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Richardson SAC, Anderson D, Burrell AJC, Byrne T, Coull J, Diehl A, Gantner D, Hoffman K, Hooper A, Hopkins S, Ihle J, Joyce P, Le Guen M, Mahony E, McGloughlin S, Nehme Z, Nickson CP, Nixon P, Orosz J, Riley B, Sheldrake J, Stub D, Thornton M, Udy A, Pellegrino V, Bernard S. Pre-hospital ECPR in an Australian metropolitan setting: a single-arm feasibility assessment-The CPR, pre-hospital ECPR and early reperfusion (CHEER3) study. Scand J Trauma Resusc Emerg Med 2023; 31:100. [PMID: 38093335 PMCID: PMC10717258 DOI: 10.1186/s13049-023-01163-0] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Survival from refractory out of hospital cardiac arrest (OHCA) without timely return of spontaneous circulation (ROSC) utilising conventional advanced cardiac life support (ACLS) therapies is dismal. CHEER3 was a safety and feasibility study of pre-hospital deployed extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) for refractory OHCA in metropolitan Australia. METHODS This was a single jurisdiction, single-arm feasibility study. Physicians, with pre-existing ECMO expertise, responded to witnessed OHCA, age < 65 yrs, within 30 min driving-time, using an ECMO equipped rapid response vehicle. If pre-hospital ECPR was undertaken, patients were transported to hospital for investigations and therapies including emergent coronary catheterisation, and standard intensive care (ICU) therapy until either cardiac and neurological recovery or palliation occurred. Analyses were descriptive. RESULTS From February 2020 to May 2023, over 117 days, the team responded to 709 "potential cardiac arrest" emergency calls. 358 were confirmed OHCA. Time from emergency call to scene arrival was 27 min (15-37 min). 10 patients fulfilled the pre-defined inclusion criteria and all were successfully cannulated on scene. Time from emergency call to ECMO initiation was 50 min (35-62 min). Time from decision to ECMO support was 16 min (11-26 min). CPR duration was 46 min (32-62 min). All 10 patients were transferred to hospital for investigations and therapy. 4 patients (40%) survived to hospital discharge neurologically intact (CPC 1/2). CONCLUSION Pre-hospital ECPR was feasible, using an experienced ECMO team from a single-centre. Overall survival was promising in this highly selected group. Further prospective studies are now warranted.
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Affiliation(s)
- S A C Richardson
- The Alfred Hospital, Melbourne, Australia.
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - D Anderson
- The Alfred Hospital, Melbourne, Australia
- Ambulance Victoria, Melbourne, Australia
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - A J C Burrell
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - T Byrne
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - J Coull
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Diehl
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - D Gantner
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - K Hoffman
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Hooper
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Hopkins
- Ambulance Victoria, Melbourne, Australia
| | - J Ihle
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - P Joyce
- The Alfred Hospital, Melbourne, Australia
| | - M Le Guen
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - E Mahony
- Ambulance Victoria, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S McGloughlin
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Z Nehme
- Ambulance Victoria, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - C P Nickson
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - P Nixon
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - J Orosz
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - B Riley
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - D Stub
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M Thornton
- Ambulance Victoria, Melbourne, Australia
| | - A Udy
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - V Pellegrino
- The Alfred Hospital, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Bernard
- The Alfred Hospital, Melbourne, Australia
- Ambulance Victoria, Melbourne, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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McMeekin N, Wu O, Boyd KA, Brown A, Tweed EJ, Best C, Craig P, Leyland AH, Demou E, Byrne T, Pell J, Semple S, Sweeting H, Graham L, Hunt K. Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs) study. Tob Control 2023; 32:701-708. [PMID: 35256533 PMCID: PMC7615232 DOI: 10.1136/tobaccocontrol-2021-056991] [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: 08/16/2021] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of a smoke-free prison policy in Scotland, through assessments of the trade-offs between costs (healthcare and non-healthcare-related expenditure) and outcomes (health and non-health-related non-monetary consequences) of implementing the policy. DESIGN A health economic evaluation consisting of three analyses (cost-consequence, cost-effectiveness and cost-utility), from the perspectives of the healthcare payer, prison service, people in custody and operational staff, assessed the trade-offs between costs and outcomes. Costs associated with the implementation of the policy, healthcare resource use and personal spend on nicotine products were considered, alongside health and non-health outcomes. The cost-effectiveness of the policy was evaluated over 12-month and lifetime horizons (short term and long term). SETTING Scotland's national prison estate. PARTICIPANTS People in custody and operational prison staff. INTERVENTION Implementation of a comprehensive (indoor and outdoor) smoke-free policy. MAIN OUTCOME MEASURES Concentration of secondhand smoke, health-related quality of life (health utilities and quality-adjusted life-years (QALY)) and various non-health outcomes (eg, incidents of assaults and fires). RESULTS The short-term analyses suggest cost savings for people in custody and staff, improvements in concentration of secondhand smoke, with no consistent direction of change across other outcomes. The long-term analysis demonstrated that implementing smoke-free policy was cost-effective over a lifetime for people in custody and staff, with approximate cost savings of £28 000 and £450, respectively, and improvement in health-related quality of life of 0.971 QALYs and 0.262, respectively. CONCLUSION Implementing a smoke-free prison policy is cost-effective over the short term and long term for people in custody and staff.
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Affiliation(s)
- Nicola McMeekin
- HEHTA, Institute of Health and Wellbeing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - Olivia Wu
- HEHTA, Institute of Health and Wellbeing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - Kathleen Anne Boyd
- HEHTA, Institute of Health and Wellbeing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - Ashley Brown
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Emily J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Catherine Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Tom Byrne
- Healthcare Improvement Scotland, Glasgow, UK
| | - Jill Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Helen Sweeting
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Condren J, Byrne T, Watts A. Seven years of SimWars - Reflecting on the educational value of competitive simulation training. Ir Med J 2023; 116:821. [PMID: 37606533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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Moloney K, Byrne T, Mathews S, Foran M, Conroy B, Molamphy A, Murphy N, Dillon A, Doyle K, Cunningham C, Romero-Ortuno R. 82 THE IMPACT OF THE COVID-19 PANDEMIC ON THE ACTIVITY OF A RAPID-ACCESS GERIATRIC DAY HOSPITAL SERVICE. Age Ageing 2022. [PMCID: PMC9620317 DOI: 10.1093/ageing/afac218.067] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background In the 1970s, Jack Flanagan developed the first Geriatric Day Hospital (GDH) in Ireland. Since, the GDH model of care has evolved to accommodate for the growing demands of our ageing population. Before the COVID-19 pandemic, the operational scope of our GDH was extended to allow for the rapid medical and multidisciplinary assessment and follow-up of older patients. During the pandemic, the GDH did not suspend operations and remained open as a COVID-negative ambulatory pathway. We evaluated the activity of this GDH service. Methods Retrospective Service Evaluation Approval was granted by our Research & Innovation Office (Reference: 7419). Pseudonymised data corresponding to all GDH attendances between January 2017 and December 2021 were retrieved from the hospital electronic records. Yearly trends in proportions were tested with the Chi-square for trend statistic. Trends in monthly attendances were assessed via Statistical Process Control (SPC) charts with three-sigma limits. Statistical significance was set at p<0.05. Results There were 27,278 attendances of patients aged 65 and over to the GDH over the 5-year period (6,362, 5,978, 6,115, 4,306, and 4,517, respectively). Mean age was 82 every year. Of the 7,813 new episodes, yearly proportions referred directly by primary care teams were 10.4%, 29.5%, 38.6%, 24.5%, and 16.3% (p<0.001). SPC charts showed that Apr-May 2020 and Jan-Feb 2021 had significantly lower numbers of review attendances (50-59 and 146-142, respectively, average 324 p/m). However, new appointments did not significantly decline (average 130 p/m). Of the 7,813 new episodes, 2,595 (33.2%) were seen by Physiotherapy, and 1,860 (23.8%) by Occupational Therapy. Conclusion Our GDH saw a sustained number of new attendances and demonstrated increased community availability during the unprecedented COVID-19 crisis, especially during the first wave of the pandemic when hospital access was most affected. A rapid access GDH model can facilitate integrated care at times of crisis to promote ageing in place.
