is a deadly disease with an overall 5-year survival of less than 8%. The current literature on patient outcomes are limited by small samples sizes and patients enrolled in clinical trials. There are no prognostic tools for patients with pancreatic cancer. Purpose To develop a prognostic survival model for patients with pancreatic cancer Method All patients with a diagnosis of pancreatic cancer cancer from January 2007 to December 2020 were identified through the Ontario Cancer Registry. The primary outcome was survival. The cohort was used to develop a multivariable cox proportional hazards regression model with baseline characteristics under a backward stepwise variable selection process to predict the risk of mortality. Covariates included patient age, sex, tumour location, cancer stage, treatment types, distance to a cancer centre, hospitalizations, comorbidities, access to family physician, and symptoms as captured using the Edmonton Symptom Assessment System datasets. Result(s) There was a total of 17,450 pancreatic cancer patients in the cohort, 48% of which were female and the mean age was 72 years. 44% of patients presented with a tumor in the head of the pancreas. Among those with stage data (44%), 24% were stage IV at diagnosis. Mean survival was approximately 0.7 years. Approximately 60% were hospitalized in the 3 months prior to diagnosis. Almost all patients had a family doctor rostered (95%). In multivariate analysis, key predictors of survival assessed at the time of diagnosis were age, sex, tumour location in the pancreas, stage at diagnosis, pain, appetite functional status and treatment choice (all p<0.001). Using these variables, we created a prediction model that can estimate one-year probability of death with high discrimination (area under the curve = 0.82, c-statistic 0.76). Conclusion(s) Our model accurately predicts one-year pancreatic cancer survival risk using clinical symptom and performance status data. The model has the potential to be a useful prognostic tool that can be completed by patients and their caregivers in support of patient-centered care. Please acknowledge all funding agencies by checking the applicable boxes below CIHR Disclosure of Interest None Declared
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Affiliation(s)
- P James
- Gastroenterology, University Health Network,Medicine, University of Toronto
| | - A Gayowsky
- Institute for Clinical Evaluative Sciences, Toronto
| | - M Salim
- Gastroenterology, University Health Network
| | - H Seow
- Oncology, McMaster, Hamilton
| | - R Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto,Department of Biostatistics, University of Toronto, Toronto
| | - P Tanuseputro
- Institute for Clinical Evaluative Sciences, Toronto,Ottawa Hospital Research Institute, Ottawa
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto
| | - J Hallet
- Institute for Clinical Evaluative Sciences, Toronto,Sunnybrook Health Sciences Centre, Toronto
| | - A Hsu
- Bruyère Research Institute , Ottawa
| | - A Mahar
- Queens University, Kingston, Canada
| | - C Webber
- Ottawa Hospital Research Institute, Ottawa
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Khan R, Homsi H, Gimpaya N, Sabrie N, Gholami R, Bansal R, Scaffidi M, Lightfoot D, James P, Siau K, Forbes N, Wani S, Keswani R, Walsh C, Grover S. A117 VALIDITY EVIDENCE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPETENCY ASSESSMENT TOOLS: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991253 DOI: 10.1093/jcag/gwac036.117] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is essential to ensure trainees possess the skills needed for independent practice. Traditionally, ERCP training has used the apprenticeship model, whereby novices learn skills under the supervision of an expert. A growing focus on procedural quality, however, has supported the implementation of competency-based medical education models which require documentation of a trainee’s competence for independent practice. Observational assessment tools with strong evidence of validity are critical to this process. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. Purpose To conduct a systematic review of ERCP assessment tools and identify tools with strong evidence of validity using a unified validity evidence framework Method We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. Result(s) From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5). Conclusion(s) The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared
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Affiliation(s)
- R Khan
- Western University, London
| | | | | | | | | | | | | | | | - P James
- University Health Network, Toronto, Canada
| | - K Siau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - N Forbes
- University of Calgary, Calgary, Canada
| | - S Wani
- University of Colorado Anschutz Medical Campus, Aurora
| | - R Keswani
- Northwestern University, Chicago, United States
| | - C Walsh
- The Hospital for Sick Children, Toronto, Canada
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Thinagaran J, Tadtayev S, Mikhail M, James P, Calubayan R, Arumainayagam N. Out of harm's way: scrotal support for transperineal prostate biopsy. Ann R Coll Surg Engl 2023; 105:183-184. [PMID: 35446696 PMCID: PMC9889179 DOI: 10.1308/rcsann.2021.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Jkr Thinagaran
- Ashford and St. Peter's Hospitals NHS Foundation Trust, UK
| | - S Tadtayev
- Ashford and St. Peter's Hospitals NHS Foundation Trust, UK
| | - M Mikhail
- Ashford and St. Peter's Hospitals NHS Foundation Trust, UK
| | - P James
- Ashford and St. Peter's Hospitals NHS Foundation Trust, UK
| | - R Calubayan
- Ashford and St. Peter's Hospitals NHS Foundation Trust, UK
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LaRiviere M, James P, Clegg K, Cummings E, Bagatell R, Balamuth N, Kolon T, Hill-Kayser C. Pencil Beam Scanning (PBS) Proton Therapy for Children Requiring Radiotherapy with Anesthesia (GA) for Pelvic Rhabdomyosarcoma (RMS). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Trytell A, Paratz ED, Van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of illicit drug use in young sudden cardiac death patients; an Australian prospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2659] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Illicit drug use may accelerate coronary disease and cardiac hypertrophy or stimulate arrhythmias. Rates of illicit drug use in young sudden cardiac death (SCD) patients are uncertain.
Purpose
To identify rates of illicit drug use in young SCD patients in Australia.
Methods
A prospective multi-centre registry identified out of hospital cardiac arrest (OHCA) patients aged 1–50 years between April 2019 and April 2020. Clinical characteristics were compared between patients with and without illicit drug use (defined by toxicological results or reported regular use). Illicit drugs included stimulants such as amphetamine-type substances and cocaine, or non-stimulants such as heroin, cannabis and novel psychoactive substances (cathinones and synthetic cannabinoids).
Results
770 OHCAs occurred, with 555 patients undergoing forensic assessment. 287 patients had confirmed cardiac cause of OHCA, with 274 undergoing toxicological assessment and 79 (28.8%) having positive toxicology for illicit drugs (n=60) or reported regular drug use (n=19). An additional 121 patients experienced non-cardiac SCD due to illicit drug toxicity, resulting in a total of 200 patients (36.0% of OHCAs) with illicit drug use. Patients with SCD and illicit drug use were more commonly male (86.1% vs 72.3%, p=0.015), regular smokers (36.7% vs 21.5%, p=0.009), had cardiomegaly (76.5% vs 57.5%, p=0.007), and higher rates of coronary disease and cardiomyopathy (coronary disease 44.3% vs 33.3%, cardiomyopathy 30.4% vs 18.5%, p=0.003). Methamphetamines (n=42, 53.1%) were the most common illicit drug identified and polysubstance abuse occurred frequently (n=15, 19.0%).
Conclusion
Approximately one-third of young SCD patients use illicit drugs, with high rates of polysubstance abuse. Illicit drug use in SCD patients is associated with coronary disease and cardiomyopathy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Trytell
- St Vincent's Hospital , Melbourne , Australia
| | - E D Paratz
- St Vincent's Hospital , Melbourne , Australia
| | | | - D Zentner
- Royal Melbourne Hospital , Melbourne , Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - T Thompson
- Royal Melbourne Hospital , Melbourne , Australia
| | - P James
- Royal Melbourne Hospital , Melbourne , Australia
| | - V Connell
- Royal Children's Hospital , Melbourne , Australia
| | - A Pflaumer
- Royal Children's Hospital , Melbourne , Australia
| | | | - J Ingles
- Garvan Institute of Medical Research , Sydney , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - A La Gerche
- St Vincent's Hospital , Melbourne , Australia
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Paratz E, Van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of coronary artery anomalies in young sudden cardiac death: insights from a prospective state-wide registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1805] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD with a reported prevalence of up to 33%.
Methods
A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1–50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants and CAAs were identified and circumstances and cause of death for patients with CAAs examined.
