26
|
Morton B, Nweze K, O'Connor J, Turton P, Joekes E, Blakey JD, Welters ID. Oxygen exchange and C-reactive protein predict safe discharge in patients with H1N1 influenza. QJM 2017; 110:227-232. [PMID: 27803369 DOI: 10.1093/qjmed/hcw176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND : Pandemic influenza has potential to overwhelm healthcare resources. There is uncertainty over performance of existing triage tools for hospital admission and discharge decisions. AIM : Our aim was to identify clinical criteria that predict safe discharge from hospital and develop a pragmatic triage tool to guide physician decision-making. DESIGN : We retrospectively examined an existing database of patients who presented to the Royal Liverpool University Hospital during the 2010-11 influenza pandemic. METHODS Inclusion criteria: patients ≥18 years, with PCR confirmed H1N1 influenza. Exclusion criteria: died in the emergency department or case notes unavailable. Successful discharge was defined as discharge within 24 h of presentation and no readmission within 7 days. RESULTS Eighty-six patients were included and 16 were successfully discharged. Estimated P/F ratio and C-reactive protein predicted safe discharge in a multivariable logistic regression model (AUC 0.883). A composite univariate predictor (estimated P/F minus C-reactive protein, AUC 0.877) was created to calculate specific cut off points for sensitivity and specificity. A pragmatic decision tool was created to incorporate these thresholds and relevant guidelines. Discharge: SpO 2 (in air) ≥ 94% and CRP <50. Observe: SpO 2 ≥ 94% and CRP >50 or SpO 2 ≤ 93% and CRP <50. Admit: SpO 2 ≤ 93% and CRP >50. CONCLUSIONS We identified that oxygen exchange and CRP, a marker of acute inflammation, were the most important predictors of safe discharge. Our proposed simple triage model requires validation but has the potential to aid clinical decisions in the event of a future pandemic, and potentially for seasonal influenza.
Collapse
|
27
|
McCann EP, Williams KL, Fifita JA, Tarr IS, O'Connor J, Rowe DB, Nicholson GA, Blair IP. The genotype-phenotype landscape of familial amyotrophic lateral sclerosis in Australia. Clin Genet 2017; 92:259-266. [PMID: 28105640 DOI: 10.1111/cge.12973] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 12/19/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a clinically and genetically heterogeneous fatal neurodegenerative disease. Around 10% of ALS cases are hereditary. ALS gene discoveries have provided most of our understanding of disease pathogenesis. We aimed to describe the genetic landscape of ALS in Australia by assessing 1013 Australian ALS patients for known ALS mutations by direct sequencing, whole exome sequencing or repeat primed polymerase chain reaction. Age of disease onset and disease duration were used for genotype-phenotype correlations. We report 60.8% of Australian ALS families in this cohort harbour a known ALS mutation. Hexanucleotide repeat expansions in C9orf72 accounted for 40.6% of families and 2.9% of sporadic patients. We also report ALS families with mutations in SOD1 (13.7%), FUS (2.4%), TARDBP (1.9%), UBQLN2 (.9%), OPTN (.5%), TBK1 (.5%) and CCNF (.5%). We present genotype-phenotype correlations between these genes as well as between gene mutations. Notably, C9orf72 hexanucleotide repeat expansion positive patients experienced significantly later disease onset than ALS mutation patients. Among SOD1 families, p.I114T positive patients had significantly later onset and longer survival. Our report highlights a unique spectrum of ALS gene frequencies among patients from the Australian population, and further, provides correlations between specific ALS mutations with disease onset and/or duration.
Collapse
|
28
|
Pavel M, Valle JW, Eriksson B, Rinke A, Caplin M, Chen J, Costa F, Falkerby J, Fazio N, Gorbounova V, de Herder W, Kulke M, Lombard-Bohas C, O'Connor J, Sorbye H, Garcia-Carbonero R. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Systemic Therapy - Biotherapy and Novel Targeted Agents. Neuroendocrinology 2017; 105:266-280. [PMID: 28351033 DOI: 10.1159/000471880] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/21/2017] [Indexed: 12/24/2022]
Abstract
Systemic therapies established in the management of patients with neuroendocrine tumors (NETs) include somatostatin analogs and interferon-α, also referred to as biotherapy. Recent randomized controlled studies have extended the knowledge on the frequency of side effects associated with biotherapy. More recently, novel targeted drugs, such as the mammalian target of rapamycin inhibitor everolimus and the multiple tyrosine kinase inhibitor sunitinib, have been introduced in the management of NETs. Although targeted drugs are generally well tolerated, with most adverse events being of mild to moderate severity and manageable, novel targeted drugs exhibit a distinct adverse event profile that warrants guidance for appropriate diagnostic and therapeutic management. This is particularly important given the widespread and potentially long-term use of everolimus in a broad spectrum of NETs and of sunitinib in pancreatic NETs. This review will focus on the most relevant toxicities associated with biotherapy and novel targeted drugs and on their management. For each drug class indication, administration and dosing schedule, most frequent adverse events, actions and dose adjustments for adverse events as well as their monitoring are presented. This review further covers the evaluation of treatment effect, patient information, drug interactions, and information on pregnancy.
