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Todd S, Foster N. Oncocytic papillary cystadenoma. Br Dent J 2024; 236:187-188. [PMID: 38332080 DOI: 10.1038/s41415-024-7093-5] [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] [Received: 12/14/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Affiliation(s)
- S Todd
- Dental Emergency Clinic, Newcastle Dental Hospital, Newcastle-Upon-Tyne, UK.
| | - N Foster
- Dental Emergency Clinic, Newcastle Dental Hospital, Newcastle-Upon-Tyne, UK.
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Linden M, Leonard R, Forbes T, Brown M, Marsh L, Todd S, Hughes N, Truesdale M. Experiences of UK and Irish family carers of people with profound and multiple intellectual disabilities during the COVID-19 pandemic. BMC Public Health 2023; 23:2475. [PMID: 38082349 PMCID: PMC10714525 DOI: 10.1186/s12889-023-17432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND People with profound and multiple intellectual disabilities (PMID) have high and intensive support needs that ordinarily place significant strain on family carers. This was further heightened by the removal of many external supports during the COVID-19 pandemic. We sought to explore the experiences of family carers of people with PMID during the COVID-19 pandemic and understand what the longer-term impact might be on their lives. METHODS Focus group interviews (n = 32) were conducted with family carers (n = 126) from the four countries of the UK and the Republic of Ireland. Participants were asked questions relating to their experiences of the COVID-19 pandemic, coping strategies, and challenges faced. All focus groups were conducted using the online platform, Zoom. These were audio recorded, transcribed verbatim and analysed employing inductive thematic analysis. FINDINGS Three main themes were generated from the data including (1.0) COVID-19 as a double-edged sword (2.0), The struggle for support (3.0), Constant nature of caring. These included 11 subthemes. (1.1) 'COVID-19 as a catalyst for change', (1.2) 'Challenges during COVID-19: dealing with change', (1.3) 'Challenges during COVID-19: fear of COVID-19', (1.4); 'The online environment: the new normal' (2.1) 'Invisibility of male carers', (2.2) 'Carers supporting carers', (2.3) 'The only service you get is lip service: non-existent services', (2.4); 'Knowing your rights' (3.1) 'Emotional response to the caring role: Feeling devalued', (3.2) 'Emotional response to the caring role: Desperation of caring', (3.3) 'Multiple demands of the caring role.' CONCLUSIONS The COVID-19 pandemic presented immense challenges to family carers of people with PMID but also provided some opportunities. Families had already struggled to receive many of the supports and services to which they were entitled to only to have these removed at the onset of the pandemic. The experiences of male carers have been largely absent from the literature with this research showing they want to be included in decision making and require tailored support services. Service providers should see the end of the COVID-19 pandemic as providing opportunity to re-examine current provision and design services with family carers. As the direct threat from COVID-19 diminishes and the experiences of those who lived through this period come to the fore, there is a need to re-examine current models and provision of support to family carers to better meet their needs.
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Affiliation(s)
- Mark Linden
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK.
| | - R Leonard
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - T Forbes
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - M Brown
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - L Marsh
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - S Todd
- School of Healthcare Sciences, University of South Wales, Cardiff, UK
| | - N Hughes
- ESRC Centre for Care, Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - M Truesdale
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Loh MM, Yaxley N, Moore G, Holmes D, Todd S, Smith A, Macdonald E, Semple S, Cherrie M, Patel M, Hamill R, Leckie A, Dancer SJ, Cherrie JW. Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals. J Hosp Infect 2023; 133:1-7. [PMID: 36473553 PMCID: PMC9721166 DOI: 10.1016/j.jhin.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are still uncertainties in our knowledge of the amount of SARS-CoV-2 virus present in the environment - where it can be found, and potential exposure determinants - limiting our ability to effectively model and compare interventions for risk management. AIM This study measured SARS-CoV-2 in three hospitals in Scotland on surfaces and in air, alongside ventilation and patient care activities. METHODS Air sampling at 200 L/min for 20 min and surface sampling were performed in two wards designated to treat COVID-19-positive patients and two non-COVID-19 wards across three hospitals in November and December 2020. FINDINGS Detectable samples of SARS-CoV-2 were found in COVID-19 treatment wards but not in non-COVID-19 wards. Most samples were below assay detection limits, but maximum concentrations reached 1.7×103 genomic copies/m3 in air and 1.9×104 copies per surface swab (3.2×102 copies/cm2 for surface loading). The estimated geometric mean air concentration (geometric standard deviation) across all hospitals was 0.41 (71) genomic copies/m3 and the corresponding values for surface contamination were 2.9 (29) copies/swab. SARS-CoV-2 RNA was found in non-patient areas (patient/visitor waiting rooms and personal protective equipment changing areas) associated with COVID-19 treatment wards. CONCLUSION Non-patient areas of the hospital may pose risks for infection transmission and further attention should be paid to these areas. Standardization of sampling methods will improve understanding of levels of environmental contamination. The pandemic has demonstrated a need to review and act upon the challenges of older hospital buildings meeting current ventilation guidance.
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Affiliation(s)
- M M Loh
- Institute of Occupational Medicine, Edinburgh, UK.
| | - N Yaxley
- UK Health Security Agency, Porton Down, UK
| | - G Moore
- UK Health Security Agency, Porton Down, UK
| | - D Holmes
- Institute of Occupational Medicine, Edinburgh, UK
| | - S Todd
- Institute of Occupational Medicine, Edinburgh, UK
| | - A Smith
- Institute of Occupational Medicine, Edinburgh, UK
| | | | - S Semple
- Institute for Social Marketing & Health, University of Stirling, Stirling, UK
| | - M Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | | | | | | | - S J Dancer
- NHS Lanarkshire, UK; Edinburgh Napier University, UK
| | - J W Cherrie
- Institute of Occupational Medicine, Edinburgh, UK; Heriot Watt University, Edinburgh, UK
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Linden MA, Forbes T, Brown M, Marsh L, Truesdale M, McCann E, Todd S, Hughes N. Correction: Impact of the COVID-19 pandemic on family carers of those with profound and multiple intellectual disabilities: perspectives from UK and Irish Non-Governmental Organisations. BMC Public Health 2022; 22:2302. [PMID: 36503401 PMCID: PMC9741943 DOI: 10.1186/s12889-022-14740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- M. A. Linden
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - T. Forbes
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Brown
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - L. Marsh
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Truesdale
- grid.8756.c0000 0001 2193 314XSchool of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - E. McCann
- grid.4464.20000 0001 2161 2573Division of Nursing at City, University of London, London, UK
| | - S. Todd
- grid.410658.e0000 0004 1936 9035School of Care Sciences, University of South Wales, Caerleon, Wales
| | - N. Hughes
- Department of Sociological Studies, University of Shefeld, Shefeld, England
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Linden MA, Forbes T, Brown M, Marsh L, Truesdale M, McCann E, Todd S, Hughes N. Impact of the COVID-19 pandemic on family carers of those with profound and multiple intellectual disabilities: perspectives from UK and Irish Non-Governmental Organisations. BMC Public Health 2022; 22:2095. [PMID: 36384516 PMCID: PMC9668390 DOI: 10.1186/s12889-022-14560-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Family carers of people with profound and multiple intellectual disabilities (PMID) experienced a reduction in healthcare services due to the COVID-19 pandemic. Many subsequently turned to Non-Governmental Organisations who worked to support families. However, little research has sought to capture the experiences of family carers or identify effective interventions which might support them. To address these concerns we explored the views of Non-Governmental sector workers across the UK and Ireland who supported families people with PMID during the COVID-19 pandemic. We also sought to explore their views on the characteristics of online support programmes for family carers. METHODS: This study employed a qualitative design using focus groups with participants (n = 24) from five Non-Governmental Organisations across the UK and Ireland. A focus group guide included questions on challenges, supports, coping and resources which helped during lockdown restrictions. Focus groups were held online, were audio recorded and transcribed verbatim. The resulting transcripts were pseudonymised and subjected to thematic analysis. FINDINGS Four themes were identified (i) 'mental and emotional health', (ii) 'they who shout the loudest' (fighting for services), (iii) 'lack of trust in statutory services' and (iv) 'creating an online support programme'. Mental and emotional health emerged as the most prominent theme and included three subthemes named as 'isolation', 'fear of COVID-19' and 'the exhaustion of caring'. CONCLUSIONS The COVID-19 pandemic has increased the vulnerability of family carers who were already experiencing difficulties in accessing services and supports for their families. While Non-Governmental Organisations have been a crucial lifeline there is urgent need to design services, including online support programmes, in partnership with family carers which adequately address their needs.