Results
Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, five (1.0%) had a CAA identified with three having anomalies of coronary origin and two having anomalies of coronary course. In no cases was the CAA deemed responsible for the SCD. In two cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified, in the third critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only one had a CAA identified (the patient with thoracic aortic dissection).
Conclusion
In this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1.0% of patients and did not cause any deaths. The role of CAAs in causing young SCD appears to be less significant than previously hypothesised.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NHMRC, NHF
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Affiliation(s)
- E Paratz
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - A Van Heusden
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - D Zentner
- Royal Melbourne Hospital , Melbourne , Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - J Ball
- Ambulance Victoria , Melbourne , Australia
| | - T Thompson
- Royal Melbourne Hospital , Melbourne , Australia
| | - P James
- Royal Melbourne Hospital , Melbourne , Australia
| | - V Connell
- Royal Children's Hospital , Melbourne , Australia
| | - A Pflaumer
- Royal Children's Hospital , Melbourne , Australia
| | - C Semsarian
- University of Sydney, Heart Research Institute , Sydney , Australia
| | - J Ingles
- Garvan Institute of Medical Research , Sydney , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute , Melbourne , Australia
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Paratz E, Rowe S, Van Heusden A, Thompson T, Morgan N, Smith K, James P, Pflaumer A, Connell V, Semsarian C, Ingles J, Parsons S, Stub D, Zentner D, La Gerche A. Clinical and pathologic features of out-of-hospital cardiac arrest in pregnancy: insights from a state-wide registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2595] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiovascular disease is the most common cause of indirect maternal mortality worldwide, and cardiac arrest occurs in up to 1 in 12,000 pregnancies.
Objective
To define rates, clinical and pathologic factors of out-of-hospital cardiac arrest (OHCA) in pregnant and post-partum females.
Methods
A prospective state-wide cardiac arrest registry combining ambulance, hospital and forensic data captured all OHCAs from 2019–2021. Clinical and pathological details for pregnant patients were identified.
Results
1,482 OHCAs occurred, including 376 females of child-bearing age of whom eight were pregnant or post-partum. OHCA incidence was lower in pregnant females compared to non-pregnant females of child-bearing age (5.2 OHCAs per 100,000 pregnant females vs 23.1 per 100,000 females of child-bearing age, p<0.0001). Seven patients (87.5%) died, with five (62.5%) having a cardiac cause of OHCA (unascertained = 2, cardiomyopathy = 2 (1 hypertrophic), ischemic heart disease = 1). Two patients had pre-existing cardiac risk factors, but none had a cardiac diagnosis pre-arrest. Compared to in-hospital cardiac arrests (IHCAs) in pregnancy, OHCAs are more likely to have a cardiac cause (odds ratio 3.81) and lower maternal survival (odds ratio 0.09).
Conclusion
Maternal OHCA affects approximately 1 in 20,000 pregnancies with high maternal mortality rates. OHCA occurs at one-quarter the rate in non-pregnant females of child-bearing age. Approximately two-thirds of maternal OHCAs had an underlying cardiac cause, but low rates of cardiac diagnosis pre-arrest. OHCAs differ markedly from IHCAs in pregnant females, requiring ongoing evaluation as to specific causes and preventability.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NHMRC, NHF
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Affiliation(s)
- E Paratz
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - S Rowe
- St Vincent's Hospital , Melbourne , Australia
| | - A Van Heusden
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - T Thompson
- Royal Melbourne Hospital , Melbourne , Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - P James
- Royal Melbourne Hospital , Melbourne , Australia
| | - A Pflaumer
- Royal Children's Hospital , Melbourne , Australia
| | - V Connell
- Royal Children's Hospital , Melbourne , Australia
| | - C Semsarian
- University of Sydney, Heart Research Institute , Sydney , Australia
| | - J Ingles
- Garvan Institute of Medical Research , Sydney , Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
| | - D Zentner
- Royal Melbourne Hospital , Melbourne , Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute , Melbourne , Australia
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Ashokkumar S, Paratz E, Van Heusden A, Smith K, Zentner D, Morgan N, Parsons S, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Obesity in young sudden cardiac death: rates, clinical features, and insights into people with body mass index >50kg/m2. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2387] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity is common in young sudden cardiac death (SCD) victims but it is unclear whether it is more common than in the general population. This study aimed to contextualize young SCD obesity rates, identifying clinical and pathologic features in WHO class II and III obesity.
Methods
A prospective state-wide out-of-hospital cardiac arrest registry included all SCDs in Victoria, Australia from 2019–2021. Body mass indices (BMIs) of patients 18–50 years were compared to age-referenced general population. Characteristics of SCD patients with WHO Class II obesity (BMI ≥30kg/m2) and non-obesity (BMI <30kg/m2) were compared. Clinical characteristics of people with BMI >50kg/m2 were assessed.
Results
504 patients were included. Obesity was strongly over-represented in young SCD compared to the age-matched general population (55.0% vs 28.7%, p<0.0001). Obese SCD patients more frequently had hypertension, diabetes and obstructive sleep apnoea (p<0.0001, p=0.009 and p=0.001 respectively), ventricular fibrillation as their arrest rhythm (p=0.008) and left ventricular hypertrophy (LVH) (p<0.0001). Obese patients were less likely to have toxicology positive for illicit substances (22.0% vs 32.6%, p=0.008) or significant alcohol history (18.8% vs 26.9%, p=0.030). Patients with BMI >50 kg/m2 represented 8.5% of young SCD. LVH (n=26, 60.5%) was their predominant cause of death and only 10 (9.3%) patients died from coronary disease.
Conclusion
Over half of young Australian SCD patients are obese, with all obesity classes over-represented compared to the general population. Obese patients had more cardiac risk factors. Almost two thirds of patients with BMI>50 kg/m2 died with LVH, with fewer than 10% dying from coronary disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - E Paratz
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - A Van Heusden
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - D Zentner
- Royal Melbourne Hospital , Melbourne , Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - T Thompson
- Royal Melbourne Hospital , Melbourne , Australia
| | - P James
- Royal Melbourne Hospital , Melbourne , Australia
| | - V Connell
- Royal Children's Hospital , Melbourne , Australia
| | - A Pflaumer
- Royal Children's Hospital , Melbourne , Australia
| | | | - J Ingles
- Garvan Institute of Medical Research , Sydney , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute , Melbourne , Australia
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12
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Oakley C, Zidere V, Suckling C, Hurn A, Nyman A, James P, Vigneswaran TV. Abstracts of the 32nd World Congress on Ultrasound in Obstetrics and Gynecology, 16-18 September 2022, London, UK & Virtual. Ultrasound Obstet Gynecol 2022; 60 Suppl 1:1-315. [PMID: 36104014 DOI: 10.1002/uog.24986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- C Oakley
- Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - V Zidere
- Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - C Suckling
- Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - A Hurn
- Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
| | - A Nyman
- Pediatric Intensive Care, Evelina London Children's Hospital, London, United Kingdom
| | - P James
- Pediatric Intensive Care, Evelina London Children's Hospital, London, United Kingdom
| | - T V Vigneswaran
- Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
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13
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Merviel P, Beauvillard D, Pertuisel D, Boue'e S, James P, Drapier H. P-581 Live birth rates in women under 38 years old with AMH level < 1.2 ng/ml in in-vitro fertilization/intracytoplasmic sperm injection: arguments for care. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
To evaluate the clinical pregnancy and live birth rates in the first IVF/ICSI cycle in women under 38 years old with AMH level < 1.2 ng/ml.
Summary answer
Our findings argue to propose IVF for those patients.
What is known already
Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy, however acceptable pregnancy rates for young women with low AMH levels were observed in IVF/ICSI. The definition of early ovarian failure is based on two classifications, Bologna and Poseidon, where an AMH level of 1.2 ng/ml appears to be the threshold for determining ovarian failure. According to La Marca's curve, this level of 1.2 ng/ml corresponds to an ovarian reserve of a 38 year-old woman.
Study design, size, duration
The primary objective of this study was to compare the live birth rates between these three groups of women. The secondary objective was to compare the rate of positive βhCG level, clinical pregnancy rate and live birth rate in women under 38 years of age during the 1st cycle of IVF+/-ICSI, regardless of whether the AMH is < 1.2 ng/ml or ≥ 1.2 ng/ml.