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Affiliation(s)
- K Moloney
- St. James's Hospital , Dublin, Ireland
| | - T Byrne
- St. James's Hospital , Dublin, Ireland
| | - S Mathews
- St. James's Hospital , Dublin, Ireland
| | - M Foran
- St. James's Hospital , Dublin, Ireland
| | - B Conroy
- St. James's Hospital , Dublin, Ireland
| | | | - N Murphy
- St. James's Hospital , Dublin, Ireland
| | - A Dillon
- St. James's Hospital , Dublin, Ireland
| | - K Doyle
- St. James's Hospital , Dublin, Ireland
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McGarry A, Ni Nualláin A, Byrne T, O'Brien J, Rice C, Breathnach O, Grogan W, McAleer C, McQuillan R, McNally, Cowie E. 1277P The role of palliative care in patients with glioblastoma multiforme: A single centre review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1410] [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: 11/01/2022] Open
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Hunt K, Brown A, Eadie D, McMeekin N, Boyd K, Bauld L, Conaglen P, Craig P, Demou E, Leyland A, Pell J, Purves R, Tweed E, Byrne T, Dobson R, Graham L, Mitchell D, O’Donnell R, Sweeting H, Semple S. Process and impact of implementing a smoke-free policy in prisons in Scotland: TIPs mixed-methods study. Public Health Res 2022. [DOI: 10.3310/wglf1204] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background
Prisons had partial exemption from the UK’s 2006/7 smoking bans in enclosed public spaces. They became one of the few workplaces with continuing exposure to second-hand smoke, given the high levels of smoking among people in custody. Despite the introduction of smoke-free prisons elsewhere, evaluations of such ‘bans’ have been very limited to date.
Objective
The objective was to provide evidence on the process and impact of implementing a smoke-free policy across a national prison service.
Design
The Tobacco in Prisons study was a three-phase, multimethod study exploring the periods before policy formulation (phase 1: pre announcement), during preparation for implementation (phase 2: preparatory) and after implementation (phase 3: post implementation).
Setting
The study was set in Scotland’s prisons.
Participants
Participants were people in custody, prison staff and providers/users of prison smoking cessation services.
Intervention
Comprehensive smoke-free prison rules were implemented across all of Scotland’s prisons in November 2018.
Main outcome measures
The main outcome measures were second-hand smoke levels, health outcomes and perspectives/experiences, including facilitators of successful transitions to smoke-free prisons.
Data sources
The study utilised cross-sectional surveys of staff (total, n = 3522) and people in custody (total, n = 5956) in each phase; focus groups and/or one-to-one interviews with staff (n = 237 across 34 focus groups; n = 38 interviews), people in custody (n = 62 interviews), providers (n = 103 interviews) and users (n = 45 interviews) of prison smoking cessation services and stakeholders elsewhere (n = 19); measurements of second-hand smoke exposure (e.g. 369,208 minutes of static measures in residential areas at three time points); and routinely collected data (e.g. medications dispensed, inpatient/outpatient visits).
Results
Measures of second-hand smoke were substantially (≈ 90%) reduced post implementation, compared with baseline, largely confirming the views of staff and people in custody that illicit smoking is not a major issue post ban. Several factors that contributed to the successful implementation of the smoke-free policy, now accepted as the ‘new normal’, were identified. E-cigarette use has become common, was recognised (by both staff and people in custody) to have facilitated the transition and raises new issues in prisons. The health economic analysis (lifetime model) demonstrated that costs were lower and the number of quality-adjusted life-years was larger for people in custody and staff in the ‘with smoke-free’ policy period than in the ‘without’ policy period, confirming cost-effectiveness against a £20,000 willingness-to-pay threshold.
Limitations
The ability to triangulate between different data sources mitigated limitations with constituent data sets.
Conclusions
To our knowledge, this is the first study internationally to analyse the views of prison staff and people in custody; objective measurements of second-hand smoke exposure and routine health and other outcomes before, during and after the implementation of a smoke-free prison policy; and to assess cost-effectiveness. The results are relevant to jurisdictions considering similar legislation, whether or not e-cigarettes are permitted. The study provides a model for partnership working and, as a multidimensional study of a national prison system, adds to a previously sparse evidence base internationally.
Future work
Priorities are to understand how to support people in custody in remaining smoke free after release from prison, and whether or not interventions can extend benefits to their families; to evaluate new guidance supporting people wishing to reduce or quit vaping; and to understand how prison vaping practices/cultures may strengthen or weaken long-term reductions in smoking.
Study registration
This study is registered as Research Registry 4802.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Ashley Brown
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Douglas Eadie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Nicola McMeekin
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathleen Boyd
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Philip Conaglen
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jill Pell
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Emily Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Tom Byrne
- Public Health Scotland, Edinburgh, UK
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | - Danielle Mitchell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Rachel O’Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Helen Sweeting
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 161 THE ROLE OF THE GERIATRIC DAY HOSPITAL DURING THE COVID 19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8690085 DOI: 10.1093/ageing/afab219.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Age Related Health Department, Tallaght University Hospital, Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.163] [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: 02/25/2023] Open
Abstract
Abstract
Background
The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians.
Methods
Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH.
Results
One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p < 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p < 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p < 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p < 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468).
Conclusion
Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.
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Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Age Related Health Care Department, Tallaght University Hospital , Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
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Martin T, O'Doherty D, Mattisa C, Byrne T, Keogh R, Murphy C, Bredin P, Devanney S, Morris P, Hennessy B, Grogan L, Breathnach O, O'Dwyer R. 212P_PR Language and understanding: The complexity of insight in cancer care. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)02054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leyland A, Tweed E, Byrne T, Conaglen P, Craig P, Graham L, McMeekin N, Boyd K, Pell J, Hunt K. Smokefree policy and medication dispensing for people in prison: interrupted time series analysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1319] [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
Previous evaluations of smokefree prison policies have suggested improvements in self-rated health and some smoking-related symptoms. No studies to date have investigated impacts on medication use as proxy measures of objective ill-health or as indicators of potential negative unintended consequences. These is limited evidence to date on these important outcomes.
Methods
We obtained from NHS National Services Scotland aggregate data on medication items dispensed in prisons, based on individual named patient medication records, and from the Scottish Prison Service data on the prison population, for the period Jan 2013-Nov 2019. Items of interest comprised those for smoking cessation (varenicline and buproprion); nicotine replacement; specific smoking-related health conditions (glyceryl trinitrate; inhaled bronchodilators and steroids; antibiotics; chloramphenicol eye drops; and proton pump inhibitors and H2 receptor antagonists), and potential unintended mental health consequences (anti-depressants). We also included a set of negative controls for which dispensing was not expected to be affected by the new smokefree policy (anticonvulsants, excluding pregabalin and gabapentin). Analyses were undertaken using AutoRegressive Integrated Moving Average (ARIMA) time series methods, with the dates of the policy's announcement and of implementation included as pre-specified breakpoints.