Collapse
|
29
|
Mair FS, Goldstein P, May C, Angus R, Shiels C, Hibbert D, O'Connor J, Boland A, Roberts C, Haycox A, Capewell S. Patient and provider perspectives on home telecare: Preliminary results from a randomized controlled trial. J Telemed Telecare 2016; 11 Suppl 1:95-7. [PMID: 16036011 DOI: 10.1258/1357633054461976] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A randomized controlled trial of home telecare for the management of acute exacerbations of chronic obstructive pulmonary disease has been undertaken in the north-west of England. A videophone was used that communicates via the ordinary telephone network. The intervention period for each participant was two weeks. Participants in the telecare arm of the trial were asked to complete logbooks to record their experiences of each telecare encounter. A simple, self-completed, 10–item questionnaire was used that consisted of a Likert scale, ranging from 1 (totally disagree) to 5 (totally agree). Fourteen nurses completed 150 logbooks and 22 patients completed 145 logbooks. These results demonstrate significant differences in perception between patients and their health-care providers with regard to telecare encounters across all the domains addressed. Participating patients consistently demonstrated more positive views of the telecare encounters than their health-care providers.
Collapse
|
30
|
Mair FS, Goldstein P, Shiels C, Roberts C, Angus R, O'Connor J, Haycox A, Capewell S. Recruitment difficulties in a home telecare trial. J Telemed Telecare 2016; 12 Suppl 1:26-8. [PMID: 16884571 DOI: 10.1258/135763306777978371] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We analysed the difficulties encountered in recruiting predominantly older patients, suffering from an acute exacerbation of a chronic illness, to a randomized controlled trial of home telecare. Of 653 patients approached for study participation, after full assessment, 80% (519) met the trial eligibility criteria. Of these, 104 (20%) consented to study participation and 415 (80%) refused. A logistic regression model was constructed to examine independent effects of patient factors on probability of trial participation. Only two independent variables were associated with decreased likelihood of consent: increasing age (1 year older: odds ratio [OR] = 0.96); and being on inhaled steroid medication (OR = 0.60). The most common reason for refusal to participate, accounting for almost one-third of respondents, was a stated preference for a face-to-face nurse visiting service rather than a telecare service. Perhaps home telecare services should continue to be targeted at the more stable chronically ill population and not at those suffering from acute illness.
Collapse
|
31
|
Adamson P, An FP, Anghel I, Aurisano A, Balantekin AB, Band HR, Barr G, Bishai M, Blake A, Blyth S, Bock GJ, Bogert D, Cao D, Cao GF, Cao J, Cao SV, Carroll TJ, Castromonte CM, Cen WR, Chan YL, Chang JF, Chang LC, Chang Y, Chen HS, Chen QY, Chen R, Chen SM, Chen Y, Chen YX, Cheng J, Cheng JH, Cheng YP, Cheng ZK, Cherwinka JJ, Childress S, Chu MC, Chukanov A, Coelho JAB, Corwin L, Cronin-Hennessy D, Cummings JP, de Arcos J, De Rijck S, Deng ZY, Devan AV, Devenish NE, Ding XF, Ding YY, Diwan MV, Dolgareva M, Dove J, Dwyer DA, Edwards WR, Escobar CO, Evans JJ, Falk E, Feldman GJ, Flanagan W, Frohne MV, Gabrielyan M, Gallagher HR, Germani S, Gill R, Gomes RA, Gonchar M, Gong GH, Gong H, Goodman MC, Gouffon P, Graf N, Gran R, Grassi M, Grzelak K, Gu WQ, Guan MY, Guo L, Guo RP, Guo XH, Guo Z, Habig A, Hackenburg RW, Hahn SR, Han R, Hans