Participants/materials, setting, methods
We analyzed the first cycle of IVF/ICSI in women under 38 years old with AMH level < 1.2 ng/ml under long GnRH agonist or GnRH antagonist protocols. We classified the women into three groups: group A: AMH < 0.4 ng/ml; group B: AMH: 0.4 to 0.8 ng/ml; group C: AMH > 0.8 ng/ml.
Main results and the role of chance
Between January 2017 and September 2020, we retained 227 cycles for analysis (group A: 50 cycles, B: 85 cycles and C: 92 cycles). No significant difference was found between the three groups for clinical pregnancy and live birth rates, either per stimulation cycle, oocyte puncture or embryo transfer. Thus, the birth rates per embryo transfer are 23.5% in group A, 25.4% in group B and 28.1% in group C. When we compared the two groups of women under 38 years of age during the 1st cycle of IVF+/-ICSI, according to AMH levels < 1.2 ng/ml (n: 227) or ≥ 1.2 ng/ml (n: 325), the only significant difference was the positive βhCG level rate per oocyte puncture (p < 0.01). Biochemical pregnancy rates were significantly different in women with AMH < 1.2 ng/ml (40.8%) compared to those with AMH ≥ 1.2 ng/ml (16.6%; p < 0.01), but the rate of first trimester miscarriage was identical in both groups (14.6% and 6.1% respectively).
Limitations, reasons for caution
Our retrospective study and the small sample size limited the level of scientific proof. The woman and male ages were significantly different between the AMH groups, but these data lead to reduce the impact of low AMHs on pregnancy rates.
Wider implications of the findings
The young age of the women (< 38 y.o) reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF/ICSI.
Trial registration number
B2020CE.43
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Affiliation(s)
- P Merviel
- Chru Brest, Art Center , Brest, France
| | | | | | - S Boue'e
- Chru Brest, Art Center , Brest, France
| | - P James
- Chru Brest, Art Center , Brest, France
| | - H Drapier
- Chru Brest, Art Center , Brest, France
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14
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Syed H, Aljoe J, China Z, Malhi G, James P, Agrawal S. ‘Tech’ towards a greener future - the impact and benefits of outpatient bladder cancer management using next generation scopes and lasers. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00203-8] [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: 11/17/2022] Open
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15
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Tertel T, Schoppet M, Stambouli O, Al-Jipouri A, James P, Giebel B. Exosomes/EVs: IMAGING FLOW CYTOMETRY CHALLENGES THE USEFULNESS OF CLASSICALLY USED EV LABELLING DYES AND QUALIFIES THAT OF A NOVEL DYE, NAMED EXORIA™ FOR THE LABELLING OF MSC-EV. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Khan R, Salim M, Tanuseputro P, Hsu A, Coburn N, Talarico R, James P. A257 PANCREATIC CANCER TREATMENT AND END OF LIFE OUTCOMES: A POPULATION BASED COHORT STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859383 DOI: 10.1093/jcag/gwab049.256] [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: 11/14/2022] Open
Abstract
Abstract
Background
Patients with pancreatic cancer face challenging decisions regarding treatment choices following their diagnosis and often lack data on end-of-life (EOL) outcomes. Without the available information, older patients may be undertreated, dying earlier than they would have with treatment, while others may be overtreated and exposed to aggressive measures with harmful side effects.
Aims
To describe survival and EOL outcomes among pancreatic cancer patients based on index cancer treatment, disease stage, and patient characteristics.
Methods
We conducted a population based cohort study in Ontario, Canada of patients who died from April 2010 to December 2017 and were diagnosed with pancreatic cancer prior to death. We used administrative databases to collect data on demographics, baseline health status, treatments, and outcomes. The primary exposure was index cancer treatment (no treatment, radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy). The primary outcomes were mortality, health care encounters per 30 days in the last six months of life, and palliative care visits per 30 days within the last six months of life. Secondary outcomes were location of death (institution vs. community), hospitalization within the last 30 days of life, and receipt of chemotherapy within the last 30 days of life. We estimated the association between the exposure and outcomes using multivariable models, adjusting for demographics, comorbidities, and cancer stage. Hazard ratios, adjusted mean differences, and odds ratios were reported with 95% confidence intervals.
Results
Our cohort included 9950 adults with a median age at diagnosis of 78. 56% received no index treatment, 5% underwent radiation, 27% underwent chemotherapy alone, 7% underwent surgery alone, and 6% underwent surgery and chemotherapy. In the multivariable regression (Table and Figure), radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy were all associated with decreased mortality and fewer healthcare encounters. All groups except radiation were associated with fewer palliative care visits. All treatment groups were associated with lower odds of institutional death and hospitalization within the last 30 days of life, and higher odds of chemotherapy within the last 30 days of life.
Conclusions
Our data, the first to provide EOL outcome estimates based on index cancer treatment, can help patients make initial treatment decisions after a diagnosis of pancreatic cancer.
Multivariable regression analyses predicting primary and secondary outcomes
Association between index cancer treatment and primary outcomes.
Funding Agencies
CIHR
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Affiliation(s)
- R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Salim
- University Health Network, Toronto, ON, Canada
| | - P Tanuseputro
- Department of Medicine in Ottawa, Ottawa, ON, Canada
| | - A Hsu
- University of Ottawa Department of Family Medicine, Ottawa, ON, Canada
| | - N Coburn
- University of Toronto Division of General Surgery, Toronto, ON, Canada
| | - R Talarico
- ICES (Formerly Institute for Clinical and Evaluative Sciences), Ottawa, ON, Canada
| | - P James
- University Health Network, Toronto, ON, Canada
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17
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Syed H, James P, Abboudi H, Shamsuddin A, Agrawal S. Outpatient Transurethral Laser Ablation (TULA) for non-muscle invasive bladder cancer; results from a multi-centre prospective 1 year EORTC risk matched study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Zentner D, Wiseman A, Thompson T, Dinatale I, Macciocca I, Connell V, Mathew J, Davis A, James P. Victorian Inherited Cardiac Disorders Family Initiative (VicDFI) – Creating a Shared Cardiac Clinical Database Across the Life Spectrum. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Ashokkumar S, Paratz E, van Heusden A, Smith K, Zentner D, Morgan N, Parsons S, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Obesity in Young Sudden Cardiac Death: Rates, Clinical Features, and Insights Into People With Body Mass Index >50 kg/m2. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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20
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Thompson T, Zentner D, James P, Taylor S. Practise Changing Research – Adding DNAH11 to a Congenital Heart Disease Panel. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Zentner D, Wiseman A, Thompson T, Dinatale I, Macciocca I, Connell V, Mathew J, Davis A, James P. Victorian Inherited Cardiac Disorders Family Initiative (VicDFI)—Creating a Shared Cardiac Clinical Database Across the Life Spectrum. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Paratz E, van Heusden A, Ball J, Smith K, Thompson T, Zentner D, James P, Parsons S, Morgan N, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Inconsistent Discharge Diagnoses for Young Cardiac Arrest Episodes: Insights From a State-wide Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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23
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Paratz E, van Heusden A, Ball J, Smith K, Zentner D, James P, Thompson T, Morgan N, Parsons S, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Predictors and Outcomes of In-Hospital Referrals for Forensic Investigation After Young Sudden Cardiac Death. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Paratz E, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Prevalence of Coronary Artery Anomalies in Young Sudden Cardiac Death: Insights From a Prospective State-Wide Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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25
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Paratz E, Rowe S, van Heusden A, Thompson T, Morgan N, Smith K, James P, Pflaumer A, Connell V, Semsarian C, Ingles J, Parsons S, Stub D, Zentner D, La Gerche A. Clinical and Pathologic Features of Out-of-Hospital Cardiac Arrest in Pregnancy: Insights From a State-Wide Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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26
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Paratz E, van Heusden A, Smith K, Ball J, Zentner D, Morgan N, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Higher Rates But Similar Causes of Young Out-Of-Hospital Cardiac Arrest in Rural Australian Patients. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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27
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Thompson T, Morgan N, Connell V, Zentner D, Woodford N, Davis A, Pflaumer A, Parsons S, James P. A Model for Collaboration: Sudden Death Pathway. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Ahmed B, Cox MJ, Cuthbertson L, James P, Gardner L, Cookson W, Davies J, Moffatt M, Bush A. Comparison of the airway microbiota in children with chronic suppurative lung disease. BMJ Open Respir Res 2021; 8:8/1/e001106. [PMID: 34949574 PMCID: PMC8705203 DOI: 10.1136/bmjresp-2021-001106] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/19/2021] [Indexed: 12/31/2022] Open
Abstract
RATIONALE The airway microbiota is important in chronic suppurative lung diseases, such as primary ciliary dyskinesia (PCD) and cystic fibrosis (CF). This comparison has not previously been described but is important because difference between the two diseases may relate to the differing prognoses and lead to pathological insights and potentially, new treatments. OBJECTIVES To compare the longitudinal development of the airway microbiota in children with PCD to that of CF and relate this to age and clinical status. METHODS Sixty-two age-matched children (age range 0.5-17 years) with PCD or CF (n=31 in each group) were recruited prospectively and followed for 1.1 years. Throat swabs or sputum as well as clinical information were collected at routine clinical appointments. 16S rRNA gene sequencing was performed. MEASUREMENTS AND MAIN RESULTS The microbiota was highly individual and more diverse in PCD and differed in community composition when compared with CF. While Streptococcus was the most abundant genus in both conditions, Pseudomonas was more abundant in CF with Haemophilus more abundant in PCD (Padj=0.0005). In PCD only, an inverse relationship was seen in the relative abundance of Streptococcus and Haemophilus with age. CONCLUSIONS Bacterial community composition differs between children with PCD and those with CF. Pseudomonas is more prevalent in CF and Haemophilus in PCD, at least until infection with Pseudomonas supervenes. Interactions between organisms, particularly members of Haemophilus, Streptococcus and Pseudomonas genera appear important. Study of the interactions between these organisms may lead to new therapies or risk stratification.