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Affiliation(s)
- M. A. Linden
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - T. Forbes
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Brown
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - L. Marsh
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Truesdale
- grid.8756.c0000 0001 2193 314XSchool of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - E. McCann
- grid.4464.20000 0001 2161 2573Division of Nursing at City, University of London, London, UK
| | - S. Todd
- grid.410658.e0000 0004 1936 9035School of Care Sciences, University of South Wales, Caerleon, Wales
| | - N. Hughes
- grid.11835.3e0000 0004 1936 9262Department of Sociological Studies, University of Sheffield, Sheffield, England
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Tierney B, Todd S, Melby V. 50 SERVICE EVALUATION COMPARING ACUTE CARE AT HOME FOR OLDER SEOPLE SERVICE AND CONVENTIONAL ACUTE HOSPITAL CARE OF THE ELDERLY WARD. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.040] [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
Background
Globally, there has been an increased demand for healthcare services caused by population growth and a rise in chronic conditions and an ageing population. Acute Care at Home services offer acute, hospital-level care in a person's own home. Five services have been commissioned across Northern Ireland since 2014 with limited research investigating their feasibility and effectiveness. This study evaluated the impact of a consultant-led Acute Care at Home service in comparison with conventional hospital admission to a care of elderly ward.
Methods
Quantitative design, using service evaluation methodology. A 1-year retrospective chart review was undertaken exploring admission demographics and post-discharge clinical outcomes of patients admitted to a Northern Ireland, Care of the Elderly ward (n = 191) and a consultant-led Acute Care at Home Service (n = 314) between April 2018–March 2019. Data were analysed using descriptive and inferential data analysis methods including frequencies, independent t tests and chi-square analysis. Outcome measurements included length of stay, 30-day, 3-and 6-month readmission and mortality rates, functional ability and residence on discharge. STROBE checklist was used in reporting this study.
Results
Acute Care at Home services are associated with higher readmission and mortality rates at 30 days, 3 and 6 months. Patients admitted to the Acute Care at Home services experience a reduced length of stay and decreased escalation in domiciliary care packages and are less likely to require subacute rehabilitation on discharge. There is no difference in gender, age and early warnings score between the two cohorts.
Conclusion
The Acute Care at Home service is a viable alternative to hospital for older patients. It prevents functional decline and the need for domiciliary care or nursing home placement. Acute Care at Home service has higher mortality and readmissions rates due to treating a higher proportion of dependent, frail older adults.
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Affiliation(s)
- B Tierney
- Western Health and Social Care Trust , Derry City, Ireland
| | - S Todd
- Western Health and Social Care Trust , Derry City, Ireland
| | - V Melby
- Ulster University , Derry City, Northern Ireland
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Wurdack M, Estrecho E, Todd S, Schneider C, Truscott AG, Ostrovskaya EA. Enhancing Ground-State Population and Macroscopic Coherence of Room-Temperature WS_{2} Polaritons through Engineered Confinement. Phys Rev Lett 2022; 129:147402. [PMID: 36240404 DOI: 10.1103/physrevlett.129.147402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Exciton polaritons (polaritons herein) in transition-metal dichalcogenide monolayers have attracted significant attention due to their potential for polariton-based optoelectronics. Many of the proposed applications rely on the ability to trap polaritons and to reach macroscopic occupation of their ground energy state. Here, we engineer a trap for room-temperature polaritons in an all-dielectric optical microcavity by locally increasing the interactions between the WS_{2} excitons and cavity photons. The resulting confinement enhances the population and the first-order coherence of the polaritons in the ground state, with the latter effect related to dramatic suppression of disorder-induced inhomogeneous dephasing. We also demonstrate efficient population transfer into the trap when optically injecting free polaritons outside of its periphery.
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Affiliation(s)
- M Wurdack
- ARC Centre of Excellence in Future Low-Energy Electronics Technologies and Department of Quantum Science and Technology, Research School of Physics, The Australian National University, Canberra, ACT 2601, Australia
| | - E Estrecho
- ARC Centre of Excellence in Future Low-Energy Electronics Technologies and Department of Quantum Science and Technology, Research School of Physics, The Australian National University, Canberra, ACT 2601, Australia
| | - S Todd
- ARC Centre of Excellence in Future Low-Energy Electronics Technologies and Department of Quantum Science and Technology, Research School of Physics, The Australian National University, Canberra, ACT 2601, Australia
| | - C Schneider
- Institut für Physik, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26126 Oldenburg, Germany
| | - A G Truscott
- Department of Quantum Science and Technology, Research School of Physics, The Australian National University, Canberra, ACT 2601, Australia
| | - E A Ostrovskaya
- ARC Centre of Excellence in Future Low-Energy Electronics Technologies and Department of Quantum Science and Technology, Research School of Physics, The Australian National University, Canberra, ACT 2601, Australia
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Hatton C, Bailey T, Bradshaw J, Caton S, Flynn S, Gillooly A, Jahoda A, Maguire R, Marriott A, Mulhall P, Oloidi E, Taggart L, Todd S, Abbott D, Beyer S, Gore N, Heslop P, Scior K, Hastings RP. The willingness of UK adults with intellectual disabilities to take COVID-19 vaccines. J Intellect Disabil Res 2021; 65:949-961. [PMID: 34529314 PMCID: PMC8657332 DOI: 10.1111/jir.12884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/29/2021] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Given the much greater COVID-19 mortality risk experienced by people with intellectual disabilities (ID), understanding the willingness of people with ID to take a COVID-19 vaccine is a major public health issue. METHOD In December 2020 to February 2021, across the United Kingdom, 621 adults with ID were interviewed remotely and 348 family carers or support workers of adults with ID with greater needs completed an online survey, including a question on willingness to take a COVID-19 vaccine if offered. RESULTS Eighty-seven per cent of interviewees with ID were willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having already had a flu vaccine, gaining information about COVID-19 from television but not from social media, and knowing COVID-19 social restrictions rules. A percentage of 81.7% of surveyed carers of adults with ID with greater needs reported that the person would be willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having a health condition of concern in the context of COVID-19, having had a flu vaccine, being close to someone who had died due to COVID-19, and having shielded at some point during the pandemic. CONCLUSIONS Reported willingness to take the COVID-19 vaccine is high among adults with ID in the United Kingdom, with factors associated with willingness having clear implications for public health policy and practice.