Results
The results of ARIMA modelling of medication dispensing are confidential until May 2020 due to their sensitivity and will be available to present at WCPH 2020.
Conclusions
The use of routinely available dispensing data as an indicator of objective health impacts and potential negative unintended consequences provides novel insights into the effectiveness of smokefree prison policies. Results will be of interest to international jurisdictions considering such policies and to those seeking to harness the potential of administrative data for natural experiments.
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Affiliation(s)
- A Leyland
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - E Tweed
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - T Byrne
- Public Health and Social Care, ISD, Edinburgh, UK
| | - P Conaglen
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, UK
| | - P Craig
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Graham
- Public Health and Social Care, ISD, Edinburgh, UK
| | - N McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Boyd
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Elmeligy K, Nadeau N, Byrne T. Analysis of Short Lever-Press Durations in Rats Responding Under a Fixed-Duration Schedule. Psychol Rec 2020. [DOI: 10.1007/s40732-020-00376-4] [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: 10/25/2022]
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12
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Byrne T. Control of response duration by delayed reinforcers: A systematic replication. Behav Processes 2019; 167:103920. [DOI: 10.1016/j.beproc.2019.103920] [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] [Received: 04/16/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
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13
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Berry DP, Amer PR, Evans RD, Byrne T, Cromie AR, Hely F. A breeding index to rank beef bulls for use on dairy females to maximize profit. J Dairy Sci 2019; 102:10056-10072. [PMID: 31495621 DOI: 10.3168/jds.2019-16912] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
Abstract
The desire to increase profit on dairy farms necessitates consideration of the revenue attainable from the sale of surplus calves for meat production. However, the generation of calves that are expected to excel in efficiency of growth and carcass merit must not be achieved to the detriment of the dairy female and her ability to calve and re-establish pregnancy early postcalving without any compromise in milk production. Given the relatively high heritability of many traits associated with calving performance and carcass merit, and the tendency for many of these traits to be moderately to strongly antagonistic, a breeding index that encompasses both calving performance and meat production could be a useful tool to fill the void in supporting decisions on bull selection. The objective of the present study was to derive a dairy-beef index (DBI) framework to rank beef bulls for use on dairy females with the aim of striking a balance between the efficiency of valuable meat growth in the calf and the subsequent performance of the dam. Traits considered for inclusion in this DBI were (1) direct calving difficulty; (2) direct gestation length; (3) calf mortality; (4) feed intake; (5) carcass merit reflected by carcass weight, conformation, and fat and the ability to achieve minimum standards for each; (6) docility; and (7) whether the calf was polled. Each trait was weighted by its respective economic weight, most of which were derived from the analyses of available phenotypic data, supplemented with some assumptions on costs and prices. The genetic merit for a range of performance metrics of 3,835 artificial insemination beef bulls from 14 breeds ranked on this proposed DBI was compared with an index comprising only direct calving difficulty and gestation length (the 2 generally most important characteristics of dairy farmers when selecting beef bulls). Within the Angus breed (i.e., the beef breed most commonly used on dairy females), the correlation between the DBI and the index of genetic merit for direct calving difficulty plus gestation length was 0.74; the mean of the within-breed correlations across all other breeds was 0.87. The ranking of breeds changed considerably when ranked based on the top 20 artificial insemination bulls excelling in the DBI versus excelling in the index of calving difficulty and gestation length. Dairy breeds ranked highest on the index of calving difficulty and gestation length, whereas the Holstein and Friesian breeds were intermediate on the DBI; the Jersey breed was one of the poorest breeds on DBI, superior only to the Charolais breed. The results clearly demonstrate that superior carcass and growth performance can be achieved with the appropriate selection of beef bulls for use on dairy females with only a very modest increase in collateral effect on cow performance (i.e., 2-3% greater dystocia expected and a 6-d-longer gestation length).
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Affiliation(s)
- D P Berry
- Teagasc, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy P61 P302, Co. Cork, Ireland.
| | - P R Amer
- AbacuBio Ltd., Dunedin 9016, New Zealand
| | - R D Evans
- Irish Cattle Breeding Federation, Highfield House, Shinagh, Bandon P72 X050, Co. Cork, Ireland
| | - T Byrne
- AbacuBio Ltd., Dunedin 9016, New Zealand
| | - A R Cromie
- Irish Cattle Breeding Federation, Highfield House, Shinagh, Bandon P72 X050, Co. Cork, Ireland
| | - F Hely
- AbacuBio Ltd., Dunedin 9016, New Zealand
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14
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Adams K, Byrne T. Histamine alters environmental place preference in planaria. Neurosci Lett 2019; 705:202-205. [PMID: 31054331 DOI: 10.1016/j.neulet.2019.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/21/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
Abstract
Although histamine functions as a punisher in vertebrate models, its potential aversive effects in invertebrates has gone largely unexamined. We investigated if planaria would develop conditioned place aversions to histamine. In the absence of any training, planaria readily move away from a light source. However, planaria will develop conditioned place preferences for lighted areas if those areas are paired with many of the same psychoactive drugs that produce conditioned place preferences in vertebrates. We confined planaria in the darkened side of a petri dish containing histamine, and they subsequently spent more time in the light than planaria confined initially to the darkened side of a petri dish containing fresh water only. This occurred whether we tested planaria individually or in groups. Pairing histamine with the light side of the petri dish had inconsistent effects, and histamine did not affect behavior under a motility assay. Although histamine altered the planaria behavior, it did not completely overcome the planaria's innate preference for darkened areas. Results add to a growing body of research showing continuity between planaria and vertebrates in the behavioral effects of psychoactive chemicals.
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Affiliation(s)
- Kara Adams
- Massachusetts College of Liberal Arts, United States
| | - Tom Byrne
- Massachusetts College of Liberal Arts, United States.
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15
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Byrne T, Sarno B. Response duration is sensitive to both immediate and delayed reinforcement. J Exp Anal Behav 2018; 111:94-115. [PMID: 30565230 DOI: 10.1002/jeab.491] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 12/05/2018] [Indexed: 11/06/2022]
Abstract
We investigated the duration of lever pressing by rats when the delivery of appetitive reinforcers was contingent upon response duration. In the first experiment, response durations increased when duration requirements were imposed, and they decreased when duration requirements were removed. This effect occurred whether reinforcers were immediate or delayed by 8 s. In order to maintain the integrity of the delay intervals, reinforcer delivery was dependent upon both lever depression and release. In a second experiment, lever depression only and a response duration of at least 4 s were required for reinforcer delivery. Compared to immediate reinforcement conditions, delayed reinforcers increased both variability and the length of the maximum response durations. In a third experiment, immediate reinforcers were delivered contingent upon lever depression and release under a variety of duration requirements. Median lever-press durations tracked the contingencies rapidly. Across all three experiments, rats emitted numerous response durations that were too short to satisfy the reinforcer requirements, and bimodal distributions similar to those produced by differential reinforcement of low rate schedules were evident for most rats. In many aspects, response duration responds to reinforcement parameters in a fashion similar to rate of discrete responding, but an examination of this continuous dimension of behavior may provide additional information about environment-behavior relationships.