S, Hartnell J, Hatcher R, He M, Heeger KM, Heng YK, Higuera A, Holin A, Hor YK, Hsiung YB, Hu BZ, Hu T, Hu W, Huang EC, Huang HX, Huang J, Huang XT, Huber P, Huo W, Hussain G, Hylen J, Irwin GM, Isvan Z, Jaffe DE, Jaffke P, James C, Jen KL, Jensen D, Jetter S, Ji XL, Ji XP, Jiao JB, Johnson RA, de Jong JK, Joshi J, Kafka T, Kang L, Kasahara SMS, Kettell SH, Kohn S, Koizumi G, Kordosky M, Kramer M, Kreymer A, Kwan KK, Kwok MW, Kwok T, Lang K, Langford TJ, Lau K, Lebanowski L, Lee J, Lee JHC, Lei RT, Leitner R, Leung JKC, Li C, Li DJ, Li F, Li GS, Li QJ, Li S, Li SC, Li WD, Li XN, Li YF, Li ZB, Liang H, Lin CJ, Lin GL, Lin S, Lin SK, Lin YC, Ling JJ, Link JM, Litchfield PJ, Littenberg L, Littlejohn BR, Liu DW, Liu JC, Liu JL, Loh CW, Lu C, Lu HQ, Lu JS, Lucas P, Luk KB, Lv Z, Ma QM, Ma XB, Ma XY, Ma YQ, Malyshkin Y, Mann WA, Marshak ML, Martinez Caicedo DA, Mayer N, McDonald KT, McGivern C, McKeown RD, Medeiros MM, Mehdiyev R, Meier JR, Messier MD, Miller WH, Mishra SR, Mitchell I, Mooney M, Moore CD, Mualem L, Musser J, Nakajima Y, Naples D, Napolitano J, Naumov D, Naumova E, Nelson JK, Newman HB, Ngai HY, Nichol RJ, Ning Z, Nowak JA, O'Connor J, Ochoa-Ricoux JP, Olshevskiy A, Orchanian M, Pahlka RB, Paley J, Pan HR, Park J, Patterson RB, Patton S, Pawloski G, Pec V, Peng JC, Perch A, Pfützner MM, Phan DD, Phan-Budd S, Pinsky L, Plunkett RK, Poonthottathil N, Pun CSJ, Qi FZ, Qi M, Qian X, Qiu X, Radovic A, Raper N, Rebel B, Ren J, Rosenfeld C, Rosero R, Roskovec B, Ruan XC, Rubin HA, Sail P, Sanchez MC, Schneps J, Schreckenberger A, Schreiner P, Sharma R, Moed Sher S, Sousa A, Steiner H, Sun GX, Sun JL, Tagg N, Talaga RL, Tang W, Taychenachev D, Thomas J, Thomson MA, Tian X, Timmons A, Todd J, Tognini SC, Toner R, Torretta D, Treskov K, Tsang KV, Tull CE, Tzanakos G, Urheim J, Vahle P, Viaux N, Viren B, Vorobel V, Wang CH, Wang M, Wang NY, Wang RG, Wang W, Wang X, Wang YF, Wang Z, Wang ZM, Webb RC, Weber A, Wei HY, Wen LJ, Whisnant K, White C, Whitehead L, Whitehead LH, Wise T, Wojcicki SG, Wong HLH, Wong SCF, Worcester E, Wu CH, Wu Q, Wu WJ, Xia DM, Xia JK, Xing ZZ, Xu JL, Xu JY, Xu Y, Xue T, Yang CG, Yang H, Yang L, Yang MS, Yang MT, Ye M, Ye Z, Yeh M, Young BL, Yu ZY, Zeng S, Zhan L, Zhang C, Zhang HH, Zhang JW, Zhang QM, Zhang XT, Zhang YM, Zhang YX, Zhang ZJ, Zhang ZP, Zhang ZY, Zhao J, Zhao QW, Zhao YB, Zhong WL, Zhou L, Zhou N, Zhuang HL, Zou JH. Limits on Active to Sterile Neutrino Oscillations from Disappearance Searches in the MINOS, Daya Bay, and Bugey-3 Experiments. PHYSICAL REVIEW LETTERS 2016; 117:151801. [PMID: 27768356 DOI: 10.1103/physrevlett.117.151801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 06/06/2023]
Abstract
Searches for a light sterile neutrino have been performed independently by the MINOS and the Daya Bay experiments using the muon (anti)neutrino and electron antineutrino disappearance channels, respectively. In this Letter, results from both experiments are combined with those from the Bugey-3 reactor neutrino experiment to constrain oscillations into light sterile neutrinos. The three experiments are sensitive to complementary regions of parameter space, enabling the combined analysis to probe regions allowed by the Liquid Scintillator Neutrino Detector (LSND) and MiniBooNE experiments in a minimally extended four-neutrino flavor framework. Stringent limits on sin^{2}2θ_{μe} are set over 6 orders of magnitude in the sterile mass-squared splitting Δm_{41}^{2}. The sterile-neutrino mixing phase space allowed by the LSND and MiniBooNE experiments is excluded for Δm_{41}^{2}<0.8 eV^{2} at 95% CL_{s}.