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Affiliation(s)
- C. Hatton
- Department of Social Care and Social WorkManchester Metropolitan UniversityManchesterUK
| | - T. Bailey
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
| | | | - S. Caton
- Department of Social Care and Social WorkManchester Metropolitan UniversityManchesterUK
| | - S. Flynn
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
| | - A. Gillooly
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - A. Jahoda
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - R. Maguire
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - A. Marriott
- National Development Team for InclusionBathUK
| | - P. Mulhall
- Institute of Nursing and Health ResearchUniversity of UlsterJordanstownUK
| | - E. Oloidi
- Unit for Development in Intellectual and Developmental DisabilitiesUniversity of South WalesPontypriddUK
| | - L. Taggart
- Institute of Nursing and Health ResearchUniversity of UlsterJordanstownUK
| | - S. Todd
- Unit for Development in Intellectual and Developmental DisabilitiesUniversity of South WalesPontypriddUK
| | - D. Abbott
- School for Policy StudiesUniversity of BristolBristolUK
| | - S. Beyer
- School of MedicineUniversity of CardiffCardiffUK
| | - N. Gore
- Tizard CentreUniversity of KentCanterburyUK
| | - P. Heslop
- School for Policy StudiesUniversity of BristolBristolUK
| | - K. Scior
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - R. P. Hastings
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and PsychologyMonash UniversityMelbourneVICAustralia
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Butterworth R, Todd S, Dickson C. P.82 Improving anaesthetic maternity follow-up through adoption of electronic maternity records. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
We investigate implicit vocabulary learning by adults who are exposed to a language in their ambient environment. Most New Zealanders do not speak Māori, yet are exposed to it throughout their lifetime. We show that this exposure leads to a large proto-lexicon - implicit knowledge of the existence of words and sub-word units without any associated meaning. Despite not explicitly knowing many Māori words, non-Māori-speaking New Zealanders are able to access this proto-lexicon to distinguish Māori words from Māori-like nonwords. What's more, they are able to generalize over the proto-lexicon to generate sophisticated phonotactic knowledge, which lets them evaluate the well-formedness of Māori-like nonwords just as well as fluent Māori speakers.
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Affiliation(s)
- Y Oh
- New Zealand Institute of Language, Brain and Behaviour, NZILBB, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.
- Department of French Language and Literature, Ajou University, Suwon, South Korea.
| | - S Todd
- New Zealand Institute of Language, Brain and Behaviour, NZILBB, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand
- Department of Linguistics, University of California, Santa Barbara, USA
| | - C Beckner
- Department of Applied Linguistics, University of Warwick, Coventry, UK
| | - J Hay
- New Zealand Institute of Language, Brain and Behaviour, NZILBB, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand
- Department of Linguistics, University of Canterbury, Christchurch, New Zealand
| | - J King
- New Zealand Institute of Language, Brain and Behaviour, NZILBB, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand
- Aotahi - School of Māori and Indigenous Studies, University of Canterbury, Christchurch, New Zealand
| | - J Needle
- New Zealand Institute of Language, Brain and Behaviour, NZILBB, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand
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Kuznicki M, Mallen A, Eggers E, Lam C, Regis J, Todd S, Tanner J, Anderson M, Rutherford T. Preliminary prospective quality of life and clinical outcomes with an opiate restrictive enhanced recovery protocol in a gynecologic oncology population. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.084] [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: 10/23/2022]
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Hodge T, Metzinger D, Pierson R, Gaskins J, Todd S. Patient outcomes following robotic radical hysterectomy in women with early stage cervical cancer: A retrospective analysis of outcomes from a high-volume robotic surgical program. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.270] [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: 10/23/2022]
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13
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Todd S, Bowen J, Ibiebele I, Patterson J, Torvaldsen S, Ford F, Nippita M, Morris J, Randall D. A composite neonatal adverse outcome indicator using population-based data: an update. Int J Popul Data Sci 2020; 5:1337. [PMID: 33644407 PMCID: PMC7893849 DOI: 10.23889/ijpds.v5i1.1337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Severe morbidity rates in neonates can be estimated using diagnosis and procedure coding in linked routinely collected retrospective data as a cost-effective way to monitor quality and safety of perinatal services. Coding changes necessitate an update to the previously published composite neonatal adverse outcome indicator for identifying infants with severe or medically significant morbidity. Objectives To update the neonatal adverse outcome indicator for identifying neonates with severe or medically significant morbidity, and to investigate the validity of the updated indicator. Methods We audited diagnosis and procedure codes and used expert clinician input to update the components of the indicator. We used linked birth, hospital and death data for neonates born alive at 24 weeks or more in New South Wales, Australia (2002–2014) to describe the incidence of neonatal morbidity and assess the validity of the updated indicator. Results The updated indicator included 28 diagnostic and procedure components. In our population of 1,194,681 live births, 5.44% neonates had some form of morbidity. The rate of morbidity was greater for higher-risk pregnancies and was lowest for those born at 39–40 weeks’ gestation. Incidence increased over the study period for overall neonatal morbidity, and for individual components: intravenous infusion, respiratory diagnoses, and non-invasive ventilation. Severe or medically significant neonatal morbidity was associated with double the risk of hospital readmission and 10 times the risk of death within the first year of life. Conclusion The updated composite indicator has maintained concurrent and predictive validity and is a standardised, economic way to measure neonatal morbidity when using population-based data. Changes within individual components should be considered when examining longitudinal data.
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Affiliation(s)
- S Todd
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia.,NSW Biostatistics Training Program, NSW Ministry of Health, St Leonards, NSW 2065, Australia
| | - J Bowen
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia.,Department of Neonatology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - I Ibiebele
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia
| | - J Patterson
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia
| | - S Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia.,School of Public Health and Community Medicine, University of New South Wales, NSW 2033, Australia
| | - F Ford
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia
| | - M Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - J Morris
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - D Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW 2065, Australia.,Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW 2065, Australia
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Mallen A, Townsend M, Boac B, Todd S, Gandhi A, Kuznicki M, Magliocco A, Fridley B, Tworoger S, Vadaparampil S, Wenham R. Predictive factors of genetic referral for advanced, epithelial ovarian cancer patients at a Single-Institution Cancer Center. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- N Stallard
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry.
| | - S Todd
- Department of Mathematics and Statistics, University of Reading, Reading
| | - D Parashar
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry; The Alan Turing Institute, London; Warwick Cancer Research Centre, University of Warwick, Coventry, UK
| | - P K Kimani
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry
| | - L A Renfro
- Division of Biostatistics, University of Southern California, Los Angeles, USA
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16
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Moronkeji K, Todd S, Dawidowska I, Barrett SD, Akhtar R. The role of subcutaneous tissue stiffness on microneedle performance in a representative in vitro model of skin. J Control Release 2016; 265:102-112. [PMID: 27838272 DOI: 10.1016/j.jconrel.2016.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/14/2016] [Accepted: 11/08/2016] [Indexed: 12/28/2022]
Abstract
There has been growing interest in the mechanical behaviour of skin due to the rapid development of microneedle devices for drug delivery applications into skin. However, most in vitro experimentation studies that are used to evaluate microneedle performance do not consider the biomechanical properties of skin or that of the subcutaneous layers. In this study, a representative experimental model of skin was developed which was comprised of subcutaneous and muscle mimics. Neonatal porcine skin from the abdominal and back regions was used, with gelatine gels of differing water content (67, 80, 88 and 96%) to represent the subcutaneous tissue, and a type of ballistic gelatine, Perma-Gel®, as a muscle mimic. Dynamic nanoindentation was used to characterize the mechanical properties of each of these layers. A custom-developed impact test rig was used to apply dense polymethylmethacrylate (PMMA) microneedles to the skin models in a controlled and repeatable way with quantification of the insertion force and velocity. Image analysis methods were used to measure penetration depth and area of the breach caused by microneedle penetration following staining and optical imaging. The nanoindentation tests demonstrated that the tissue mimics matched expected values for subcutaneous and muscle tissue, and that the compliance of the subcutaneous mimics increased linearly with water content. The abdominal skin was thinner and less stiff as compared to back skin. The maximum force decreased with gel water content in the abdominal skin but not in the back skin. Overall, larger and deeper perforations were found in the skin models with increasing water content. These data demonstrate the importance of subcutaneous tissue on microneedle performance and the need for representative skin models in microneedle technology development.