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Affiliation(s)
- Bushra Ahmed
- National Heart and Lung Institute, Imperial College London, London, UK .,Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Michael J Cox
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Phillip James
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Laura Gardner
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | | | - Jane Davies
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.,Gene Therapy, Imperial College London, London, UK
| | | | - Andrew Bush
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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29
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Cuthbertson L, James P, Habibi MS, Thwaites RS, Paras A, Chiu C, Openshaw PJM, Cookson WOC, Moffatt MF. Resilience of the respiratory microbiome in controlled adult RSV challenge study. Eur Respir J 2021; 59:13993003.01932-2021. [PMID: 34711536 PMCID: PMC8754103 DOI: 10.1183/13993003.01932-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022]
Abstract
This study of healthy adults revealed no major changes in the bacterial community of the respiratory tracts following RSV inoculation, suggesting that the adult respiratory microbial community is resilient to viral perturbationshttps://bit.ly/3AwnMc8
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Affiliation(s)
- Leah Cuthbertson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Phillip James
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Paras
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | | | - Miriam F Moffatt
- National Heart and Lung Institute, Imperial College London, London, UK
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30
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Thirunavukarasu D, Cheng LY, Song P, Chen SX, Borad MJ, Kwong L, James P, Turner DJ, Zhang DY. Oncogene Concatenated Enriched Amplicon Nanopore Sequencing for rapid, accurate, and affordable somatic mutation detection. Genome Biol 2021; 22:227. [PMID: 34482832 PMCID: PMC8419911 DOI: 10.1186/s13059-021-02449-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/02/2021] [Indexed: 12/13/2022] Open
Abstract
We develop the Oncogene Concatenated Enriched Amplicon Nanopore Sequencing (OCEANS) method, in which variants with low variant allele frequency (VAFs) are amplified and subsequently concatenated for Nanopore Sequencing. OCEANS allows accurate detection of somatic mutations with VAF limits of detection between 0.05 and 1%. We construct 4 distinct multi-gene OCEANS panels targeting recurrent mutations in acute myeloid leukemia, melanoma, non-small- cell lung cancer, and hepatocellular carcinoma and validate them on clinical samples. By demonstrating detection of low VAF single nucleotide variant mutations using Nanopore Sequencing, OCEANS is poised to enable same-day clinical sequencing panels.
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Affiliation(s)
| | - Lauren Y Cheng
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Ping Song
- Department of Bioengineering, Rice University, Houston, TX, USA
| | | | | | - Lawrence Kwong
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - David Yu Zhang
- NuProbe USA Inc, Houston, TX, USA.
- Department of Bioengineering, Rice University, Houston, TX, USA.
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31
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Turek EM, Cox MJ, Hunter M, Hui J, James P, Willis-Owen SAG, Cuthbertson L, James A, Musk AW, Moffatt MF, Cookson WOCM. Airway microbial communities, smoking and asthma in a general population sample. EBioMedicine 2021; 71:103538. [PMID: 34425308 PMCID: PMC8387768 DOI: 10.1016/j.ebiom.2021.103538] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Normal airway microbial communities play a central role in respiratory health but are poorly characterized. Cigarette smoking is the dominant global environmental influence on lung function, and asthma has become the most prevalent chronic respiratory disease worldwide. Both conditions have major microbial components that are incompletely defined. METHODS We investigated airway bacterial communities in a general population sample of 529 Australian adults. Posterior oropharyngeal swabs were analyzed by sequencing of the 16S rRNA gene. The microbiota were characterized according to their prevalence, abundance and network memberships. FINDINGS The microbiota were similar across the general population, and were strongly organized into co-abundance networks. Smoking was associated with diversity loss, negative effects on abundant taxa, profound alterations to network structure and expansion of Streptococcus spp. By contrast, the asthmatic microbiota were selectively affected by an increase in Neisseria spp. and by reduced numbers of low abundance but prevalent organisms. INTERPRETATION Our study shows that the healthy airway microbiota in this population were contained within a highly structured ecosystem, suggesting balanced relationships between the microbiome and human host factors. The marked abnormalities in smokers may contribute to chronic obstructive pulmonary disease (COPD) and lung cancer. The narrow spectrum of abnormalities in asthmatics encourages investigation of damaging and protective effects of specific bacteria. FUNDING The study was funded by the Asmarley Trust and a Wellcome Joint Senior Investigator Award to WOCC and MFM (WT096964MA and WT097117MA). The Busselton Healthy Ageing Study is supported by the Government of Western Australia (Office of Science, Department of Health) the City of Busselton, and private donations.
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Affiliation(s)
- Elena M Turek
- National Heart and Lung Institute, Centre for Genomic Medicine, Imperial College London SW3 6LY, United Kingdom
| | - Michael J Cox
- National Heart and Lung Institute, Centre for Genomic Medicine, Imperial College London SW3 6LY, United Kingdom
| | - Michael Hunter
- School of Population and Global Health, University of Western Australia, Australia; Busselton Population Medical Research Institute, Western Australia, Australia
| | - Jennie Hui
- School of Population and Global Health, University of Western Australia, Australia; Busselton Population Medical Research Institute, Western Australia, Australia; PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Western Australia, Australia
| | - Phillip James
- National Heart and Lung Institute, Centre for Genomic Medicine, Imperial College London SW3 6LY, United Kingdom
| | - Saffron A G Willis-Owen
- National Heart and Lung Institute, Centre for Genomic Medicine, Imperial College London SW3 6LY, United Kingdom
| | - Leah Cuthbertson
- National Heart and Lung Institute, Centre for Genomic Medicine, Imperial College London SW3 6LY, United Kingdom
| | - Alan James
- Busselton Population Medical Research Institute, Western Australia, Australia; Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, UWA Medical School, University of Western Australia, Australia
| | - A William Musk
- School of Population and Global Health, University of Western Australia, Australia; Busselton Population Medical Research Institute, Western Australia, Australia; Department of Respiratory Medicine Sir Charles Gairdner Hospital, UWA Medical School, University of Western Australia, Australia
| | - Miriam F Moffatt
- National Heart and Lung Institute, Centre for Genomic Medicine, Imperial College London SW3 6LY, United Kingdom.
| | - William O C M Cookson
- National Heart and Lung Institute, Centre for Genomic Medicine, Imperial College London SW3 6LY, United Kingdom.