Collapse
|
32
|
Adamson P, Anghel I, Aurisano A, Barr G, Bishai M, Blake A, Bock GJ, Bogert D, Cao SV, Carroll TJ, Castromonte CM, Chen R, Childress S, Coelho JAB, Corwin L, Cronin-Hennessy D, de Jong JK, De Rijck S, Devan AV, Devenish NE, Diwan MV, Escobar CO, Evans JJ, Falk E, Feldman GJ, Flanagan W, Frohne MV, Gabrielyan M, Gallagher HR, Germani S, Gomes RA, Goodman MC, Gouffon P, Graf N, Gran R, Grzelak K, Habig A, Hahn SR, Hartnell J, Hatcher R, Holin A, Huang J, Hylen J, Irwin GM, Isvan Z, James C, Jensen D, Kafka T, Kasahara SMS, Koizumi G, Kordosky M, Kreymer A, Lang K, Ling J, Litchfield PJ, Lucas P, Mann WA, Marshak ML, Mayer N, McGivern C, Medeiros MM, Mehdiyev R, Meier JR, Messier MD, Miller WH, Mishra SR, Moed Sher S, Moore CD, Mualem L, Musser J, Naples D, Nelson JK, Newman HB, Nichol RJ, Nowak JA, O'Connor J, Orchanian M, Pahlka RB, Paley J, Patterson RB, Pawloski G, Perch A, Pfützner MM, Phan DD, Phan-Budd S, Plunkett RK, Poonthottathil N, Qiu X, Radovic A, Rebel B, Rosenfeld C, Rubin HA, Sail P, Sanchez MC, Schneps J, Schreckenberger A, Schreiner P, Sharma R, Sousa A, Tagg N, Talaga RL, Thomas J, Thomson MA, Tian X, Timmons A, Todd J, Tognini SC, Toner R, Torretta D, Tzanakos G, Urheim J, Vahle P, Viren B, Weber A, Webb RC, White C, Whitehead L, Whitehead LH, Wojcicki SG, Zwaska R. Search for Sterile Neutrinos Mixing with Muon Neutrinos in MINOS. PHYSICAL REVIEW LETTERS 2016; 117:151803. [PMID: 27768323 DOI: 10.1103/physrevlett.117.151803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 06/06/2023]
Abstract
We report results of a search for oscillations involving a light sterile neutrino over distances of 1.04 and 735 km in a ν_{μ}-dominated beam with a peak energy of 3 GeV. The data, from an exposure of 10.56×10^{20} protons on target, are analyzed using a phenomenological model with one sterile neutrino. We constrain the mixing parameters θ_{24} and Δm_{41}^{2} and set limits on parameters of the four-dimensional Pontecorvo-Maki-Nakagawa-Sakata matrix, |U_{μ4}|^{2} and |U_{τ4}|^{2}, under the assumption that mixing between ν_{e} and ν_{s} is negligible (|U_{e4}|^{2}=0). No evidence for ν_{μ}→ν_{s} transitions is found and we set a world-leading limit on θ_{24} for values of Δm_{41}^{2}≲1 eV^{2}.
Collapse
|
33
|
Bianconi F, Bonomo M, Marconi A, Kolliakou A, Stilo SA, Iyegbe C, Gurillo Muñoz P, Homayoun S, Mondelli V, Luzi S, Dazzan P, Prata D, La Cascia C, O'Connor J, David A, Morgan C, Murray RM, Lynskey M, Di Forti M. Differences in cannabis-related experiences between patients with a first episode of psychosis and controls. Psychol Med 2016; 46:995-1003. [PMID: 26670601 DOI: 10.1017/s0033291715002494] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many studies have reported that cannabis use increases the risk of a first episode of psychosis (FEP). However, only a few studies have investigated the nature of cannabis-related experiences in FEP patients, and none has examined whether these experiences are similar in FEP and general populations. The aim of this study was to explore differences in self-reported cannabis experiences between FEP and non-psychotic populations. METHOD A total of 252 subjects, who met International Classification of Diseases (ICD)-10 criteria for FEP, and 217 controls who reported cannabis use were selected from the Genetics and Psychosis (GAP) study. The Medical Research Council Social Schedule and the Cannabis Experience Questionnaire were used to collect sociodemographic data and cannabis use information, respectively. RESULTS Both 'bad' and 'enjoyable' experiences were more commonly reported by FEP subjects than controls. Principal components factor analysis identified four components which explained 62.3% of the variance. Linear regression analysis on the whole sample showed that the type of cannabis used and beliefs about the effect of cannabis on health all contributed to determining the intensity and frequency of experiences. Linear regression analysis on FEP subjects showed that the duration of cannabis use and amount of money spent on cannabis were strongly related to the intensity and frequency of enjoyable experiences in this population. CONCLUSIONS These results suggest a higher sensitivity to cannabis effects among people who have suffered their first psychotic episode; this hypersensitivity results in them reporting both more 'bad' and 'enjoyable' experiences. The greater enjoyment experienced may provide an explanation of why FEP patients are more likely to use cannabis and to continue to use it despite experiencing an exacerbation of their psychotic symptoms.
Collapse
|
34
|
Niederle B, Pape UF, Costa F, Gross D, Kelestimur F, Knigge U, Öberg K, Pavel M, Perren A, Toumpanakis C, O'Connor J, O'Toole D, Krenning E, Reed N, Kianmanesh R. ENETS Consensus Guidelines Update for Neuroendocrine Neoplasms of the Jejunum and Ileum. Neuroendocrinology 2016; 103:125-38. [PMID: 26758972 DOI: 10.1159/000443170] [Citation(s) in RCA: 291] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
35
|
Pape UF, Niederle B, Costa F, Gross D, Kelestimur F, Kianmanesh R, Knigge U, Öberg K, Pavel M, Perren A, Toumpanakis C, O'Connor J, Krenning E, Reed N, O'Toole D. ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas). Neuroendocrinology 2016; 103:144-52. [PMID: 26730583 DOI: 10.1159/000443165] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
36
|
Tanner R, Twomey M, Maher MM, Fitzgerald E, O'Connor J. A Rare Cause of Testicular Pain: Thrombosis of the Pampiniform Plexus. IRISH MEDICAL JOURNAL 2016; 109:347-348. [PMID: 26904794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Testicular pain is a common presentation in the emergency department. The cause includes a wide array of differentials. This report highlights a case of thrombosis of the pampiniform plexus as a rare cause of testicular pain. Doppler ultrasound should be the first line investigation. Symptomatic relief with anti-inflammatory medication should be sufficient for management.