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Affiliation(s)
- K Moronkeji
- Centre for Materials and Structures, School of Engineering, University of Liverpool, L69 3GH, United Kingdom
| | - S Todd
- Renephra Ltd., MedTech Centre, Manchester Science Park, Pencroft Way, M15 6JJ, United Kingdom
| | - I Dawidowska
- Renephra Ltd., MedTech Centre, Manchester Science Park, Pencroft Way, M15 6JJ, United Kingdom
| | - S D Barrett
- Department of Physics, University of Liverpool, L69 7ZE, United Kingdom
| | - R Akhtar
- Centre for Materials and Structures, School of Engineering, University of Liverpool, L69 3GH, United Kingdom.
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Todd S, Xu J, Millar BC, Moore JE, Crowe M, Raoult D, Harrison T, Hill C, Douglas J. Culture-negative Bartonella endocarditis in a patient with renal failure: the value of molecular methods in diagnosis. Br J Biomed Sci 2016; 61:190-3. [PMID: 15649011 DOI: 10.1080/09674845.2004.11732670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Members of the genus Bartonella are increasingly recognised as a cause of culture-negative endocarditis, particularly in those patients with underlying risk factors (e.g., homelessness and alcoholism (B. quintana) or valvulopathy and cat ownership (B. henselae). The aortic and mitral-valves are most commonly involved. Here, a case is reported of culture-negative right-sided endocarditis, without any of the above risk factors, due to Bartonella sp. in a 69-year-old man who presented with acute renal failure. The diagnosis was made using a broad-range 16S rRNA polymerase chain reaction (PCR) technique and direct automated sequencing on a peripheral blood sample, which was subsequently confirmed serologically. A review of the literature on Bartonella endocarditis is also presented. Molecular laboratory methods using peripheral blood or blood cultures may be very useful in the diagnosis of causal agents in culture-negative endocarditis and add further support to the recently inclusion of molecular (PCR) diagnosis, as a major Duke's criterion, for the diagnosis of infective endocarditis.
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Affiliation(s)
- S Todd
- Directorate of Nephrology, Belfast City Hospital, Belfast, Northern Ireland
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Tuffrey-Wijne I, Wicki M, Heslop P, McCarron M, Todd S, Oliver D, de Veer A, Ahlström G, Schäper S, Hynes G, O'Farrell J, Adler J, Riese F, Curfs L. Developing research priorities for palliative care of people with intellectual disabilities in Europe: a consultation process using nominal group technique. BMC Palliat Care 2016; 15:36. [PMID: 27009550 PMCID: PMC4806426 DOI: 10.1186/s12904-016-0108-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 06/25/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background Empirical knowledge around palliative care provision and needs of people with intellectual disabilities is extremely limited, as is the availability of research resources, including expertise and funding. This paper describes a consultation process that sought to develop an agenda for research priorities for palliative care of people with intellectual disabilities in Europe. Methods A two-day workshop was convened, attended by 16 academics and clinicians in the field of palliative care and intellectual disability from six European countries. The first day consisted of round-table presentations and discussions about the current state of the art, research challenges and knowledge gaps. The second day was focused on developing consensus research priorities with 12 of the workshop participants using nominal group technique, a structured method which involved generating a list of research priorities and ranking them in order of importance. Results A total of 40 research priorities were proposed and collapsed into eleven research themes. The four most important research themes were: investigating issues around end of life decision making; mapping the scale and scope of the issue; investigating the quality of palliative care for people with intellectual disabilities, including the challenges in achieving best practice; and developing outcome measures and instruments for palliative care of people with intellectual disabilities. Conclusions The proposal of four major priority areas and a range of minor themes for future research in intellectual disability, death, dying and palliative care will help researchers to focus limited resources and research expertise on areas where it is most needed and support the building of collaborations. The next steps are to cross-validate these research priorities with people with intellectual disabilities, carers, clinicians, researchers and other stakeholders across Europe; to validate them with local and national policy makers to determine how they could best be incorporated in policy and programmes; and to translate them into actual research studies by setting up European collaborations for specific studies that require such collaboration, develop research proposals and attract research funding.
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Affiliation(s)
- I Tuffrey-Wijne
- Kingston University & St George's University of London, Faculty of Health, Social Care and Education, Cranmer Terrace, London, SW17 0RE, UK.
| | - M Wicki
- Internationale Hochschule für Heilpädagogik Zürich, Zürich, Switzerland
| | - P Heslop
- Norah Fry Research Centre, School for Policy Studies, University of Bristol, Bristol, UK
| | - M McCarron
- Trinity College, University of Dublin, Dublin, Ireland
| | - S Todd
- Faculty of Life Sciences and Education, University of South Wales, Cardiff, Newport, UK
| | - D Oliver
- Tizard Centre, University of Kent, Kent, UK
| | - A de Veer
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | | | - S Schäper
- Department Muenster, Catholic University of Applied Sciences, Muenster, Germany
| | - G Hynes
- Trinity College, University of Dublin, Dublin, Ireland
| | - J O'Farrell
- Trinity College, University of Dublin, Dublin, Ireland
| | - J Adler
- University of Applied Sciences of Special Needs Education, Zürich, Switzerland
| | - F Riese
- Division of Psychiatry Research and Psychogeriatric Medicine, Zurich, Switzerland
| | - L Curfs
- Maastricht University Medical Centre, Governor Kremers Centre, Maastricht, The Netherlands