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Affiliation(s)
- Tom Byrne
- Massachusetts College of Liberal Arts
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16
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Simmons MM, Fincke BG, Drainoni ML, Kim B, Byrne T, Smelson D, Casey K, Ellison ML, Visher C, Blue-Howells J, McInnes DK. A two-state comparative implementation of peer-support intervention to link veterans to health-related services after incarceration: a study protocol. BMC Health Serv Res 2017; 17:647. [PMID: 28899394 PMCID: PMC5596492 DOI: 10.1186/s12913-017-2572-x] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 600,000 persons are released from prison annually in the United States. Relatively few receive sufficient re-entry services and are at risk for unemployment, homelessness, poverty, substance abuse relapse and recidivism. Persons leaving prison who have a mental illness and/or a substance use disorder are particularly challenged. This project aims to create a peer mentor program to extend the reach and effectiveness of reentry services provided by the Department of Veterans' Affairs (VA). We will implement a peer support for reentry veterans sequentially in two states. Our outcome measures are 1) fidelity of the intervention, 2) linkage to VA health care and, 3) continued engagement in health care. The aims for this project are as follows: (1) Conduct contextual analysis to identify VA and community reentry resources, and describe how reentry veterans use them. (2) Implement peer-support, in one state, to link reentry veterans to Veterans' Health Administration (VHA) primary care, mental health, and SUD services. (3) Port the peer-support intervention to another, geographically, and contextually different state. DESIGN This intervention involves a 2-state sequential implementation study (Massachusetts, followed by Pennsylvania) using a Facilitation Implementation strategy. We will conduct formative and summative analyses, including assessment of fidelity, and a matched comparison group to evaluate the intervention's outcomes of veteran linkage and engagement in VHA health care (using health care utilization measures). The study proceeds in 3 phases. DISCUSSION We anticipate that a peer support program will be effective at improving the reentry process for veterans, particularly in linking them to health, mental health, and SUD services and helping them to stay engaged in those services. It will fill a gap by providing veterans with access to a trusted individual, who understands their experience as a veteran and who has experienced justice involvement. The outputs from this project, including training materials, peer guidebooks, and implementation strategies can be adapted by other states and regions that wish to enhance services for veterans (or other populations) leaving incarceration. A larger cluster-randomized implementation-effectiveness study is planned. TRIAL REGISTRATION This protocol is registered with clinicaltrials.gov on November 4, 2016 and was assigned the number NCT02964897 .
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Affiliation(s)
- Molly M Simmons
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA. .,Boston University School of Public Health, Boston, USA.
| | - Benjamin G Fincke
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bo Kim
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Harvard Medical School, Boston, USA
| | - Tom Byrne
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Social Work, Boston, USA
| | - David Smelson
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,VA National Center on Homelessness among Veterans, Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | - Kevin Casey
- VA New England Healthcare System, Bedford, USA
| | - Marsha L Ellison
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | | | | | - D Keith McInnes
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
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17
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Abstract
Timeouts are sometimes used in applied settings to reduce target responses, and in some circumstances delays are unavoidably imposed between the onset of a timeout and the offset of the response that produces it. The present study examined the effects of signaled and unsignaled timeouts in rats exposed to concurrent fixed-ratio 1 fixed-ratio 1 schedules of food delivery, where each response on one lever, the location of which changed across conditions, produced both food and a delayed 10-s timeout. Delays of 0 to 38 s were examined. Delayed timeouts often, but not always, substantially reduced the number of responses emitted on the lever that produced timeouts relative to the number emitted on the lever that did not produce timeouts. In general, greater sensitivity was observed to delayed timeouts when they were signaled. These results demonstrate that delayed timeouts, like other delayed consequences, can affect behavior, albeit less strongly than immediate consequences.
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Affiliation(s)
- Tom Byrne
- Massachusetts College of Liberal Arts
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18
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Peat R, Furlong J, Byrne T, Young R, Kangombe A, Elkin T, Renwick S, Russell D, Oelbaum S, Burhan H, Walker PP. P198 Anchoring copd screening to drug services in heroin and crack smokers to improve diagnosis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.341] [Citation(s) in RCA: 2] [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: 11/04/2022]
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19
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Peck S, Byrne T. Demand in rats responding under duration-based schedules of reinforcement. Behav Processes 2016; 128:47-52. [DOI: 10.1016/j.beproc.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 10/22/2022]
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20
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Borad M, Renfro L, Foster N, Martin P, Alberts S, Hubbard J, Silva A, Halfdanarson T, Byrne T, Erlichman C. P-100 Phase IB study of sorafenib + evofosfamide in patients (pts) with advanced hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC): NCCTG N1153 (Alliance). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.95] [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: 11/13/2022] Open
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21
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Abstract
We describe a schedule of reinforcement involving systematic, within-session increases in response-duration requirements. Rats received access to appetitive reinforcers for depressing and holding down a response lever. Duration requirements increased after each reinforcer delivery. Sessions ended when reinforcement criteria were unmet for a period of ten minutes. Breaking points, defined as the terminal duration requirement in effect prior to the end of the session, stabilized when environmental conditions were held constant. Breaking points were sensitive to manipulations of both food deprivation and reinforcer quality. Analogous to progressive-ratio schedules, progressive-duration schedules may provide an assay for measuring the amount of behavior an organism will emit for a given reinforcer under current motivational conditions.
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Affiliation(s)
- Kara B Gulotta
- Department of Psychology, Massachusetts College of Liberal Arts, United States
| | - Tom Byrne
- Department of Psychology, Massachusetts College of Liberal Arts, United States.
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22
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McNamara AA, Johnson LE, Tate C, Chiang T, Byrne T. Acquisition of operant behavior in rats with delayed reinforcement: A retractable-lever procedure. Behav Processes 2014; 111:37-41. [PMID: 25464338 DOI: 10.1016/j.beproc.2014.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/16/2014] [Accepted: 11/18/2014] [Indexed: 11/28/2022]
Abstract
Experimentally naïve rats acquired lever pressing with delayed reinforcement when the immediate programmed consequence for lever pressing was the simultaneous retraction of two identical levers. Presses on one lever also produced access to sweetened condensed milk after a delay of 10s following retraction. Presses on the second lever resulted in retraction only. Lever retraction prevented the possibility of adventitious reinforcement of contacting the operanda during the reinforcement delays. Several measures indicated that the delayed reinforcers strengthened behavior. The majority of responses for all rats were on the lever that initiated reinforcer delivery. Responding for seven out of eight rats decreased during a subsequent extinction phase in which retraction was the only consequence arranged for lever pressing. Responding recovered rapidly when food reinforcement was available again. Furthermore, when contingencies on the two levers were switched, rats allocated their behavior accordingly, showing control by the delayed reinforcers.
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Affiliation(s)
- Andrew A McNamara
- Department of Psychology, Massachusetts College of Liberal Arts, United States
| | - Lyndsey E Johnson
- Department of Psychology, Massachusetts College of Liberal Arts, United States
| | - Christopher Tate
- Department of Psychology, Massachusetts College of Liberal Arts, United States
| | - Thomas Chiang
- Department of Psychology, Massachusetts College of Liberal Arts, United States
| | - Tom Byrne
- Department of Psychology, Massachusetts College of Liberal Arts, United States.