Collapse
|
37
|
Soliman EZ, Sharma S, Arastéh K, Wohl D, Achhra A, Tambussi G, O'Connor J, Stein JH, Duprez DA, Neaton JD, Phillips A. Baseline cardiovascular risk in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:46-54. [PMID: 25711323 DOI: 10.1111/hiv.12233] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The Strategic Timing of AntiRetroviral Treatment (START) trial has recruited antiretroviral-naïve individuals with high CD4 cell counts from all regions of the world. We describe the distribution of cardiovascular disease (CVD) risk factors, overall and by geographical region, at study baseline. METHODS The distribution of CVD risk factors was assessed and compared by geographical region among START participants who had a baseline electrocardiogram (n = 4019; North America, 11%; Europe/Australia/Israel, 36%; South America, 26%; Asia, 4%; Africa, 23%; median age 36 years; 26% female). RESULTS About 58.3% (n = 2344) of the participants had at least one CVD risk factor and 18.9% (n = 761) had two or more. The most common CVD risk factors were current smoking (32%), hypertension (19.3%) and obesity (16.5%). There were significant differences in the prevalence of CVD risk factors among geographical regions. The prevalence of at least one risk factor across regions was as follows: North America, 70.0%; Europe/Australia/Israel, 65.1%; South America, 49.4%; Asia, 37.0%; Africa, 55.8% (P-value < 0.001). Significant regional differences were also observed when risk factors were used as part of the Framingham and Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) risk scores or used to define a favourable risk profile. CONCLUSIONS CVD risk factors are common among START participants, and their distribution varies by geographical region. Better understanding of how and why CVD risk factors develop in people with HIV infection and their geographical distributions could shed light on appropriate strategies for CVD prevention and may inform the interpretation of the results of START, as CVD is expected to be a major fraction of the primary endpoints observed.
Collapse
|
38
|
Mease P, Etzel C, Kremer J, Deveikis S, Li Y, O'Connor J, Kavanaugh A, Ruderman E, Curtis J, Ritchlin C, van der Heijde D, Solomon D, Greenberg J. AB1157 Characteristics of a US Psoriatic Arthritis/Spondyloarthritis Cohort: Baseline Data from the Corrona PSA/SPA Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
Viney K, Cavanaugh J, Kienene T, Harley D, Kelly PM, Sleigh A, O'Connor J, Mase S. Tuberculosis and diabetes mellitus in the Republic of Kiribati: a case-control study. Trop Med Int Health 2015; 20:650-657. [PMID: 25598275 DOI: 10.1111/tmi.12462] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To better inform local management of TB-diabetes collaborative activities, we aimed to determine the prevalence of diabetes among persons with and without TB and to determine the association between TB and diabetes in Kiribati, a Pacific Island nation. METHODS We compared consecutively enrolled TB cases to a group of randomly selected community controls without evidence of TB. Diabetes was diagnosed by HbA1c, and clinical and demographic data were collected. A tuberculin skin test was administered to controls. The chi-square test was used to assess significance in differences between cases and controls. We also calculated an odds ratio, with 95% confidence intervals, for the odds of diabetes among cases relative to controls. Unweighted multivariate logistic regression was performed to adjust for the effects of age and sex. RESULTS A total of 275 TB cases and 499 controls were enrolled. The diabetes prevalence in cases (101, 37%) was significantly greater than in controls (94, 19%) (adjusted odds ratio: 2.8; 95% CI 2.0-4.1). Fifty-five percent (108) of all diabetic diagnoses were new; this proportion was higher among controls (64.8%) than cases (46.5%). Five patients with TB were screened to detect one patient with diabetes. CONCLUSIONS There is a strong association between TB and diabetes in Kiribati and bidirectional screening should be conducted in this setting.
Collapse
|
40
|
Cavanaugh J, Viney K, Kienene T, Harley D, Kelly PM, Sleigh A, O'Connor J, Mase S. Effect of diabetes on tuberculosis presentation and outcomes in Kiribati. Trop Med Int Health 2015; 20:643-649. [PMID: 25630576 DOI: 10.1111/tmi.12468] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the association between diabetes and the clinical features and treatment outcomes of TB in Kiribati. METHODS We enrolled consecutive patients with TB who presented from August 2010 to February 2012 and compared clinical features and TB treatment outcomes for patients with and without diabetes, as measured by haemoglobin A1c assay. Poor outcome was defined as death, default or treatment failure, and good outcome as treatment success or cure. RESULTS Two hundred and seventy-five eligible persons with TB disease were enrolled; 101 (37%) had diabetes. TB patients with diabetes were more likely to have acid-fast bacilli (AFB) seen on sputum smear microscopy (RR: 1.3; 95% CI: 1.03-1.62). The risk of poor outcome did not differ between patients with or without diabetes (RR: 1.1; 95% CI: 0.5-2.7). CONCLUSION TB patients with diabetes are more likely than those without to have sputum with AFB on microscopy. This could increase transmission in the community. Early detection of TB by screening patients with diabetes, and the converse, could be important public health interventions where diabetes and TB are prevalent.