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James P, Bekiroglu F, Broderick D, Khattak O, Lowe D, Schache A, Shaw RJ, Rogers SN. Immediate postoperative care on high dependency unit or ward following microvascular free tissue transfer: lessons learnt from a change in practice imposed during the COVID-19 pandemic. Br J Oral Maxillofac Surg 2021; 60:343-349. [PMID: 34852938 PMCID: PMC8388193 DOI: 10.1016/j.bjoms.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic resulted in sudden changes to the established practice of using the high dependency unit (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and neck ward. This retrospective case-note review aimed to report outcomes in consecutive patients treated before and during the pandemic, and to reflect on the implications of ward-based rather than HDU care. A total of 235 patients had free tissue transfer between 3 January 2019 and 25 February 2021: 125 before (lockdown 23 March 2020), and 110 during the pandemic (52 ward-managed and 58 HDU-managed). There were subtle case-mix differences during the pandemic, with 92% of ward-treated patients having oral cancers compared with 64% of HDU patients, and 73% of ward patients having a tracheostomy compared with 40% of HDU patients. Ward patients were less likely to receive electrolyte replacement (45% HDU vs 0% ward) and inotropes (12% HDU vs 2% ward). There were fewer returns to theatre for evacuation of a haematoma or re-anastomosis during the pandemic than there were before it. Other than fewer haematoma complications during the pandemic, the nature of complications was similar. In conclusion, the dramatic changes imposed by the pandemic have shown that the ward is a safe place for patients to be cared for immediately postoperatively, and it alleviates the bed pressures experienced in HDU. Careful case selection and clear criteria are required to identify patients who need the HDU.
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Affiliation(s)
- P James
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - F Bekiroglu
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - D Broderick
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - O Khattak
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - D Lowe
- Astraglobe Ltd, Congleton, Cheshire, UK.
| | - A Schache
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - R J Shaw
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK
| | - S N Rogers
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK; Faculty of Health and Social Care, Edge Hill University, Ormskirk L39 4QP, UK.
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Saheer S, Paul A, James P, Palak R. PLEURAL ENDOMETRIOSIS: BLOODY PLEURAL EFFUSION IN A 28-YEAR-OLD FEMALE WITH PRIMARY INFERTILITY (CASE REPORT). IJMMR 2021. [DOI: 10.11603/ijmmr.2413-6077.2020.2.11512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Endometriosis is defined as presence of endometrial glands outside the uterine cavity and it most commonly involves the structures within the pelvic cavity. Thoracic endometriosis syndrome usually presents as pneumothorax, hemoptysis, hemothorax or pulmonary nodules. Endometriosis presenting as hemorrhagic pleural effusion is rarely reported.
Objectives. The aim of the study was to describe pleural endometriosis presenting as hemorrhagic pleural effusion and to insist on the role of medical thoracoscopy in making the diagnosis with the help of a case report.
Methods. A case report of pleural endometriosis as a non-resolving hemorrhagic pleural effusion is presented.
Results. A 28-years old female on treatment for her primary infertility presented with non-resolving bloody pleural effusion and she was on empirical anti-tubercular drugs for the last four months. Medical thoracoscopy revealed flat brownish grey plaques over the diaphragmatic pleura and the histology of pleural tissue revealed pleural endometriosis. She was initiated on gonadotropin releasing hormone-leuprolide and there was some clinico-radiological improvement.
Conclusions. Thoracic endometriosis should be considered as one of the differentials for pleural effusion in female patient especially on treatment for infertility. Medical thoracoscopy should be the investigation of choice for evaluating pleural effusions before initiating empirical treatments.
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Paratz E, Ross L, van Heusden A, Zentner D, Thompson T, James P, Smith K, Ball J, Pflaumer A, Stub D, La Gerche A, Morgan N, Bouwer H, Lynch M, Parsons S. Unrecognised Intracoronary IgG4-Related Disease: A Rare Cause of Two Sudden Cardiac Deaths. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peters S, Thompson B, Perrin M, James P, Zentner D, Kalman J, Fatkin D. Arrhythmias are a Requisite Feature of SCN5A Mediated Dilated Cardiomyopathy: A Systematic Review of Variants. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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James P, Harding M, Beecher T, Browne D, Cronin M, Guiney H, O'Mullane D, Whelton H. Impact of Reducing Water Fluoride on Dental Caries and Fluorosis. J Dent Res 2020; 100:507-514. [PMID: 33345672 DOI: 10.1177/0022034520978777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/15/2022] Open
Abstract
Guidance intended to reduce fluoride toothpaste ingestion in early childhood was introduced in Ireland in 2002. In 2007, water fluoride concentration was adjusted from 0.8-1.0 to 0.6-0.8 ppm. The objective of this study was to determine the difference in caries and fluorosis levels following introduction of these 2 policy measures. A before-and-after study compared caries and fluorosis in random samples of 8-y-olds in Dublin (n = 707) and Cork-Kerry (n = 1148) in 2017 with 8-y-olds in Dublin (n = 679) and Cork-Kerry (n = 565) in 2002. Dentinal caries experience (primary teeth, d3vcmft(cde)) and fluorosis (permanent teeth, Dean's index of very mild or higher) were clinically measured. Lifetime exposure to community water fluoridation (CWF) was classified as "full CWF"/"no CWF." Effect of examination year on caries prevalence and severity and fluorosis prevalence was assessed using multivariate regression adjusting for other explanatory variables. There was little change in commencement of fluoride toothpaste use at ≤24 mo following introduction of toothbrushing guidance. Among children with full CWF, there was no statistically significant difference in caries prevalence or severity between 2017 and 2002. In 2017, caries prevalence was 55% in Dublin (full CWF) and 56% in Cork-Kerry (full CWF), and mean d3vcmft(cde) among children with caries was 3.4 and 3.7, respectively. Caries severity was less in 2017 (mean 4.2) than 2002 (mean 4.9) among children with no CWF (P = 0.039). The difference in caries severity between children with full CWF and no CWF was less in 2017 than in 2002 (interaction P = 0.013), suggesting a reduced benefit for CWF in 2017. In 2017, fluorosis prevalence was 18% in Dublin (full CWF) and 12% in Cork-Kerry (full CWF). Fluorosis was predominantly "very mild" with no statistically significant difference between 2017 and 2002. CWF at 0.6 to 0.8 ppm is an effective caries-preventive measure. Results suggested low uptake of toothbrushing guidance, a reduced caries-preventive effect for CWF in primary teeth, and no reduction in fluorosis following introduction of the policy measures.
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Affiliation(s)
- P James
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - M Harding
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland.,Cork Kerry Community Healthcare Area, Health Services Executive, Dental Clinic, St. Finbarr's Hospital, Cork, Ireland
| | - T Beecher
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - D Browne
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland.,Cork Kerry Community Healthcare Area, Health Services Executive, Dental Clinic, St. Finbarr's Hospital, Cork, Ireland
| | - M Cronin
- Department of Statistics, School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - H Guiney
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - D O'Mullane
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - H Whelton
- College of Medicine and Health, University College Cork, Erinville, Cork, Ireland
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Kalson NS, Mathews JA, Alvand A, Morgan-Jones R, Jenkins N, Phillips JRA, Toms AD, Barrett D, Bloch B, Carrington R, Deehan D, Eyres K, Gambhir A, Hopgood P, Howells N, Jackson W, James P, Jeys L, Kerry R, Miles J, Mockford B, Murray J, Pavlou G, Porteous A, Price A, Sarungi M, Spencer-Jones R, Walmsley P, Waterson B, Whittaker J. Investigation and management of prosthetic joint infection in knee replacement: A BASK Surgical Practice Guideline. Knee 2020; 27:1857-1865. [PMID: 33202289 DOI: 10.1016/j.knee.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/23/2020] [Accepted: 09/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burden of knee replacement prosthetic joint infection (KR PJI) is increasing. KR PJI is difficult to treat, outcomes can be poor and it is financially expensive and limited evidence is available to guide treatment decisions. AIM To provide guidelines for surgeons and units treating KR PJI. METHODS Guideline formation by consensus process undertaken by BASK's Revision Knee Working Group, supported by outputs from UK-PJI meetings. RESULTS Improved outcomes should be achieved through provision of care by revision centres in a network model. Treatment of KR PJI should only be undertaken at specialist units with the required infrastructure and a regular infection MDT. This document outlines practice guidelines for units providing a KR PJI service and sets out: CONCLUSIONS: KR PJI patients treated within the NHS should be provided the best care possible. This report sets out guidance and support for surgeons and units to achieve this.