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Bort J, Van Parijs SM, Stevick PT, Summers E, Todd S. North Atlantic right whale Eubalaena glacialis vocalization patterns in the central Gulf of Maine from October 2009 through October 2010. ENDANGER SPECIES RES 2015. [DOI: 10.3354/esr00650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lambert JC, Ibrahim-Verbaas CA, Harold D, Naj AC, Sims R, Bellenguez C, DeStafano AL, Bis JC, Beecham GW, Grenier-Boley B, Russo G, Thorton-Wells TA, Jones N, Smith AV, Chouraki V, Thomas C, Ikram MA, Zelenika D, Vardarajan BN, Kamatani Y, Lin CF, Gerrish A, Schmidt H, Kunkle B, Dunstan ML, Ruiz A, Bihoreau MT, Choi SH, Reitz C, Pasquier F, Cruchaga C, Craig D, Amin N, Berr C, Lopez OL, De Jager PL, Deramecourt V, Johnston JA, Evans D, Lovestone S, Letenneur L, Morón FJ, Rubinsztein DC, Eiriksdottir G, Sleegers K, Goate AM, Fiévet N, Huentelman MW, Gill M, Brown K, Kamboh MI, Keller L, Barberger-Gateau P, McGuiness B, Larson EB, Green R, Myers AJ, Dufouil C, Todd S, Wallon D, Love S, Rogaeva E, Gallacher J, St George-Hyslop P, Clarimon J, Lleo A, Bayer A, Tsuang DW, Yu L, Tsolaki M, Bossù P, Spalletta G, Proitsi P, Collinge J, Sorbi S, Sanchez-Garcia F, Fox NC, Hardy J, Deniz Naranjo MC, Bosco P, Clarke R, Brayne C, Galimberti D, Mancuso M, Matthews F, Moebus S, Mecocci P, Del Zompo M, Maier W, Hampel H, Pilotto A, Bullido M, Panza F, Caffarra P, Nacmias B, Gilbert JR, Mayhaus M, Lannefelt L, Hakonarson H, Pichler S, Carrasquillo MM, Ingelsson M, Beekly D, Alvarez V, Zou F, Valladares O, Younkin SG, Coto E, Hamilton-Nelson KL, Gu W, Razquin C, Pastor P, Mateo I, Owen MJ, Faber KM, Jonsson PV, Combarros O, O'Donovan MC, Cantwell LB, Soininen H, Blacker D, Mead S, Mosley TH, Bennett DA, Harris TB, Fratiglioni L, Holmes C, de Bruijn RF, Passmore P, Montine TJ, Bettens K, Rotter JI, Brice A, Morgan K, Foroud TM, Kukull WA, Hannequin D, Powell JF, Nalls MA, Ritchie K, Lunetta KL, Kauwe JS, Boerwinkle E, Riemenschneider M, Boada M, Hiltuenen M, Martin ER, Schmidt R, Rujescu D, Wang LS, Dartigues JF, Mayeux R, Tzourio C, Hofman A, Nöthen MM, Graff C, Psaty BM, Jones L, Haines JL, Holmans PA, Lathrop M, Pericak-Vance MA, Launer LJ, Farrer LA, van Duijn CM, Van Broeckhoven C, Moskvina V, Seshadri S, Williams J, Schellenberg GD, Amouyel P. Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer's disease. Nat Genet 2013; 45:1452-8. [PMID: 24162737 PMCID: PMC3896259 DOI: 10.1038/ng.2802] [Citation(s) in RCA: 2947] [Impact Index Per Article: 267.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 09/27/2013] [Indexed: 12/12/2022]
Abstract
Eleven susceptibility loci for late-onset Alzheimer's disease (LOAD) were identified by previous studies; however, a large portion of the genetic risk for this disease remains unexplained. We conducted a large, two-stage meta-analysis of genome-wide association studies (GWAS) in individuals of European ancestry. In stage 1, we used genotyped and imputed data (7,055,881 SNPs) to perform meta-analysis on 4 previously published GWAS data sets consisting of 17,008 Alzheimer's disease cases and 37,154 controls. In stage 2, 11,632 SNPs were genotyped and tested for association in an independent set of 8,572 Alzheimer's disease cases and 11,312 controls. In addition to the APOE locus (encoding apolipoprotein E), 19 loci reached genome-wide significance (P < 5 × 10(-8)) in the combined stage 1 and stage 2 analysis, of which 11 are newly associated with Alzheimer's disease.
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Abstract
BACKGROUND Reporting of cause of death in patients with Alzheimer's disease (AD) has changed over the past few decades but concerns persist over the accuracy of death certificate completion in this setting. OBJECTIVES To examine the causes of death in AD and examine how this compares with those affecting the normal population. METHODS Death certificates were obtained for 85 AD patients and 52 control subjects from a cohort of 396 participants. Underlying causes of death and other conditions mentioned on the death certificates of the AD patients were analysed and compared with the Northern Ireland population age-and-sex adjusted mortality rates and subsequently to the death certificates of control subjects. RESULTS AD and pneumonia were causes of significant excess mortality and the most common underlying causes of death in the AD patient group (23.53 and 17.65%, respectively). When compared with the control subjects, AD and gastrointestinal diseases were found to be more prevalent. AD was recorded on 63.5% of death certificates of AD subjects who died during follow-up. CONCLUSION The cause of death documented for AD patients may be affected by the physician's knowledge of the patient or reflects the approach to management of patients with end-stage dementia.
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Affiliation(s)
- S Todd
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen’s University of Belfast, Belfast BT7 9BL, UK.
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22
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Malcolm J, Todd S, Todd P. Ian Douglas Hutchinson Todd. West J Med 2012. [DOI: 10.1136/bmj.e421] [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: 11/04/2022]
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Baker KS, Todd S, Marsh G, Fernandez-Loras A, Suu-Ire R, Wood JLN, Wang LF, Murcia PR, Cunningham AA. Co-circulation of diverse paramyxoviruses in an urban African fruit bat population. J Gen Virol 2011; 93:850-856. [PMID: 22205718 PMCID: PMC3542712 DOI: 10.1099/vir.0.039339-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [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] [Indexed: 12/17/2022] Open
Abstract
Bats constitute a reservoir of zoonotic infections and some bat paramyxoviruses are capable of cross-species transmission, often with fatal consequences. Determining the level of viral diversity in reservoir populations is fundamental to understanding and predicting viral emergence. This is particularly relevant for RNA viruses where the adaptive mutations required for cross-species transmission can be present in the reservoir host. We report the use of non-invasively collected, pooled, neat urine samples as a robust sample type for investigating paramyxoviruses in bat populations. Using consensus PCR assays we have detected a high incidence and genetic diversity of novel paramyxoviruses in an urban fruit bat population over a short period of time. This may suggest a similarly unique relationship between bats and the members of the family Paramyxoviridae as proposed for some other viral families. Additionally, the high rate of bat–human contact at the study site calls for the zoonotic potential of the detected viruses to be investigated further.
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Affiliation(s)
- K S Baker
- Cambridge Infectious Diseases Consortium, University of Cambridge, Department of Veterinary Medicine, Madingley Road, Cambridge CB3 0ES, UK.,Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK
| | - S Todd
- CSIRO Australian Animal Health Laboratories, Portarlington Road, East Geelong, VIC 3219, Australia
| | - G Marsh
- CSIRO Australian Animal Health Laboratories, Portarlington Road, East Geelong, VIC 3219, Australia
| | - A Fernandez-Loras
- Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK
| | - R Suu-Ire
- Wildlife Division of the Forestry Commission, Accra, Ghana
| | - J L N Wood
- Cambridge Infectious Diseases Consortium, University of Cambridge, Department of Veterinary Medicine, Madingley Road, Cambridge CB3 0ES, UK
| | - L F Wang
- CSIRO Australian Animal Health Laboratories, Portarlington Road, East Geelong, VIC 3219, Australia
| | - P R Murcia
- University of Glasgow Centre for Virus Research, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, Garscube Estate, Bearsden Road, Glasgow G61 1QH, UK
| | - A A Cunningham
- Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK
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Friede T, Parsons N, Stallard N, Todd S, Valdes Marquez E, Chataway J, Nicholas R. Designing a seamless phase II/III clinical trial using early outcomes for treatment selection: An application in multiple sclerosis. Stat Med 2011; 30:1528-40. [DOI: 10.1002/sim.4202] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 12/09/2010] [Indexed: 11/10/2022]
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Affiliation(s)
- S Todd
- Ageing Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, The Queen's University of Belfast, Belfast, UK.