Collapse
|
41
|
Kolliakou A, Castle D, Sallis H, Joseph C, O'Connor J, Wiffen B, Gayer-Anderson C, McQueen G, Taylor H, Bonaccorso S, Gaughran F, Smith S, Greenwood K, Murray RM, Di Forti M, Atakan Z, Ismail K. Reasons for cannabis use in first-episode psychosis: does strength of endorsement change over 12 months? Eur Psychiatry 2014; 30:152-9. [PMID: 25541346 DOI: 10.1016/j.eurpsy.2014.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time. METHODS FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n=69), 3 months (n=29) and 12 months (n=36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point. RESULTS Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed 'enhancement' followed by 'coping with unpleasant affect' and 'social motive' more highly for their cannabis use than any other reason. 'Conformity and acceptance' followed closely. 'Relief of positive symptoms and side effects' was the least endorsed motive. CONCLUSIONS Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated 'enhancement' most highly for their cannabis use.
Collapse
|
42
|
Osman M, Mantor C, O'Connor J. Duodenal and retroperitoneal hematoma after upper gastrointestinal endoscopy: First presentation of a child with Hemophilia B. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
43
|
Adamson P, Anghel I, Aurisano A, Barr G, Bishai M, Blake A, Bock GJ, Bogert D, Cao SV, Castromonte CM, Cherdack D, Childress S, Coelho JAB, Corwin L, Cronin-Hennessy D, de Jong JK, Devan AV, Devenish NE, Diwan MV, Escobar CO, Evans JJ, Falk E, Feldman GJ, Frohne MV, Gallagher HR, Gomes RA, Goodman MC, Gouffon P, Graf N, Gran R, Grzelak K, Habig A, Hahn SR, Hartnell J, Hatcher R, Himmel A, Holin A, Huang J, Hylen J, Irwin GM, Isvan Z, James C, Jensen D, Kafka T, Kasahara SMS, Koizumi G, Kordosky M, Kreymer A, Lang K, Ling J, Litchfield PJ, Lucas P, Mann WA, Marshak ML, Mayer N, McGivern C, Medeiros MM, Mehdiyev R, Meier JR, Messier MD, Michael DG, Miller WH, Mishra SR, Moed Sher S, Moore CD, Mualem L, Musser J, Naples D, Nelson JK, Newman HB, Nichol RJ, Nowak JA, O'Connor J, Orchanian M, Pahlka RB, Paley J, Patterson RB, Pawloski G, Perch A, Phan-Budd S, Plunkett RK, Poonthottathil N, Qiu X, Radovic A, Rebel B, Rosenfeld C, Rubin HA, Sanchez MC, Schneps J, Schreckenberger A, Schreiner P, Sharma R, Sousa A, Tagg N, Talaga RL, Thomas J, Thomson MA, Tian X, Timmons A, Tognini SC, Toner R, Torretta D, Tzanakos G, Urheim J, Vahle P, Viren B, Weber A, Webb RC, White C, Whitehead L, Whitehead LH, Wojcicki SG, Zwaska R. Combined analysis of νμ disappearance and νμ→νe appearance in MINOS using accelerator and atmospheric neutrinos. PHYSICAL REVIEW LETTERS 2014; 112:191801. [PMID: 24877929 DOI: 10.1103/physrevlett.112.191801] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Indexed: 06/03/2023]
Abstract
We report on a new analysis of neutrino oscillations in MINOS using the complete set of accelerator and atmospheric data. The analysis combines the ν(μ) disappearance and ν(e) appearance data using the three-flavor formalism. We measure |Δm(32)(2)| = [2.28-2.46] × 10(-3) eV(2) (68% C.L.) and sin(2)θ(23) = 0.35-0.65 (90% C.L.) in the normal hierarchy, and |Δm(32)(2)| = [2.32-2.53] × 10(-3) eV(2) (68% C.L.) and sin(2)θ(23) = 0.34-0.67 (90% C.L.) in the inverted hierarchy. The data also constrain δ(CP), the θ(23} octant degeneracy and the mass hierarchy; we disfavor 36% (11%) of this three-parameter space at 68% (90%) C.L.
Collapse
|
44
|
Cambiano V, O'Connor J, Phillips AN, Rodger A, Lodwick R, Pharris A, Lampe F, Nakagawa F, Smith C, van de Laar MJ. Antiretroviral therapy for prevention of HIV transmission: implications for Europe. ACTA ACUST UNITED AC 2013; 18:20647. [PMID: 24308982 DOI: 10.2807/1560-7917.es2013.18.48.20647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.