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23
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Seliem MK, Komarneni S, Byrne T, Cannon F, Shahien M, Khalil A, Abd El-Gaid I. Removal of nitrate by synthetic organosilicas and organoclay: Kinetic and isotherm studies. Sep Purif Technol 2013. [DOI: 10.1016/j.seppur.2013.03.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Fargo J, Metraux S, Byrne T, Munley E, Montgomery AE, Jones H. Prevalence and Risk of Homelessness Among US Veterans. Prev Chronic Dis 2012. [DOI: 10.5888/pcd9.110112] [Citation(s) in RCA: 21] [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: 11/10/2022] Open
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25
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Abstract
CASE HISTORY A skeletal disease characterised by dwarfism, limb deformity and sometimes sudden death occurred over a period of 5 years in lambs born on a commercial sheep farm in Southland. The disease showed variable expression and occurred in crossbred sheep. A genetic aetiology was supported by the birth of affected lambs over two seasons in a flock of putative carrier and affected sheep transported to Massey University. CLINICAL FINDINGS Affected lambs appeared normal at birth but showed evidence of dwarfism, wide-based stance and exercise intolerance as early as 1 week of age. Most died within the first 3 months of life, often after developing bilateral varus deformity of the forelimbs. Some severely-affected lambs died suddenly of respiratory embarrassment, probably due to tracheal collapse. Mildly-affected individuals had a short, blocky stature and some survived to breeding age. PATHOLOGICAL FINDINGS Gross and microscopic lesions of variable severity were present in the tracheal, articular, epiphyseal and physeal cartilages. In severe cases, articular cartilage in major joints was eroded from weight-bearing surfaces. The trachea was flaccid, abnormally kinked, and had thickened cartilaginous rings and a narrow lumen. Affected sheep that survived to breeding age eventually developed severe degenerative joint disease. Histologically, chondrocytes were disorganised, surrounded by concentric rings of abnormal fibrillar material, and the matrix often contained focal to coalescing areas of chondrolysis. DIAGNOSIS Inherited chondrodysplasia of Texel sheep. CLINICAL RELEVANCE AND CONCLUSIONS: This chondrodysplasia differs from those previously described in sheep and is considered to be a newly-recognised, recessively-inherited genetic disease of the Texel breed. A defect in the synthesis of glycosaminoglycans in cartilage matrix is suspected. This disease of sheep may provide a suitable model for studying various forms of therapy for human chondrodysplasias.
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Affiliation(s)
- K G Thompson
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Private Bag 11222, Palmerston North, New Zealand.
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Moss AA, Mekeel KL, Reddy KS, Harrison ME, Douglas DD, Vargas H, Carey E, Byrne T, Mulligan DC. A CHANGE IN BILIARY ANASTOMOTIC TECHNIQUE LEADS TO A SIGNIFICANT IMPACT ON COMPLICATIONS FOLLOWING ADULT LIVING DONOR LIVER TRANSPLANTATION (LDLT). Transplantation 2008. [DOI: 10.1097/01.tp.0000331447.70202.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Mulligan D, Moss A, Reddy S, Mekeel K, Byrne T, Carey E, Harrison ME, Vargas H, Douglas D, Rakela J. HEPATIC ARTERY THROMBOSIS AFTER ADULT LIVING DONOR LIVER TRANSPLANTATION: RISK FACTORS AND MANAGEMENT FOR SUCCESSFUL OUTCOMES. Transplantation 2008. [DOI: 10.1097/01.tp.0000332676.37855.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Byrne T. e-Nirvana: we're not there yet. Fam Pract Manag 2008; 15:11. [PMID: 18551761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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29
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Byrne T, Ramsey C, Mahan S, Chase D. The Dosimetric Impact of Respiration Motion on 3D, IMRT, and Tomotherapy Treatment Delivery. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.845] [Citation(s) in RCA: 2] [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: 11/30/2022]
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30
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Byrne T, Ramsey C, Mahan S, Desai D. WE-C-J-6C-07: Dose Reconstruction and Adaptive Radiation Therapy in Prostate Cancer. Med Phys 2005. [DOI: 10.1118/1.1998512] [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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31
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Archibald LK, Dobbie H, Kazembe P, Nwanyanwu O, McKnight C, Byrne T, Addison RM, Bell M, Reller LB, Jarvis WR. Utility of paired BACTEC MYCO/F LYTIC blood culture vials for detection of bacteremia, mycobacteremia, and fungemia. J Clin Microbiol 2001; 39:1960-2. [PMID: 11326022 PMCID: PMC88057 DOI: 10.1128/jcm.39.5.1960-1962.2001] [Citation(s) in RCA: 7] [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: 11/20/2022] Open
Abstract
In previous bloodstream infection studies in Malawi, we inoculated blood from a single venesection into a single BACTEC MYCO/F LYTIC (MFL) vial. Inoculation of one vial, however, would be expected to reduce the sensitivity of bloodstream pathogen detection with MFL vials. To ascertain the degree of this loss of sensitivity, blood was drawn from each of 228 febrile, adult inpatients in Malawi and 5 ml of each blood sample was inoculated into each of two MFL vials. Of 228 paired vials, 51 (22%) were both positive, 172 (75%) were both negative, and 5 (3%) had discordant results. Bloodstream infection would have been detected in 11 (92%) of 12 patients with mycobacteremia and 38 (92%) of 41 patients with bacteremia had only one MFL vial been inoculated. Our study shows that a second MFL vial does not significantly increase diagnostic sensitivity.
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Affiliation(s)
- L K Archibald
- Hospital Infections Program, Centers for Disease Control and Prevention, Mailstop A-35, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Abstract
With the ever-increasing diagnosis of attention deficit hyperactivity disorder, methylphenidate has become readily accessible in the college environment. Several properties of methylphenidate indicate abuse liability. A survey regarding the recreational use of methylphenidate was distributed to the student body at a public, liberal arts college. More than 16% of the students reported they had tried methylphenidate recreationally, and 12.7% reported they had taken the drug intranasally. Use of the drug was more common among traditional students than among nontraditional students. Among traditional-age students, reports of methylphenidate use were roughly equivalent to reports of cocaine and amphetamine use. Environmental conditions characteristic of college student life may influence the recreational use of the drug.
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Affiliation(s)
- Q Babcock
- Massachusetts College of Liberal Arts, North Adams, USA
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33
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Archibald LK, McDonald LC, Addison RM, McKnight C, Byrne T, Dobbie H, Nwanyanwu O, Kazembe P, Reller LB, Jarvis WR. Comparison of BACTEC MYCO/F LYTIC and WAMPOLE ISOLATOR 10 (lysis-centrifugation) systems for detection of bacteremia, mycobacteremia, and fungemia in a developing country. J Clin Microbiol 2000; 38:2994-7. [PMID: 10921966 PMCID: PMC87169 DOI: 10.1128/jcm.38.8.2994-2997.2000] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In less-developed countries, studies of bloodstream infections (BSI) have been hindered because of the difficulty and costs of culturing blood for bacteria, mycobacteria, and fungi. During two study periods (study period I [1997] and study period II [1998]), we cultured blood from patients in Malawi by using the BACTEC MYCO/F LYTIC (MFL), ISOLATOR 10 (Isolator), Septi-Chek AFB (SC-AFB), and Septi-Chek bacterial (SC-B) systems. During study period I, blood was inoculated at 5 ml into an MFL bottle, 10 ml into an Isolator tube for lysis and centrifugation, and 10 ml into an SC-B bottle. Next, 0.5-ml aliquots of Isolator concentrate were inoculated into an SC-AFB bottle and onto Middlebrook 7H11 agar slants, chocolate agar slants, and Inhibitory Mold Agar (IMA) slants. During study period II, the SC-B and chocolate agar cultures were discontinued. MFL growth was detected by fluorescence caused by shining UV light (lambda = 365 nm) onto the indicator on the bottom of the bottle. During study period I, 251 blood cultures yielded 44 bacterial isolates. For bacteremia, the MFL was similar to the Isolator concentrate on chocolate agar (34 of 44 versus 27 of 44; P, not significant [NS]), but more sensitive than the SC-B bottle (34 of 44 versus 24 of 44; P = 0.05). For both study periods combined, 486 blood cultures yielded 37 mycobacterial and 13 fungal isolates. For mycobacteremia, the sensitivities of the MFL and Isolator concentrate in the SC-AFB bottle were similar (30 of 37 versus 29 of 37; P, NS); the MFL bottle was more sensitive than the concentrate on Middlebrook agar (30 of 37 versus 15 of 37; P = 0.002). For fungemia, the MFL bottle was as sensitive as the SC-B bottle or Isolator concentrate on chocolate agar or IMA slants. We conclude that the MFL bottle, inoculated with just 5 ml of blood and examined under UV light, provides a sensitive and uncomplicated method for comprehensive detection of BSI in less-developed countries.