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Ogmen H, Breitmeyer BG, Kafaligonul H, Todd S, Mardon L, Ziegler R. Temporal aspects of contour and brightness processing in meta- and paracontrast. J Vis 2010. [DOI: 10.1167/6.6.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Chataway J, Nicholas R, Todd S, Stallard N, Valdes-Marquez E, Parsons N, Friede T. FP36-WE-01 Adaptive seamless trial designs in neurology: a case study in secondary progressive multiple sclerosis. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70456-3] [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: 11/28/2022]
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Haworth A, Duggan L, Butler D, Ebert M, Todd S, Nguyen A, Kron T. TOWARDS AN AUSTRALASIAN BRACHYTHERAPY DOSIMETRY AUDIT-RESULTS OF THE PILOT STUDY. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72953-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Proitsi P, Hamilton G, Tsolaki M, Lupton M, Daniilidou M, Hollingworth P, Archer N, Foy C, Stylios F, McGuinness B, Todd S, Lawlor B, Gill M, Brayne C, Rubinsztein DC, Owen M, Williams J, Craig D, Passmore P, Lovestone S, Powell JF. A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD). Neurobiol Aging 2009; 32:434-42. [PMID: 19386383 DOI: 10.1016/j.neurobiolaging.2009.03.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 02/11/2009] [Accepted: 03/10/2009] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Although there is evidence for distinct behavioural sub-phenotypes in Alzheimer's disease (AD), their inter-relationships and the effect of clinical variables on their expression have been little investigated. METHODS We have analysed a sample of 1850 probable AD patients from the UK and Greece with 10 item Neuropsychiatric Inventory (NPI) data. We applied a Multiple Indicators Multiple Causes (MIMIC) approach to investigate the effect of MMSE, disease duration, gender, age and age of onset on the structure of a four-factor model consisting of "psychosis", "moods", "agitation" and "behavioural dyscontrol". RESULTS Specific clinical variables predicted the expression of individual factors. When the inter-relationship of factors is modelled, some previously significant associations are lost. For example, lower MMSE scores predict psychosis, agitation and behavioural dyscontrol factors, but psychosis and mood predict the agitation factor. Taking these associations into account MMSE scores did not predict agitation. CONCLUSIONS The complexity of the inter-relations between symptoms, factors and clinical variables is efficiently captured by this MIMIC model.
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Affiliation(s)
- P Proitsi
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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Butler D, Haworth A, Sander T, Todd S. Comparison of192Ir air kerma calibration coefficients derived at ARPANSA using the interpolation method and at the National Physical Laboratory using a direct measurement. ACTA ACUST UNITED AC 2008; 31:332-8. [DOI: 10.1007/bf03178603] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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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31
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Todd S, McKnight AJ, Liu WW, Carson R, Heggarty S, McGuinness B, Irvine GB, Craig D, Passmore AP, Johnston JA. BACE1 Polymorphisms Do Not Influence Platelet Membrane β-secretase Activity or Genetic Susceptibility for Alzheimer’s Disease in the Northern Irish Population. Neuromolecular Med 2008; 10:368-76. [DOI: 10.1007/s12017-008-8045-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 06/13/2008] [Indexed: 11/30/2022]
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Whitaker M, Whitaker J, Todd S, Kenny M, Hagekyriakou J, Kron T. SU-GG-T-175: Analysis of Inter- and Intra-Fraction Breathing Patterns Using the Varian Real Time Position Management System. Med Phys 2008. [DOI: 10.1118/1.2961927] [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: 11/07/2022] Open
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Liu WW, Todd S, Craig D, Passmore AP, Coulson DTR, Murphy S, Irvine GB, Johnston JA. Elevated platelet beta-secretase activity in mild cognitive impairment. Dement Geriatr Cogn Disord 2008; 24:464-8. [PMID: 17986817 DOI: 10.1159/000110739] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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] [Accepted: 09/05/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We have recently reported that platelet activity of the rate-limiting enzyme for beta-amyloid peptide production is elevated in established Alzheimer's disease. Laboratory investigation of the very early stages of dementia provides an opportunity to investigate pathological mechanisms before advanced disease hinders interpretation. Mild cognitive impairment (MCI) exists prior to obvious dementia, and is associated with increased risk of conversion to overt disease. METHODS We developed and used a fluorimetric assay to quantify platelet membrane beta-secretase activity in 52 patients with MCI and 75 controls. RESULTS Platelet membrane beta-secretase activity was 24% higher in individuals with MCI compared to controls (p = 0.001, unpaired t test with Welch correction). CONCLUSION Elevated platelet beta-secretase activity in subjects with MCI is an area for further study in relation to the etiology and diagnosis of MCI.
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Affiliation(s)
- W W Liu
- Division of Psychiatry and Neuroscience, School of Medicine and Dentistry, Queen's University Belfast, Belfast, UK
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McGuinness B, Todd S, Passmore AP, Bullock R. Systematic review: Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. J Neurol Neurosurg Psychiatry 2008; 79:4-5. [PMID: 18079296 DOI: 10.1136/jnnp.2007.118505] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- B McGuinness
- Department of Geriatric Medicine, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 5HP, UK.
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Abstract
BACKGROUND This paper examines the bereavement experiences of parents of people with intellectual disabilities (IDs). It is based upon an understanding that there exists little research-based understanding of those experiences or of the support needs of parents after the death of their child. METHODS In-depth interviews were held with 13 parents on the deaths of their children with IDs. RESULTS The data highlighted the deep sense of loss that these parents experience after the death of their child. The loss was intensely felt. They also show that their loss was a form of compounded loss. To begin with the scale and depth of loss is misrecognized. They also lose contact with a world that they had previously been heavily involved in. There was a sense that ID services and professionals withdrew from the family with too much haste. The data reveal that there exists no adequate supportive emotional community for these parents to express their grief. CONCLUSIONS It is argued that the experiences of these parents have much in common with understandings of disenfranchised grief. The implications of these findings for research and practice are briefly discussed.
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Affiliation(s)
- S Todd
- Welsh Centre for Learning Disabilities, Centre for Health Sciences Research, Cardiff University, Cardiff, UK.
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Johnston JA, Liu WW, Coulson DTR, Todd S, Murphy S, Brennan S, Foy CJ, Craig D, Irvine GB, Passmore AP. Platelet beta-secretase activity is increased in Alzheimer's disease. Neurobiol Aging 2006; 29:661-8. [PMID: 17174011 DOI: 10.1016/j.neurobiolaging.2006.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 10/31/2006] [Accepted: 11/09/2006] [Indexed: 01/02/2023]
Abstract
beta-Secretase activity is the rate-limiting step in Abeta peptide production from amyloid precursor protein. Abeta is a major component of Alzheimer's disease (AD) cortical amyloid plaques. beta-Secretase activity is elevated in post mortem brain tissue in AD. The current study investigated whether beta-secretase activity was also elevated in peripheral blood platelets. We developed a novel fluorimetric beta-secretase activity assay to investigate platelets isolated from individuals with AD (n=86), and age-matched controls (n=115). Platelet membrane beta-secretase activity (expressed as initial rate) varied over fourfold between individuals, raising important questions about in vivo regulation of this proteolytic activity. Nonetheless, we identified a significant 17% increase in platelet membrane beta-secretase activity in individuals with AD compared to controls (p=0.0003, unpaired t-test). Platelet membrane beta-secretase activity did not correlate with mini-mental state examination (MMSE) score in the AD group (mean MMSE=17.7, range 1-23), indicating that the increase did not occur as a secondary result of the disease process, and may even have preceded symptom onset.
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Affiliation(s)
- J A Johnston
- Queen's University Belfast, School of Medicine and Dentistry, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom.
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Pinna M, Zvelindovsky AV, Todd S, Goldbeck-Wood G. Cubic phases of block copolymers under shear and electric fields by cell dynamics simulation. I. Spherical phase. J Chem Phys 2006; 125:154905. [PMID: 17059291 DOI: 10.1063/1.2356468] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cell dynamics simulation is used to investigate pathways of sphere-to-cylinder transition in block copolymer melt under applied simple shear flow and electric field. Both fields can induce the transition when their strength is above some critical value. At weak fields the spherical phase is preserved, with spheres being deformed into ellipsoids. Weak shear flow is found to improve order in the spherical phase. Observed sliding of layers of spheres under shear is very similar to the experimental finding by Hamley et al. [J. Chem. Phys. 108, 6929 (1998)]. The kinetic pathways are sensitive to the degree of microphase separation in the system and hence affected by temperature. The details of the pathways are described by means of Minkowski functionals.