Collapse
|
45
|
Inamdar PM, Cook S, Sharma AK, Corby N, O'Connor J, Perera BJC. A GIS based screening tool for locating and ranking of suitable stormwater harvesting sites in urban areas. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2013; 128:363-370. [PMID: 23786875 DOI: 10.1016/j.jenvman.2013.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/04/2013] [Accepted: 05/08/2013] [Indexed: 06/02/2023]
Abstract
There is the need to re-configure current urban water systems to achieve the objective of sustainable water sensitive cities. Stormwater represents a valuable alternative urban water source to reduce pressure on fresh water resources, and to mitigate the environmental impact of urban stormwater runoff. The selection of suitable urban stormwater harvesting sites is generally based on the judgement of water planners, who are faced with the challenge of considering multiple technical and socio-economic factors that influence the site suitability. To address this challenge, the present study developed a robust GIS based screening methodology for identifying potentially suitable stormwater harvesting sites in urban areas as a first pass for then more detailed investigation. The study initially evaluated suitability based on the match between harvestable runoff and demand through a concept of accumulated catchments. Drainage outlets of these accumulated catchments were considered as potential stormwater harvesting sites. These sites were screened and ranked under screening parameters namely demand, ratio of runoff to demand and weighted demand distance. The methodology described in this paper was successfully applied to a case study in Melbourne, Australia in collaboration with the local water utility. The methodology was found to be effective in supporting the selection of priority sites for stormwater harvesting schemes, as it provided the basis to identify, short-list and rank sites for further detailed investigation. The rapid identification of suitable sites for stormwater harvesting can assist planners in prioritising schemes in areas that will have the most impact on reducing potable water demand.
Collapse
|
46
|
Adamson P, Anghel I, Backhouse C, Barr G, Bishai M, Blake A, Bock GJ, Bogert D, Cao SV, Castromonte CM, Childress S, Coelho JAB, Corwin L, Cronin-Hennessy D, de Jong JK, Devan AV, Devenish NE, Diwan MV, Escobar CO, Evans JJ, Falk E, Feldman GJ, Frohne MV, Gallagher HR, Gomes RA, Goodman MC, Gouffon P, Graf N, Gran R, Grzelak K, Habig A, Hahn SR, Hartnell J, Hatcher R, Himmel A, Holin A, Hylen J, Irwin GM, Isvan Z, James C, Jensen D, Kafka T, Kasahara SMS, Koizumi G, Kordosky M, Kreymer A, Lang K, Ling J, Litchfield PJ, Lucas P, Mann WA, Marshak ML, Mathis M, Mayer N, McGowan AM, Medeiros MM, Mehdiyev R, Meier JR, Messier MD, Michael DG, Miller WH, Mishra SR, Moed Sher S, Moore CD, Mualem L, Musser J, Naples D, Nelson JK, Newman HB, Nichol RJ, Nowak JA, O'Connor J, Oliver WP, Orchanian M, Pahlka RB, Paley J, Patterson RB, Pawloski G, Phan-Budd S, Plunkett RK, Qiu X, Radovic A, Rebel B, Rosenfeld C, Rubin HA, Sanchez MC, Schneps J, Schreckenberger A, Schreiner P, Sharma R, Sousa A, Tagg N, Talaga RL, Thomas J, Thomson MA, Tinti G, Tognini SC, Toner R, Torretta D, Tzanakos G, Urheim J, Vahle P, Viren B, Weber A, Webb RC, White C, Whitehead L, Whitehead LH, Wojcicki SG, Zwaska R. Measurement of neutrino and antineutrino oscillations using beam and atmospheric data in MINOS. PHYSICAL REVIEW LETTERS 2013; 110:251801. [PMID: 23829728 DOI: 10.1103/physrevlett.110.251801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Indexed: 06/02/2023]
Abstract
We report measurements of oscillation parameters from ν(μ) and ν(μ) disappearance using beam and atmospheric data from MINOS. The data comprise exposures of 10.71×10(20) protons on target in the ν(μ)-dominated beam, 3.36×10(20) protons on target in the ν(μ)-enhanced beam, and 37.88 kton yr of atmospheric neutrinos. Assuming identical ν and ν oscillation parameters, we measure |Δm2| = (2.41(-0.10)(+0.09))×10(-3) eV2 and sin2(2θ) = 0.950(-0.036)(+0.035). Allowing independent ν and ν oscillations, we measure antineutrino parameters of |Δm2| = (2.50(-0.25)(+0.23))×10(-3) eV2 and sin2(2θ) = 0.97(-0.08)(+0.03), with minimal change to the neutrino parameters.