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Affiliation(s)
- L K Archibald
- Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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34
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Abstract
In two experiments, the effects of MDMA on the acquisition of lever-press responding of rats were examined under procedures in which water delivery was delayed by 0, 10, or 20 s relative to the response that produced it. In the first study, experimentally naive, water-deprived rats received an intraperitoneal injection of MDMA (0, 1.0, 3.2, or 5.6 mg/kg) prior to one 8-h experimental session. Response acquisition was observed under all conditions at all drug doses. MDMA increased the total number of responses emitted and the total number of water deliveries earned in dose-dependent fashion, but only when reinforcement was immediate. Under conditions of delay, MDMA had no effect on either measure. Under all reinforcement conditions, higher doses of MDMA typically produced an initial reduction in lever pressing, and in that sense interfered with learning. In the second study, rats received an MDMA injection regimen previously shown to be neurotoxic. Control rats received saline solution according to the same injection schedule. Two weeks after completing the regimen, rats were water deprived and exposed to behavioral procedures as described for the first experiment. Although MDMA significantly reduced 5-HT and 5-HIAA levels in the striatum and prefrontal cortex, mean performance of rats exposed to MDMA did not differ from that of rats exposed to vehicle. Twenty-five percent of the rats exposed to MDMA and delayed reinforcement did fail to acquire responding, which suggests that further study of the effects of neurotoxic doses of MDMA on initial response acquisition is warranted.
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Affiliation(s)
- T Byrne
- Western Michigan University, Department of Psychology, Kalamazoo, MI 49008, USA
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Poling A, Byrne T, Christian L, Lesage MG. Effects of cocaine and morphine under mixed-ratio schedules of food delivery: support for a behavioral momentum analysis. Pharmacol Biochem Behav 2000; 66:313-21. [PMID: 10880684 DOI: 10.1016/s0091-3057(00)00184-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previous studies have shown that ratio size influenced the development of tolerance under simple and multiple schedules, but not under progressive-ratio (PR) schedules. PR schedules share certain features with mixed-ratio (MR) schedules, and pilot data suggested that ratio size fails to modulate tolerance to cocaine or morphine under MR schedules. The present study examined more comprehensively the pre- and postchronic effects of cocaine and (in separate birds) morphine under MR schedules with fixed-ratio (FR) 5 and FR 95, FR 25 and FR 75, and FR 50 and FR 50 components. Acute doses of cocaine and morphine initially were given in an ascending series (beginning with 0.56 mg/kg) until responding was reduced to near-zero levels. Chronic (daily) dosing with a dose that reduced, but did not eliminate, responding then occurred until response rates stabilized. Finally, postchronic dose-response determinations were conducted. Both cocaine and morphine reduced response rates at all FR values. Tolerance was consistently observed to the effects of morphine, but not to those of cocaine. With both drugs the degree of tolerance observed did not vary as a function of FR value. These findings, like those obtained under PR schedules, indicate that ratio size does not always modulate drug tolerance. A behavioral momentum analysis of drug action appears to account for whether or not ratio size modulates tolerance, and such an analysis is provided.
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Affiliation(s)
- A Poling
- Western Michigan University, College of Arts and Sciences, Department of Psychology, Kalamazoo, MI 49008-5052, USA
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Douglas DD, Pasha T, Mulligan DC, Nelson L, Byrne T, Hemker J, Wiesner RH. CURRENT APPROACH TO THE UTILIZATION OF LIVER DONORS POSITIVE FOR EITHER ANTI-HBC OR ANTI-HCV IN THE UNITED STATES. Transplantation 1999. [DOI: 10.1097/00007890-199905150-00476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Byrne T. The setup and care of a patient in Buck's traction. Orthop Nurs 1999; 18:79-83. [PMID: 10410051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Buck's traction is certainly one of the more common traction setups seen in orthopaedic patient care today. However, just because it is common doesn't mean we can take it for granted. Specific setup techniques as well as patient evaluation methods must be understood if the traction is to accomplish its task. The goal of this article is to go through some of the basics in techniques and perhaps explain why this traction is so commonly used.
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Affiliation(s)
- T Byrne
- Department of Orthopedics, University of California San Diego Center Medical Center, USA
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Abstract
Groups of 8 experimentally naive rats were exposed during 8-hr sessions to resetting delay procedures in which responses on one lever (the reinforcement lever) produced water after a delay of 8, 16, 32, or 64 s. For rats in one condition, responses on a second (no-consequences) lever had no programmed consequences. For rats in another condition, responses on a second (cancellation) lever during a delay initiated by a response on the reinforcement lever prevented delivery of the scheduled reinforcer; responses on the cancellation lever at other times had no programmed consequences. Under both conditions and at all delays, most subjects emitted more responses on the reinforcement lever than did control rats that never received water emitted on either lever. At 8-s delays, both conditions engendered substantially more responding on the reinforcement lever than on the other lever, and performance closely resembled that of immediate-reinforcement controls. At delays of 16 and 32 s, however, there was clear differential responding on the two levers under the cancellation condition but not under the other condition. When the delay was 64 s, differential responding on the two levers did not occur consistently under either condition. These findings provide strong evidence that the behavior of rats is sensitive to consequences delayed by 8, 16, and 32 s, but only equivocal evidence of such sensitivity to consequences delayed 64 s. They also indicate that acquisition depends, in part, on the measure of performance used to index it.
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Affiliation(s)
- G Sutphin
- Western Michigan University, Kalamazoo 49008, USA
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40
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Woods WG, Tuchman M, Robison LL, Bernstein M, Leclerc JM, Brisson LC, Brossard J, Hill G, Shuster J, Luepker R, Byrne T, Weitzman S, Bunin G, Lemieux B, Brodeur GM. Screening for neuroblastoma is ineffective in reducing the incidence of unfavourable advanced stage disease in older children. Eur J Cancer 1997; 33:2106-12. [PMID: 9516863 DOI: 10.1016/s0959-8049(97)00310-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neuroblastoma exhibits many characteristics which would suggest that preclinical detection may improve outcome. The Quebec Neuroblastoma Screening Project was initiated to determine whether mass screening could reduce mortality in a large cohort of infants. All 476,603 children born in the province of Quebec during a 5-year period of time (1 May 1989 to 30 April 1994) were eligible for determinations of urinary catecholamine metabolites at 3 weeks and 6 months of age. Children with positive screening were referred to one of four paediatric cancer centres in Quebec for uniform evaluation and treatment. Standardised incidence ratios (SIRs) were calculated for neuroblastoma in Quebec and two comparable population-based controls during the same period of time using similar ascertainment procedures. Compliance with screening in Quebec was 91% at 3 weeks (n = 425,816) and 74% at 6 months (n = 349,706). Up to 31 July 1995 with a follow-up of the birth cohort of 15-75 months, 118 cases of neuroblastoma were diagnosed, 43 detected preclinically by screening, 20 detected clinically prior to screening at 3 weeks of age and 55 detected clinically after 3 weeks of age having normal screens (n = 52) or never screened (n = 3). Based on data from concurrent control populations, 54.5 cases of neuroblastoma would have been expected in Quebec during the study period for an SIR of 2.17 (95% CI 1.79-2.57, P < 0.0001). For the two control groups, the overall SIR was 1.00 (NS). SIRs for Quebec by age at diagnosis in yearly intervals show a marked increased incidence under 1 year of age (SIR = 2.85, 95% CI 2.26-3.50), with no reduction in incidence in subsequent years. We conclude that screening for neuroblastoma markedly increases the incidence in infants without decreasing the incidence of unfavourable advanced stage disease in older children. It is unlikely that screening for neuroblastoma in infants will reduce the mortality of this disease.