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Affiliation(s)
- N S Kalson
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - J A Mathews
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - A Alvand
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - R Morgan-Jones
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - N Jenkins
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - J R A Phillips
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - A D Toms
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland.
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- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
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Paratz E, Rowsell L, Ball J, Zentner D, Parsons S, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Stub D, Liew D, Smith K, La Gerche A. Economic impact of sudden cardiac arrest. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3542] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Each year, there are approximately 5,000 out-of-hospital cardiac arrests (OHCAs) in the state of Victoria, Australia (population 6.4 million, state healthcare budget AUD$2.9 billion / €1.8billion). Mortality from OHCA approaches ninety percent. High mortality rates and survivors not returning to work is likely to have an adverse effect on the Victorian economy but this has not been previously investigated.
Purpose
To model the economic impact of OHCA mortality and survivors not returning to work.
Methods
Data on all OHCAs transported by Ambulance Victoria from July 2017- June 2018 in Victoria, Australia was collected, including age, gender, survival to hospital, survival to discharge, and survival to 12 months. Cases were excluded if arrest was precipitated by trauma, exsanguination, overdose, terminal illness, hanging, SIDS, electrocution, sepsis, respiratory causes, drowning, or neurological causes. Pre-arrest employment status of patients was modelled using the Australian Bureau of Statistics Economic Security dataset, which provides contemporary employment rates for gender-matched five-year cohorts for Australians aged 15–79 years. For survivors to 12 months, pre-arrest and post-arrest work status were confirmed. Economic impact was then calculated to a five year horizon utilizing a Markov model with probabilistic sensitivity analysis.
Results
4,934 arrests meeting the inclusion criteria were transported by Ambulance Victoria in twelve months, of whom 4,639 were determined to be cardiac arrests without any exclusion criteria as a precipitant. 695 patients survived to hospital (15.0%), and 325 to discharge (7.0%). At 12 months, 303 patients were alive (6.5% of overall cases, 93.2% of those discharged from hospital). Economic modelling of age and gender-matched data indicated that 1516 patients (35%) would have been employed pre-cardiac arrest, but only 216 survivors (4.7%) would be employed at five years post-arrest. Using Markov modelling incorporating estimated earnings and the pre-determined value of a statistical life, the annual economic burden of cardiac arrest approximated AUD$4 billion (€2.5 billion) at a five-year horizon.
Conclusion
The annual economic impact of cardiac arrest in Victoria, Australia is approximately AUD$4 billion (€2.5 billion) in a five-year horizon. As the annual Victorian state budget for all healthcare is AUD$2.93 billion (€1.8 billion), our data suggests that the economic impact of cardiac arrest is under-appreciated. Therefore, research in this area and providing state-of-the-art care for all cardiac arrest patients should be a healthcare priority.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NHMRC/NHF Postgraduate Scholarship, RACP JJ Billings Scholarship
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Affiliation(s)
- E Paratz
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L Rowsell
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Ball
- Ambulance Victoria, Melbourne, Australia
| | - D Zentner
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - T Thompson
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - P James
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - A Pflaumer
- Royal Children's Hospital, Cardiology, Melbourne, Australia
| | - C Semsarian
- University of Sydney, Centenary Institute, Sydney, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - D Liew
- Monash University, School of Public Health & Preventive Medicine, Melbourne, Australia
| | - K Smith
- Ambulance Victoria, Melbourne, Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Habibi MS, Thwaites RS, Chang M, Jozwik A, Paras A, Kirsebom F, Varese A, Owen A, Cuthbertson L, James P, Tunstall T, Nickle D, Hansel TT, Moffatt MF, Johansson C, Chiu C, Openshaw PJM. Neutrophilic inflammation in the respiratory mucosa predisposes to RSV infection. Science 2020; 370:eaba9301. [PMID: 33033192 PMCID: PMC7613218 DOI: 10.1126/science.aba9301] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
Abstract
The variable outcome of viral exposure is only partially explained by known factors. We administered respiratory syncytial virus (RSV) to 58 volunteers, of whom 57% became infected. Mucosal neutrophil activation before exposure was highly predictive of symptomatic RSV disease. This was associated with a rapid, presymptomatic decline in mucosal interleukin-17A (IL-17A) and other mediators. Conversely, those who resisted infection showed presymptomatic activation of IL-17- and tumor necrosis factor-related pathways. Vulnerability to infection was not associated with baseline microbiome but was reproduced in mice by preinfection chemokine-driven airway recruitment of neutrophils, which caused enhanced disease mediated by pulmonary CD8+ T cell infiltration. Thus, mucosal neutrophilic inflammation at the time of RSV exposure enhances susceptibility, revealing dynamic, time-dependent local immune responses before symptom onset and explaining the as-yet unpredictable outcomes of pathogen exposure.
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Affiliation(s)
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Agnieszka Jozwik
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Paras
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Freja Kirsebom
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Augusto Varese
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Amber Owen
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Leah Cuthbertson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Phillip James
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - David Nickle
- Genetics & Pharmacogenomics, Department of Translational Medicine, Merck & Co., Inc., Boston, MA, USA
| | - Trevor T Hansel
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Miriam F Moffatt
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Cecilia Johansson
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, UK.
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Tyson JR, James P, Stoddart D, Sparks N, Wickenhagen A, Hall G, Choi JH, Lapointe H, Kamelian K, Smith AD, Prystajecky N, Goodfellow I, Wilson SJ, Harrigan R, Snutch TP, Loman NJ, Quick J. Improvements to the ARTIC multiplex PCR method for SARS-CoV-2 genome sequencing using nanopore. bioRxiv 2020:2020.09.04.283077. [PMID: 32908977 DOI: 10.1101/2020.09.04.283077v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Genome sequencing has been widely deployed to study the evolution of SARS-CoV-2 with more than 90,000 genome sequences uploaded to the GISAID database. We published a method for SARS-CoV-2 genome sequencing ( https://www.protocols.io/view/ncov-2019-sequencing-protocol-bbmuik6w ) online on January 22, 2020. This approach has rapidly become the most popular method for sequencing SARS-CoV-2 due to its simplicity and cost-effectiveness. Here we present improvements to the original protocol: i) an updated primer scheme with 22 additional primers to improve genome coverage, ii) a streamlined library preparation workflow which improves demultiplexing rate for up to 96 samples and reduces hands-on time by several hours and iii) cost savings which bring the reagent cost down to £10 per sample making it practical for individual labs to sequence thousands of SARS-CoV-2 genomes to support national and international genomic epidemiology efforts.
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Tyson JR, James P, Stoddart D, Sparks N, Wickenhagen A, Hall G, Choi JH, Lapointe H, Kamelian K, Smith AD, Prystajecky N, Goodfellow I, Wilson SJ, Harrigan R, Snutch TP, Loman NJ, Quick J. Improvements to the ARTIC multiplex PCR method for SARS-CoV-2 genome sequencing using nanopore. bioRxiv 2020:2020.09.04.283077. [PMID: 32908977 PMCID: PMC7480024 DOI: 10.1101/2020.09.04.283077] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genome sequencing has been widely deployed to study the evolution of SARS-CoV-2 with more than 90,000 genome sequences uploaded to the GISAID database. We published a method for SARS-CoV-2 genome sequencing (https://www.protocols.io/view/ncov-2019-sequencing-protocol-bbmuik6w) online on January 22, 2020. This approach has rapidly become the most popular method for sequencing SARS-CoV-2 due to its simplicity and cost-effectiveness. Here we present improvements to the original protocol: i) an updated primer scheme with 22 additional primers to improve genome coverage, ii) a streamlined library preparation workflow which improves demultiplexing rate for up to 96 samples and reduces hands-on time by several hours and iii) cost savings which bring the reagent cost down to £10 per sample making it practical for individual labs to sequence thousands of SARS-CoV-2 genomes to support national and international genomic epidemiology efforts.