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Affiliation(s)
- Marco Pinna
- Centre for Materials Science, Department of Physics, Astronomy and Mathematics, University of Central Lancashire, Preston PR1 2HE, United Kingdom
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McGuinness B, Todd S, Passmore P, Bullock R. The effects of blood pressure lowering on development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease. Cochrane Database Syst Rev 2006:CD004034. [PMID: 16625595 DOI: 10.1002/14651858.cd004034.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hypertension and cognitive impairment are prevalent in older people. It is known that hypertension is a direct risk factor for vascular dementia and recent studies have suggested hypertension also impacts upon prevalence of Alzheimer's disease. The question is therefore whether treatment of hypertension lowers the rate of cognitive decline. OBJECTIVES To assess the effects of blood pressure lowering treatments for the prevention of dementia and cognitive decline in patients with hypertension but no history of cerebrovascular disease. SEARCH STRATEGY The trials were identified through a search of CDCIG's Specialised Register, CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL on 27 April 2005. SELECTION CRITERIA Randomized, double-blind, placebo controlled trials in which pharmacological or non-pharmacological interventions to lower blood pressure were given for at least six months. DATA COLLECTION AND ANALYSIS Two independent reviewers assessed trial quality and extracted data. The following outcomes were assessed: incidence of dementia, cognitive change from baseline, blood pressure level, incidence and severity of side effects and quality of life. MAIN RESULTS Three trials including 12,091 hypertensive subjects were identified. Average age was 72.8 years. Participants were recruited from industrialised countries. Mean blood pressure at entry across the studies was 170/84 mmHg. All trials instituted a stepped care approach to hypertension treatment, starting with a calcium-channel blocker, a diuretic or an angiotensin receptor blocker. The combined result of the three trials reporting incidence of dementia indicated no significant difference between treatment and placebo (Odds Ratio (OR) = 0.89, 95% CI 0.69, 1.16). Blood pressure reduction resulted in a 11% relative risk reduction of dementia in patients with no prior cerebrovascular disease but this effect was not statistically significant (p = 0.38) and there was considerable heterogeneity between the trials. The combined results from the two trials reporting change in Mini Mental State Examination (MMSE) did not indicate a benefit from treatment (Weighted Mean Difference (WMD) = 0.10, 95% CI -0.03, 0.23). Both systolic and diastolic blood pressure levels were reduced significantly in the two trials assessing this outcome (WMD = -7.53, 95% CI -8.28, -6.77 for systolic blood pressure, WMD = -3.87, 95% CI -4.25, -3.50 for diastolic blood pressure). Two trials reported adverse effects requiring discontinuation of treatment and the combined results indicated a significant benefit from placebo (OR = 1.18, 95% CI 1.06, 1.30). When analysed separately, however, more patients on placebo in SCOPE were likely to discontinue treatment due to side effects; the converse was true in SHEP 1991. Quality of life data could not be analysed in the three studies. There was difficulty with the control group in this review as many of the control subjects received antihypertensive treatment because their blood pressures exceeded pre-set values. In most cases the study became a comparison between the study drug against a usual antihypertensive regimen. AUTHORS' CONCLUSIONS There was no convincing evidence from the trials identified that blood pressure lowering prevents the development of dementia or cognitive impairment in hypertensive patients with no apparent prior cerebrovascular disease. There were significant problems identified with analysing the data, however, due to the number of patients lost to follow-up and the number of placebo patients given active treatment. This introduced bias. More robust results may be obtained by analysing one year data to reduce differential drop-out or by conducting a meta-analysis using individual patient data.
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Affiliation(s)
- B McGuinness
- Department of Geriatric Medicine, Whitla Medical Building, 97 Lisburn Road, Belfast, UK, BT9 5 HP.
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Abstract
The incidence of Type 1 diabetes is increasing worldwide, imposing enormous public health costs, as well as profoundly affecting individual quality of life. There is evidence that psychological problems are increased in children with diabetes and this morbidity is often associated with poor metabolic control. Specific risk factors for this dual morbidity are emerging from empirical studies. The next challenge is to identify effective interventions for use with children at risk for adverse mental and physical health outcomes. The intervention literature is reviewed. It is noted that most studies have used diabetes-specific, unstandardized interventions in groups of adolescents, with few interventions trialled with younger children. No study has targeted a specific psychological disorder such as behaviour problems or depression, both of which are known to be increased in children with diabetes and for which effective standardized interventions are available. Attention is drawn to methodological limitations in many of the studies conducted to date and suggestions made to reduce these in future interventions attempting to reduce the burden of illness in children with diabetes.
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Affiliation(s)
- E A Northam
- Department of Psychology, University of Melbourne, Melbourne, Vic., Australia.
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Todd S, Jones S. Looking at the future and seeing the past: the challenge of the middle years of parenting a child with intellectual disabilities. J Intellect Disabil Res 2005; 49:389-404. [PMID: 15882390 DOI: 10.1111/j.1365-2788.2005.00675.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND This paper seeks to understand and conceptualize the experience of mothers of adolescents with intellectual disabilities (IDs) at a time in their lives which others have characterized as 'mid-life' or the 'middle years of parenting'. The concerns of the paper are the lifecourse concerns in mothers' own lives and with biographical elements of becoming and being such a parent. METHODS Qualitative interviews were conducted with mothers of adolescents with IDs. The average age of mothers was 48 years. Typically parents were interviewed on two to three occasions. RESULTS The data suggest that despite the difficulties they faced, these parents had constructed a 'life-as-ordinary' in the early phase of their parental careers. They saw themselves as 'ordinary mothers'. However, the social content and events of the middle years of parenting prompt a realization that their lives and, for some, their sense of 'self', are undergoing considerable change. Mothers are forced to look over their lives to find the meaning and significance of these events. For some, there is biographical reinforcement. For others, there is only disruption. DISCUSSION The overall picture of these years is one of considerable changes and challenges, and underlines the need for a focus on the lifecourse concerns of parents as well as their children. The implications of the data for further research and service development are discussed in the context of identity theory.
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Affiliation(s)
- S Todd
- Welsh Centre for Learning Disabilities, Department of Psychological Medicine, University of Wales College of Medicine, Cardiff, Wales, UK.
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Young L, Polzin J, Todd S, Simuncak S. 259Validation of the nursing diagnosis anxiety as experienced by adult bone marrow transplant patients from the perspective of the patient, significant other and nurse. Biol Blood Marrow Transplant 2003. [DOI: 10.1016/s1083-8791(03)80244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
The solution conformation of two peptides [1: PSGSNIISNLFKED; 2: GSSTLTALTTSVLKNNL] from human CD81 (hCD81) large extra-cellular loop (LEL) with known importance in the hepatitis C virus glycoprotein E2 (HCV-E2) binding interaction was characterized using circular dichroism spectroscopy. In addition, the solution structure of peptide 1 that contains a phenylalanine residue (F186 in hCD81) known to be critical in the binding interaction with HCV-E2 was determined using 1D and 2D 1H NMR spectroscopy. Both peptides are unstructured in water but begin forming significant helical conformation following the addition of 20% or more trifluoroethanol (v/v), a result consistent with their alpha-helical conformation found in the native protein. The CD data recorded as a function of pH and NaCl concentration are consistent with stabilization of the helical structure from electrostatic forces for both peptides. Peptide 1 is able to block the binding interaction of recombinant HCV-E2 (rHCV-E2) to hCD81 expressed on Molt-4 T cells at high concentrations (3.5 mM), a low affinity that we attributed to the random coil structure in water.