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Affiliation(s)
- W G Woods
- University of Minnesota, Minneapolis, USA
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41
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Abstract
The effects of chlorpromazine (0, 2, 6, and 10 mg/kg) on the acquisition of lever-press responding by rats were examined under conditions where reinforcement (water delivery) was immediate or delayed. Under the immediate reinforcement condition, water-deprived rats were exposed during 8-h sessions to a fixed-ratio 1 (FR 1) schedule of water delivery without prior autoshaping or hand shaping. Under the delayed reinforcement condition, similar rats were exposed to a tandem FR 1 fixed-time 8-s schedule of water delivery. A different squad of eight rats was exposed to each delay condition and drug dose. For all subjects, responses on one lever produced water and responses on a second lever had no programmed consequences. Regardless of whether reinforcement was immediate or delayed, chlorpromazine reduced in dose-dependent fashion the mean number of operative-lever responses emitted, which suggests that the drug interfered with learning. At all chlorpromazine doses except 10 mg/kg, substantially more operative-lever than inoperative-lever responding occurred, indicating that the operant response was acquired. Chlorpromazine at 2 and 6 mg/kg disrupted the acquisition of stimulus control by the operative lever when reinforcement was delayed, but not when it was immediate. At 10 mg/kg, most subjects did not acquire lever-pressing regardless of whether they were exposed to the immediate or delayed reinforcement procedure. Procedures similar to those used in the present study appear to provide a reasonable assay for examining how drugs affect the initial behavioral effects of immediate and delayed reinforcement, and may merit further investigation.
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Affiliation(s)
- T Byrne
- Department of Psychology, Western Michigan University, Kalamazoo 49008, USA
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Dial SM, Byrne T, Haskins M, Gasper PW, Rose B, Wenger DA, Thrall MA. Urine glycosaminoglycan concentrations in mucopolysaccharidosis VI-affected cats following bone marrow transplantation or leukocyte infusion. Clin Chim Acta 1997; 263:1-14. [PMID: 9247723 DOI: 10.1016/s0009-8981(96)06501-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Urinary glycosaminoglycan (GAG) concentrations were determined in nineteen normal cats (eleven kittens and eight adult cats), eighteen mucopolysaccharidosis VI (MPS VI)-affected untreated cats (ten kittens and eight adult cats), thirteen cats MPS VI-affected cats following bone marrow transplants (BMT), and two MPS VI-affected cats following intravenous infusion of leukocytes from normal cats. Mucopolysaccharidosis VI-affected cats treated with BMT had a precipitous decrease in urinary GAG by day 7 post-BMT, then a transient increase just prior to engraftment, followed by a sustained decrease to within, or near, the range of urinary GAG concentration established for normal cats. The pre-engraftment changes in urinary GAG excretion were reproduced by leukocyte infusion. After infusion of comparable members of normal peripheral blood leukocytes, a significant decrease in urinary GAG concentrations, specifically dermatan sulfate (DS), was seen with a nadir at day 5 post-infusion, followed by a return by day 9 to pre-infusion values. Post-engraftment, a continued low urinary GAG concentration with a specific decrease in DS can be utilized to document successful autologous engraftment in MPS VI-affected cats.
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Affiliation(s)
- S M Dial
- Department of Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins 80523, USA
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Abstract
Symptoms of anti-Hu associated paraneoplastic encephalomyelitis (PEM) and sensory neuropathy (PSN) are usually severe and irreversible. Two patients are reported whose symptoms improved spontaneously, and in one of them they resolved after resection of an inflammatory lesion of the lung. Spontaneous neurological improvement, although rare, should be considered in the evaluation of therapies for PEM/PSN.
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Affiliation(s)
- T Byrne
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Woods WG, Tuchman M, Robison LL, Bernstein M, Leclerc JM, Brisson LC, Brossard J, Hill G, Shuster J, Luepker R, Byrne T, Weitzman S, Bunin G, Lemieux B. A population-based study of the usefulness of screening for neuroblastoma. Lancet 1996; 348:1682-7. [PMID: 8973429 DOI: 10.1016/s0140-6736(96)06020-5] [Citation(s) in RCA: 177] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neuroblastoma has many characteristics which suggest that preclinical detection might improve outcome. The Quebec Neuroblastoma Screening Project was initiated to determine whether mass screening could reduce mortality in a large cohort of infants. As an early endpoint, we report whether screening could reduce the incidence of poor-prognosis neuroblastoma in children with advanced-stage disease over 1 year of age. METHODS All 476,603 children born in the province of Quebec during the 5-year period of May 1, 1989, to April 30, 1994, were eligible for urinary assay of homovanillic acid and vanillylmandelic acid at 3 weeks and 6 months of age. Children with a positive screen were referred to one of four paediatric cancer centres in the province for uniform evaluation and treatment if necessary. Standardised incidence ratios (SIRs) were calculated for neuroblastoma in the province and two similar population-based controls, the state of Minnesota and the province of Ontario, during the same period of time and with similar ascertainment procedures. FINDINGS Compliance with screening in Quebec province was 91% at 3 weeks (n = 425,816) and 74% at 6 months (n = 349,706). Through July 31, 1995, with a follow-up of the birth cohort of 15-75 months, 118 cases of neuroblastoma were diagnosed, 43 detected preclinically by screening, 20 detected clinically before screening at 3 weeks of age, and 55 detected clinically after 3 weeks of age having normal screens (52) or never screened (3). Retrospective analysis of stored samples confirmed that 49 of 52 patients missed by screening had levels of catecholamine metabolites that were too low to be detected at 6 months or earlier. Based on US Surveillance, Epidemiology and End Results data, 54.5 cases of neuroblastoma would have been expected in Quebec province during the study period, for an SIR of 2.17 (95% CI 1.79-2.57, p < 0.0001). For the two control groups, 43 and 80 cases of neuroblastoma were detected, respectively, compared with 37.9 and 85.4 expected, overall SIR 1.00 (not significant). SIRs for Quebec province by age at diagnosis in yearly intervals show a marked increased incidence under 1 year of age (SIR 2.85, 2.26-3.50), with no reduction in incidence in subsequent years. Limiting analysis to only patients diagnosed over 1 year of age with advanced-stage disease, 22 cases were detected in Quebec province versus 14.4 expected (SIR 1.52, 0.95-2.23). Data in the two control groups show no significant increase or decrease in any-stage disease in children under or over the age of 1 year, except for an increase in early-stage disease in Minnesota children over 1 year: 10 versus 3.8 expected (SIR 2.67, 1.27-4.58). INTERPRETATION Screening for neuroblastoma increases the incidence in infants without decreasing the incidence of unfavourable advanced-stage disease in older children. It is unlikely that screening for neuroblastoma in infants will reduce mortality for this disease.