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Affiliation(s)
- John R Tyson
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | | | | | - Natalie Sparks
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | | | - Grant Hall
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Ji Hyun Choi
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hope Lapointe
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kimia Kamelian
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
| | - Andrew D Smith
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Oxford Nanopore Technologies Ltd., Oxford, UK
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, UK
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Ian Goodfellow
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Sam J Wilson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Richard Harrigan
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Terrance P Snutch
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Nicholas J Loman
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Joshua Quick
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
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Cook PA, Dennis M, Wheater CP, James P, Lindley S. Urban green infrastructure size, quality and proximity and health outcomes in older populations. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A city's multi-functional network of green and blue spaces has an important role underpinning the health and wellbeing of its residents. Although evidence of positive links between nature and health is plentiful, little is known about which particular aspects of green and blue spaces are most influential, and how benefits might vary between social groups and age.
Methods
We used a green infrastructure (GI) approach combining a high-resolution spatial dataset of land-cover and function with area-level demographic and socio-economic data. A comprehensive characterisation of the Greater Manchester UK city region was generated. The GI attributes were used in step-wise multi-level regression analyses to test for associations between population chronic morbidity and the functional, physical and spatial components of GI across an urban socio-demographic gradient.
Results
Individual GI attributes were significantly associated with health in all socio-demographic contexts; even when associations between health and overall green cover were non-significant. For areas with having higher proportions of older people ('older neighbourhoods'), associations were found between health and land-cover diversity, informal greenery and patch size in high income areas. In lower income areas, health was predicted by proximity to public parks and recreation land.
Conclusions
A nuanced description of greenspace in terms of quality, cover type, diversity explains more variation in population health than a single metric such as percentage green cover. People in urban neighbourhoods that have older age populations and lower income are disproportionately healthy if their neighbourhoods contain accessible, good quality public greenspace. This has implications for strategies to decrease health inequalities and inform international initiatives, such as the World Health Organisation's Age-Friendly Cities programme.
Key messages
A nuanced description of green and blue space in terms of quality, cover type, diversity explains more variation in population health than a single metric such as percentage green cover. People in urban neighbourhoods that have older age populations and lower income are disproportionately healthy if their neighbourhoods contain accessible, good quality public greenspace.
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Affiliation(s)
- P A Cook
- School of Health and Society, University of Salford, Salford, UK
| | - M Dennis
- Department of Geography, University of Manchester, Manchester, UK
| | - C P Wheater
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - P James
- School of Science, Engineering and Environment, University of Salford, Salford, UK
| | - S Lindley
- Department of Geography, University of Manchester, Manchester, UK
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Brown M, Hooper N, James P, Scott D, Bodger O, John A. A Web-Delivered Acceptance and Commitment Therapy Intervention With Email Reminders to Enhance Subjective Well-Being and Encourage Engagement With Lifestyle Behavior Change in Health Care Staff: Randomized Cluster Feasibility Stud. JMIR Form Res 2020; 4:e18586. [PMID: 32763887 PMCID: PMC7442951 DOI: 10.2196/18586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor mental health and emotional well-being can negatively impact ability to engage in healthy lifestyle behavior change. Health care staff have higher rates of sickness and absence than other public sector staff, which has implications at both individual and societal levels. Individual efforts to self-manage health and well-being which add to the UK mental health prevention agenda need to be supported. OBJECTIVE The objective of this study was to establish the feasibility and acceptability of the inclusion of a self-guided, automated, web-based acceptance and commitment therapy intervention in an existing health promotion program, to improve subjective well-being and encourage engagement with lifestyle behavior change. METHODS For this 12-week, 4-armed, randomized controlled cluster feasibility study, we recruited participants offline and randomly allocated them to 1 of 3 intervention arms or control (no well-being intervention) using an automated web-based allocation procedure. Eligibility criteria were current health care staff in 1 Welsh health board, age≥18 years, ability to read English, and ability to provide consent. The primary researcher was blinded to cluster allocation. Feasibility outcomes were randomization procedure, acceptance of intervention, and adherence to and engagement with the wider program. We evaluated health and well-being data via self-assessment at 2 time points, registration and postintervention, using the 14-item Warwick-Edinburgh Mental Well-Being Scale, the 4-item Patient Health Questionnaire, and the 7-item Acceptance and Action Questionnaire-Revised. RESULTS Of 124 participants who provided consent and were randomly allocated, 103 completed full registration and engaged with the program. Most participants (76/103) enrolled in at least one health behavior change module, and 43% (41/96) of those randomly allocated to an intervention arm enrolled in the well-being module. Adherence and engagement was low (7/103, 6.8%), but qualitative feedback was positive. CONCLUSIONS The procedure and randomization process proved feasible, and the addition of the well-being module proved acceptable to health care staff. However, participant engagement was limited, and no one completed the full 12-week program. User feedback should be used to develop the intervention to address poor engagement. Effectiveness should then be evaluated in a full-scale randomized controlled trial, which would be feasible with additional recruitment. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) 50074817; http://www.isrctn.com/ISRCTN50074817.
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Affiliation(s)
- Menna Brown
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Nic Hooper
- Department of Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Phillip James
- Department of Computer Science, Swansea University, Swansea, United Kingdom
| | - Darren Scott
- Department of Computer Science, Swansea University, Swansea, United Kingdom
| | - Owen Bodger
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
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James P, Morgant R, Merviel P, Saraux A, Giroux-Metges MA, Guillodo Y, Dupré PF, Muller M. How to promote physical activity during pregnancy : A systematic review. J Gynecol Obstet Hum Reprod 2020; 49:101864. [PMID: 32663651 DOI: 10.1016/j.jogoh.2020.101864] [Citation(s) in RCA: 4] [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: 06/26/2019] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sedentary lifestyles and physical inactivity have been shown to increase during pregnancy and are a cause of obstetric comorbidity. The objective of this study was to conduct a systematic review of interventions aiming to promote physical activity during pregnancy. MATERIAL AND METHODS Databases were searched from January 2008 to September 2019. Selection criteria included randomized controlled trials evaluating the efficacy of interventions promoting physical activity during pregnancy. RESULTS In total, 256 articles were extracted from databases. 202 articles were excluded. Finally, 15 articles were included in the study. 5633 patients were included from various populations. Six studies rated physical activity (PA) as the primary outcome. Five studies suggested promoting physical activity through individual interviews which in two studies showed an increase in PA. Three studies evaluated an intervention based on group interviews and one of these reported a significant increase in PA. Two studies evaluated the use of a Smartphone application to promote physical activity but they did not conclude that they were effective because they were designed with low statistical power. CONCLUSION The practice of regular PA during pregnancy reduces obstetrical comorbidity. However, interventions seem to have a low impact on the promotion of PA during pregnancy. New intervention strategies need to assessed, such as the use of mobile health interventions.
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Affiliation(s)
- P James
- JAMES Pandora, Resident, Centre Hospitalier Universitaire Brest, France.
| | - R Morgant
- Dr MORGANT Romain, Cabinet de traumatologie du TER, Clinique du TER, 56270, Ploemeur, France
| | - P Merviel
- Pr MERVIEL Philippe, Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHRU Brest - Hôpital Morvan, France
| | - A Saraux
- Pr SARAUX Alain, Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, France
| | - M A Giroux-Metges
- Pr GIROUX-METGES Marie-Agnès, Service des EFR, Hôpital de la Cavale Blanche, CHRU Brest, France
| | - Y Guillodo
- Dr GUILLODO Yannick, Service de Rhumatologie, CHRU Brest, France
| | - P F Dupré
- Dr DUPRE Pierre-François, Chirurgie Oncologique Gynécologique et mammaire, CHRU Brest, France
| | - M Muller
- Dr MULLER Matthieu, Service Gynécologie-Obstétrique, Centre Hospitalier des Pays de Morlaix, France
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Cuthbertson L, Felton I, James P, Cox MJ, Bilton D, Schelenz S, Loebinger MR, Cookson WOC, Simmonds NJ, Moffatt MF. The fungal airway microbiome in cystic fibrosis and non-cystic fibrosis bronchiectasis. J Cyst Fibros 2020; 20:295-302. [PMID: 32540174 PMCID: PMC8048771 DOI: 10.1016/j.jcf.2020.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 02/08/2023]
Abstract
The prevalence of fungal disease is increasing in CF and non-CF bronchiectasis. Effective management of fungal disease requires an understanding of the mycobiome. Culture methods alone are inadequate for the accurate diagnosis of fungal disease. Our study provides a framework to characterize fungal airway disease using NGS. NGS can improve detection and clinical management of fungal infections.