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McGuinness B, Todd S, Passmore P, Bullock R. The effects of blood pressure lowering on development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease. Hippokratia 2003. [DOI: 10.1002/14651858.cd004034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Green LM, Tran DT, Murray DK, Rightnar SS, Todd S, Nelson GA. Response of thyroid follicular cells to gamma irradiation compared to proton irradiation: II. The role of connexin 32. Radiat Res 2002; 158:475-85. [PMID: 12236815 DOI: 10.1667/0033-7587(2002)158[0475:rotfct]2.0.co;2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The objective of this study was to determine whether connexin 32-type gap junctions contribute to the "contact effect" in follicular thyrocytes and whether the response is influenced by radiation quality. Our previous studies demonstrated that early-passage follicular cultures of Fischer rat thyroid cells express functional connexin 32 gap junctions, with later-passage cultures expressing a truncated nonfunctional form of the protein. This model allowed us to assess the role of connexin 32 in radiation responsiveness without relying solely on chemical manipulation of gap junctions. The survival curves generated after gamma irradiation revealed that early-passage follicular cultures had significantly lower values of alpha (0.04 Gy(-1)) than later-passage cultures (0.11 Gy(-1)) (P < 0.0001, n = 12). As an additional way to determine whether connexin 32 was contributing to the difference in survival, cultures were treated with heptanol, resulting in higher alpha values, with early-passage cultures (0.10 Gy(-1)) nearly equivalent to untreated late-passage cultures (0.11 Gy(-1)) (P > 0.1, n = 9). This strongly suggests that the presence of functional connexin 32-type gap junctions was contributing to radiation resistance in gamma-irradiated thyroid follicles. Survival curves from proton-irradiated cultures had alpha values that were not significantly different whether cells expressed functional connexin 32 (0.10 Gy(-1)), did not express connexin 32 (0.09 Gy(-1)), or were down-regulated (early-passage plus heptanol, 0.09 Gy(-1); late-passage plus heptanol, 0.12 Gy(-1)) (P > 0.1, n = 19). Thus, for proton irradiation, the presence of connexin 32-type gap junctional channels did not influence their radiosensitivity. Collectively, the data support the following conclusions. (1) The lower alpha values from the gamma-ray survival curves of the early-passage cultures suggest greater repair efficiency and/or enhanced resistance to radiation-induced damage, coincident with the expression of connexin 32-type gap junctions. (2) The increased sensitivity of FRTL-5 cells to proton irradiation was independent of their ability to communicate through connexin 32 gap junctions. (3) The fact that the beta components of the survival curves from both gamma rays and proton beams were similar (average 0.022 +/- 0.008 Gy(-2), P > 0.1, n = 39) suggests that at higher doses the loss of viability occurs at a relatively constant rate and is independent of radiation quality and the presence of functional gap junctions.
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Affiliation(s)
- L M Green
- Radiobiology Program, Department of Radiation Medicine, Loma Linda University, California 92354, USA.
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Todd S, Sahdra M. A case study of the effect of covariate adjustment in a sequential survival clinical trial. J Biopharm Stat 2001; 11:297-311. [PMID: 12018781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Recent literature has discussed the value of adjustment for important covariates in models involving nonnormal data. It is generally concluded that, when performing traditional "fixed sample size" clinical trials, covariate adjustment influences the magnitude of the treatment effect but has little effect on precision of the estimate. In fact, it may actually reduce it. In this paper, we investigate the effect of covariate adjustment in the sequential setting via a case study of a survival clinical trial. Sequential and fixed sample analyses are compared, with and without covariate adjustment of the treatment effect. It was found that conclusions similar to those for the fixed sample size case also apply in the sequential case, but that incorporation of covariate information can present added complications in this setting.
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Affiliation(s)
- S Todd
- Medical & Pharmaceutical Statistics Research Unit, The University of Reading, Berkshire, UK.
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Abstract
Dose escalation in phase I studies is generally performed on the basis of clinical experience and judgement. In this paper some of the statistical approaches that have been proposed for the formalization of the procedure are described. Apart from the use of the Continual Reassessment Method in oncology studies, such formal methods have received little implementation. The purpose of presenting them here is to promote their further exploration and appropriate implementation. Certain limitations are discussed, which will be best overcome by collaboration between clinical pharmacologists and statisticians.
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Affiliation(s)
- J Whitehead
- Medical and Pharmaceutical Statistics Research Unit, The University of Reading, PO Box 240, Earley Gate, Reading, Berkshire, RG6 6FN.
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Abstract
This paper, the second in a series of three papers concerned with the statistical aspects of interim analyses in clinical trials, is concerned with stopping rules in phase II clinical trials. Phase II trials are generally small-scale studies, and may include one or more experimental treatments with or without a control. A common feature is that the results primarily determine the course of further clinical evaluation of a treatment rather than providing definitive evidence of treatment efficacy. This means that there is more flexibility available in the design and analysis of such studies than in phase III trials. This has led to a range of different approaches being taken to the statistical design of stopping rules for such trials. This paper briefly describes and compares the different approaches. In most cases the stopping rules can be described and implemented easily without knowledge of the detailed statistical and computational methods used to obtain the rules.
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Affiliation(s)
- N Stallard
- Medical and Pharmaceutical Statistics Research Unit, The University of Reading, PO Box 240, Earley Gate, Reading, Berkshire, RG6 6FN, UK.
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Johnson CD, Puntis M, Davidson N, Todd S, Bryce R. Randomized, dose-finding phase III study of lithium gamolenate in patients with advanced pancreatic adenocarcinoma. Br J Surg 2001; 88:662-8. [PMID: 11350436 DOI: 10.1046/j.0007-1323.2001.01770.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chemotherapy for pancreatic cancer offers small survival benefits and considerable side-effects. Unsaturated fatty acids have an antitumour effect in experimental studies; in phase II studies few side-effects were seen. METHODS In this group-sequential, open-label, randomized study, 278 patients with a diagnosis of inoperable pancreatic cancer were treated with either oral (700 mg daily for 15 days), low-dose (0.28 g/kg) or high-dose (0.84 g/kg) intravenous lithium gamolenate (LiGLA). The primary endpoint was survival time from randomization using Kaplan-Meier estimates. RESULTS Median survival after oral and low-dose intravenous treatment was 129 and 121 days respectively. Median survival after high-dose intravenous treatment was 94 days. A good Karnofsky score and the absence of metastases were associated with increased survival. Haemolysis, a marker of rapid infusion, was associated with a median survival time of 249 days in the low-dose intravenous group. CONCLUSION Oral or low-dose intravenous LiGLA led to survival times similar to those of other treatments for pancreatic cancer although one subgroup (low-dose intravenous LiGLA with haemolysis) had longer survival. High-dose intravenous treatment appeared to have an adverse effect. Systemic treatment with LiGLA cannot be recommended for the treatment of pancreatic cancer.
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Affiliation(s)
- C D Johnson
- University Surgical Unit, Southampton General Hospital, Southampton, UK.
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Abstract
Recruitment of patients to a clinical trial usually occurs over a period of time, resulting in the steady accumulation of data throughout the trial's duration. Yet, according to traditional statistical methods, the sample size of the trial should be determined in advance, and data collected on all subjects before analysis proceeds. For ethical and economic reasons, the technique of sequential testing has been developed to enable the examination of data at a series of interim analyses. The aim is to stop recruitment to the study as soon as there is sufficient evidence to reach a firm conclusion. In this paper we present the advantages and disadvantages of conducting interim analyses in phase III clinical trials, together with the key steps to enable the successful implementation of sequential methods in this setting. Examples are given of completed trials, which have been carried out sequentially, and references to relevant literature and software are provided.
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Affiliation(s)
- S Todd
- Medical and Pharmaceutical Statistics Research Unit, The University of Reading, PO Box 240, Earley Gate, Reading, Berkshire, RG6 6FN.
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