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Affiliation(s)
- W G Woods
- University of Minnesota, Minneapolis, USA
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Jackson R, Chambless LE, Yang K, Byrne T, Watson R, Folsom A, Shahar E, Kalsbeek W. Differences between respondents and nonrespondents in a multicenter community-based study vary by gender ethnicity. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. J Clin Epidemiol 1996; 49:1441-46. [PMID: 8970495 DOI: 10.1016/0895-4356(95)00047-x] [Citation(s) in RCA: 245] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study provides data on differences between respondents and nonrespondents by gender and ethnicity in a multicenter community-based study that is rarely collected and that may be useful for estimating bias in prevalence estimates in other studies. Demographic, general health, and cardiovascular risk factors were examined in black and white respondents and nonrespondents to the Atherosclerosis Risk in Communities (ARIC) Study, a prospective study investigating cardiovascular risk factors in approximately 16,000 adults that was initiated in 1986 in four U.S. communities. In one of the communities (Jackson, MS) black participants were recruited exclusively; in another (Forsyth County, NC) 12% of the eligible sample were black, whereas the samples in Washington County, MD and the northwestern suburbs of Minneapolis, MN were almost all white. Demographic and health characteristics were collected during a home interview. Subjects who subsequently agreed to complete a clinical examination were defined as respondents, while eligible participants who only took part in the home interview were considered to be nonrespondents. Approximately 75% of age-eligible individuals (45-64 years) in each community completed the home interview. In three of the communities 86-88% of those who took part in the home interview also completed the clinic examination, whereas only 65% did so in Jackson. Among white participants, response rates were similar in men and women and between communities. Among black participants, the response rates were considerably lower, particularly in men. White male respondents reported a higher socioeconomic status, better general health and a lower prevalence of cardiovascular disease and associated risk factors than white male nonrespondents. The difference between white respondents and nonrespondents were greater for men than women despite similar response rates. Among black participants, respondent/nonrespondent difference were usually of smaller magnitude or absent, particularly in women. General health status and recent hospitalization rates were almost identical in black respondents and nonrespondents. Low response rates can bias estimates of prevalence in community-based studies although differences between respondents and nonrespondents tend to exaggerate real differences between respondents and the eligible population sampled. For example, among white males 25% of respondents and 44% of nonrespondents were current smokers, yet the estimated community prevalence of smoking was 31%. In conclusion, difference observed between respondents and nonrespondents were in the expected direction, but were greater for men than women and for whites than blacks.
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Affiliation(s)
- R Jackson
- Department of Community Health, University of Auckland, New Zealand
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46
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Abstract
The present study examined in 8-hour sessions the effects of d-amphetamine (1.0, 5.6, and 10 mg/kg) on the acquisition of lever-press responding in rats that were exposed to procedures in which water delivery was delayed by 0, 8, or 16 seconds relative to the response that produced it. Both nonresetting- and resetting-delay conditions were studied. Although neither shaping nor autoshaping occurred, substantial levels of operative-lever responding developed under all conditions in which responses produced water. The lowest dose (1.0 mg/kg) of d-amphetamine either had no effect on or increased operative-lever pressing, whereas higher doses typically produced an initial reduction in lever pressing. Nonetheless, overall rates of operative-lever pressing at these doses were as high as, or higher than, those observed with vehicle. Thus, response acquisition was observed under all reinforcement procedures at all drug doses. In the absence of the drug, most responding occurred on the operative lever when reinforcement was immediate. Such differential responding also developed under both nonresetting- and resetting-delay procedures when the delay was 8 seconds, but not when it was 16 seconds. d-Amphetamine did not affect the development of differential responding under any procedure. Thus, consistent with d-amphetamine's effects under repeated acquisition procedures, the drug had no detrimental effect on learning until doses that produced general behavioral disruption were administered.
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Affiliation(s)
- M G LeSage
- Western Michigan University, Kalamazoo 49008, USA
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Byrne T, Nolan T, O'Donnell R. A comparison of two column agglutination technologies for routine antibody screening using the indirect antiglobulin technique. Br J Biomed Sci 1996; 53:193-5. [PMID: 8914345] [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: 02/03/2023]
Abstract
Two commercial column agglutination technologies were compared for routine antibody screening using the indirect antiglobulin technique with 1000 heparinised blood samples from a general hospital. The I.D. microtyping system (Diamed) utilises a Sephadex gel, and the Biovue system (Ortho Diagnostics) consists of a column containing minute glass beads. Both systems have antihuman globulin incorporated into them resulting in agglutinates being trapped and allowing free red cells to pass through to the base. The purpose of this study was to compare the two technologies with the minimum amount of variables possible. The spin tube antiglobulin technique was not included in this study as this technology has not been used in this laboratory since January 1991. The systems compared well, despite different serological problems.
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Affiliation(s)
- T Byrne
- Beaumont Hospital, Dublin 9, Ireland
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Abstract
The development of anorexia nervosa in a high-functioning, early adolescent, autistic female is described. This case raises the issue of co-occurrence of childhood-onset disorders sharing the phenomena of obsessions and compulsions. The role of dysregulation of the serotonergic neurotransmitter system as a common underlying mechanism in these disorders is suggested. Psychoactive agents affecting the serotonin system and in particular the atypical neuroleptic risperidone may be of value in these disorders. There is added benefit to the combined use of biological and behavioral therapies.
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Affiliation(s)
- S Fisman
- Division of Child and Adolescent Psychiatry, Children's Hospital of Western Ontario, London, Canada
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Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Knisel JP, Lacy J, Tsukerman L, Makuch R. Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. Neurosurgery 1996; 38:872-8; discussion 878-9. [PMID: 8727811 DOI: 10.1097/00006123-199605000-00002] [Citation(s) in RCA: 199] [Impact Index Per Article: 7.1] [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: 02/01/2023] Open
Abstract
Data from 55 consecutive patients with low-grade astrocytomas treated between 1982 and 1990 were analyzed to determine specific outcome factors, including time to recurrence, incidence of anaplastic transformation, and survival. Gender, type of symptoms, contrast enhancement, and timing of radiation therapy were not significant in determining outcome. Patients who had symptoms for > 2 years and underwent gross-total resection of the tumor, with age as a continuous variable, were associated with significantly longer time to recurrence and survival. Within the population of patients with low-grade astrocytomas, patients with chronic epilepsy clearly had the best prognoses. There were no tumor recurrences or deaths in 27 patients with chronic epilepsy, regardless of the extent of surgery and without the use of radiotherapy. Ten-year survival was 100% for 31 patients who underwent gross-total tumor resection, regardless of the length of preoperative symptoms. Immediate postoperative radiotherapy did not prolong the time to recurrence, reduce the incidence of transition to more malignant tumors at recurrence, or increase the length of survival when compared with delayed radiotherapy. Because recurrence with a high-grade lesion caused 92% of the mortality in our series, the benefit in patients who underwent aggressive surgery seems to result from a significant decrease in the risk of recurrence when compared with patients who underwent anything less than gross-total resection. Our data also suggest that variability in the natural history of low-grade astrocytomas has a strong influence in determining survival and that tumors associated with chronic epilepsy are much less likely to become more malignant over time.
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Affiliation(s)
- J Piepmeier
- Department of Surgery/Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
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