Background The prevalence of fungal disease in cystic fibrosis (CF) and non-CF bronchiectasis is increasing and the clinical spectrum is widening. Poor sensitivity and a lack of standard diagnostic criteria renders interpretation of culture results challenging. In order to develop effective management strategies, a more accurate and comprehensive understanding of the airways fungal microbiome is required. The study aimed to use DNA sequences from sputum to assess the load and diversity of fungi in adults with CF and non-CF bronchiectasis. Methods Next generation sequencing of the ITS2 region was used to examine fungal community composition (n = 176) by disease and underlying clinical subgroups including allergic bronchopulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, non-tuberculous mycobacteria, and fungal bronchitis. Patients with no known active fungal disease were included as disease controls. Results ITS2 sequencing greatly increased the detection of fungi from sputum. In patients with CF fungal diversity was lower, while burden was higher than those with non-CF bronchiectasis. The most common operational taxonomic unit (OTU) in patients with CF was Candida parapsilosis (20.4%), whereas in non-CF bronchiectasis sputum Candida albicans (21.8%) was most common. CF patients with overt fungal bronchitis were dominated by Aspergillus spp., Exophiala spp., Candida parapsilosis or Scedosporium spp. Conclusion This study provides a framework to more accurately characterize the extended spectrum of fungal airways diseases in adult suppurative lung diseases.
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Affiliation(s)
- Leah Cuthbertson
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Imogen Felton
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Phillip James
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Michael J Cox
- National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Diana Bilton
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Silke Schelenz
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - William O C Cookson
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK.
| | - Nicholas J Simmonds
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Miriam F Moffatt
- National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
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Gleeson M, Kentwell M, Meiser B, Do J, Nevin S, Taylor N, Barlow-Stewart K, Kirk J, James P, Scott CL, Williams R, Gamet K, Burke J, Murphy M, Antill YC, Pearn A, Pachter N, Ebzery C, Poplawski N, Friedlander M, Tucker KM. The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients. Gynecol Oncol 2020; 158:431-439. [PMID: 32451123 DOI: 10.1016/j.ygyno.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women. METHODS A training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming. RESULTS 185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either 'always' or 'nearly always' having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training. CONCLUSIONS Oncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.
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Affiliation(s)
- M Gleeson
- Hunter Family Cancer Service, Newcastle, Australia.
| | - M Kentwell
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; The Royal Women's Hospital, Oncology and Dysplasia, Melbourne, Australia
| | - B Meiser
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - J Do
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - S Nevin
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - N Taylor
- The Cancer Council New South Wales, Sydney and Faculty of Health Science, University of Sydney, Australia
| | | | - J Kirk
- Familial Cancer Service, Westmead Hospital, Sydney Medical School, University of Sydney and Centre for Cancer Research, The Westmead Institute for Medical Research, Australia
| | - P James
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C L Scott
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology and Department of Medical Biology, University of Melbourne, Australia
| | - R Williams
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - K Gamet
- Genetic Health Service NZ Northern Hub, Auckland City Hospital, Auckland, New Zealand
| | - J Burke
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, Australia
| | - M Murphy
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Bendigo Health Cancer Centre, Bendigo, Australia
| | - Y C Antill
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Familial Cancer Centre, Monash Health, Victoria, Australia
| | - A Pearn
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - N Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - C Ebzery
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - N Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Australia
| | - M Friedlander
- Dept Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - K M Tucker
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
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Khanabdali R, Shojaee M, Johnson J, Law S, Whitmore M, Lim M, Schoppet M, Silva A, James P, Kalionis B, Dixon I, Lichtfuss GG, Tester A. Characterization of extracellular vesicles derived from two populations of human placenta derived mesenchymal stem/stromal cells. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li S, Monachese M, James P. A277 DISCREPANCIES IN EUS-FNA CYTOPATHOLOGY AND SURGICAL SPECIMEN PATHOLOGY FOR HIGH RISK PANCREATIC MUCINOUS CYSTIC LESIONS: A CASE SERIES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.276] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is the primary method of sampling pancreatic cystic lesions with reported specificity near 100% for diagnosing malignancy. Discrepant positive malignant cytopathology with final surgical pathology of pancreatic cystic lesions has not previously been described.
Aims
To present a case series and review the literature regarding the implications of positive malignant cytology with discrepant surgical pathology for high risk pancreatic mucinous cystic lesions.
Methods
Patient demographics, clinical history, procedure details, pathology evaluations and follow-up were collected. A thorough literature review was performed.
Results
Three patients with high-risk pancreatic cystic lesions on cross-sectional imaging underwent EUS-FNA evaluation. None of these patients had a history of pancreatitis. Cytology was reported as positive for adenocarcinoma in all patients by separate gastrointestinal cytopathologists. All patients underwent surgical resection. The pathology for all resected specimens were reported as intraductal papillary mucinous neoplasm. The resected cysts for two patients demonstrated foci of high-grade dysplasia and the third noted low grade dysplasia. All surgical pathology underwent consensus review by three separate gastrointestinal pathologists. None of the patients were treated with adjuvant chemotherapy. All patients have been followed post-operatively with surveillance magnetic resonance imaging with no evidence of recurrence to date (median follow-up time 239 days, range 133 – 447 days).
Conclusions
This phenomenon sheds light on the potential for variable interpretations of EUS-FNA cytopathology and surgical resection pathology for high risk pancreatic cystic neoplasms. EUS-FNA may identify foci of adenocarcinoma that is not seen on surgical pathology specimens. Further research is required to examine the long-term outcomes of these patients.
Funding Agencies
None
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Affiliation(s)
- S Li
- University of Toronto, Toronto, ON, Canada
| | | | - P James
- University Health Network, Toronto, ON, Canada
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Abstract
Abstract
Background
One of the complications of portal hypertension, with or without the presence of cirrhosis, is the development of varices along the length of the gastrointestinal tract. The commonest sites are along the esophagus or in the stomach. Ectopic varices in the small and large bowels can also be observed, but ectopic varices in the pharynx are extremely uncommon.
Aims
To present a case series and review the literature regarding pharyngeal varcies.
Methods
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Results
Three elderly female patients presented for esophagogastric varices surveillance gastroscopy were diagnosed with pharyngeal varices. One patient has hepatitis C cirrhosis, while the other two non-cirrhotic patients have myeloproliferative neoplasm (MPN). None of the patients had thromboses of the portal vein or its tributaries. All three patient have concomitant esophageal varices, but only one required band ligation of her esophageal varices. All patients are asymptotic except for mild dysphagia. No patient has bled from their pharyngeal varices to date. Two patients have had prophylactic treatment of their portal hypertension with non-selective beta blocker (NSBB), while the third one has not received NSBB prophylaxis because of her age.
Conclusions
Pharyngeal varices are extremely rare. To date, there are three case reports in the literature, however, we have been able to identify three cases in our practice. The previous two cases reported possible left-sided portal hypertension with splenic vein thrombosis, leading to the development of collateral vessels including a gastrocaval shunt, which by some contiguous route connects to the brachiocephalic vein; and a third case was a complication of neck dissection surgery. In our case series, none of our patients had splenic vein thrombosis. However, none of them has had a careful CT angiogram to delineate the portal vein tributaries and the collateral vessels, which may further help to define their pathogenesis. It is unclear whether NSBB would be effective as primary prophylaxis against their bleeding, The plan is to continue to monitor these patients to learn about the natural history of these pharyngeal varices.
Funding Agencies
None
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Affiliation(s)
- J Ghaith
- University of Toronto, Toronto, ON, Canada
| | - P James
- University of Toronto, Toronto, ON, Canada
| | - F Wong
- Medicine, 9N/983 Toronto General Hospital, Toronto, ON, Canada
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