Collapse
|
47
|
Adamson P, Anghel I, Backhouse C, Barr G, Bishai M, Blake A, Bock GJ, Bogert D, Cao SV, Cherdack D, Childress S, Coelho JAB, Corwin L, Cronin-Hennessy D, de Jong JK, Devan AV, Devenish NE, Diwan MV, Escobar CO, Evans JJ, Falk E, Feldman GJ, Frohne MV, Gallagher HR, Gomes RA, Goodman MC, Gouffon P, Graf N, Gran R, Grzelak K, Habig A, Hahn SR, Hartnell J, Hatcher R, Himmel A, Holin A, Hylen J, Irwin GM, Isvan Z, Jaffe DE, James C, Jensen D, Kafka T, Kasahara SMS, Koizumi G, Kordosky M, Kreymer A, Lang K, Ling J, Litchfield PJ, Lucas P, Mann WA, Marshak ML, Mathis M, Mayer N, Medeiros MM, Mehdiyev R, Meier JR, Messier MD, Michael DG, Miller WH, Mishra SR, Moed Sher S, Moore CD, Mualem L, Musser J, Naples D, Nelson JK, Newman HB, Nichol RJ, Nowak JA, Ochoa-Ricoux JP, O'Connor J, Oliver WP, Orchanian M, Pahlka RB, Paley J, Patterson RB, Pawloski G, Phan-Budd S, Plunkett RK, Qiu X, Radovic A, Rebel B, Rosenfeld C, Rubin HA, Sanchez MC, Schneps J, Schreckenberger A, Schreiner P, Sharma R, Sousa A, Tagg N, Talaga RL, Thomas J, Thomson MA, Tinti G, Toner R, Torretta D, Tzanakos G, Urheim J, Vahle P, Viren B, Weber A, Webb RC, White C, Whitehead L, Wojcicki SG, Yang T, Zwaska R. Electron neutrino and antineutrino appearance in the full MINOS data sample. PHYSICAL REVIEW LETTERS 2013; 110:171801. [PMID: 23679706 DOI: 10.1103/physrevlett.110.171801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 02/24/2013] [Indexed: 06/02/2023]
Abstract
We report on ν(e) and ν(e) appearance in ν(μ) and ν(μ) beams using the full MINOS data sample. The comparison of these ν(e) and ν(e) appearance data at a 735 km baseline with θ13 measurements by reactor experiments probes δ, the θ23 octant degeneracy, and the mass hierarchy. This analysis is the first use of this technique and includes the first accelerator long-baseline search for ν(μ) → ν(e). Our data disfavor 31% (5%) of the three-parameter space defined by δ, the octant of the θ23, and the mass hierarchy at the 68% (90%) C.L. We measure a value of 2sin(2)(2θ13)sin(2)(θ23) that is consistent with reactor experiments.
Collapse
|
48
|
Corcoran M, Morris D, De Lappe N, O'Connor J, Lalor P, Dockery P, Cormican M. Salmonella enterica biofilm formation and density in the Centers for Disease Control and Prevention's biofilm reactor model is related to serovar and substratum. J Food Prot 2013; 76:662-7. [PMID: 23575130 DOI: 10.4315/0362-028x.jfp-12-303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Foodborne pathogens can attach to, and survive on, food contact surfaces for long periods by forming a biofilm. Salmonella enterica is the second most common cause of foodborne illness in Ireland. The ability of S. enterica to form a biofilm could contribute to its persistence in food production areas, leading to cross-contamination of products and surfaces. Arising from a large foodborne outbreak of S. enterica serovar Agona associated with a food manufacturing environment, a hypothesis was formulated that the associated Salmonella Agona strain had an enhanced ability to form a biofilm relative to other S. enterica. To investigate this hypothesis, 12 strains of S. enterica, encompassing three S. enterica serovars, were assessed for the ability to form a biofilm on multiple food contact surfaces. All isolates formed a biofilm on the contact surfaces, and there was no consistent trend for the Salmonella Agona outbreak strain to produce a denser biofilm compared with other strains of Salmonella Agona or Salmonella Typhimurium. However, Salmonella Enteritidis biofilm was considerably less dense than Salmonella Typhimurium and Salmonella Agona biofilms. Biofilm density was greater on tile than on concrete, polycarbonate, stainless steel, or glass.
Collapse
|
49
|
Nkire N, Ekwegbalu UO, Iro C, O'Connor J. Subjective sleep complaints in patients attending a substance use disorder clinic. IRISH MEDICAL JOURNAL 2013; 106:21-22. [PMID: 23472373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study evaluated subjective reports of sleep difficulties in patients attending a designated consultant in The Drug Treatment Centre Board (DTCB). 89 patients consented to participate representing a 51% response rate. Approximately 65% complained of sleep difficulties. All those who complained of sleep problems had multiple sleep difficulties. About 37% reported six month duration of complaints at time of assessment. There was a significant association between reports of sleep difficulties with homelessness (Pearson's X2 = 6.298, p < 0.012), cigarette smoking (Pearson's X2 = 6.017, p < 0.014) and day time sleep (Pearson's X2 = 3.920, p < 0.048). Sleep problems are common amongst patients attending our opioid replacement treatment programme. The present study suggests measures to ensure a holistic management of complaints.
Collapse
|
50
|
Somers CJ, O'Connor J. Retrospective study of outcomes, for patients admitted to a drug treatment centre board. IRISH MEDICAL JOURNAL 2012; 105:295-298. [PMID: 23240280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Retrospective study of urinary heroin outcomes of a cohort (123) of patients commenced on a methadone treatment program. Significantly poorer outcomes were associated with urines positive for cocaine (OR 0.69 CI 0.59-0.81) benzodiazepines (OR 0.7 CI 0.53-0.93) with prescribing of low dose methadone (OR 0.65 CI 0.48-0.87), with urines positive for heroin at time of admission (OR 0.74 CI 0.56-0.97) and with behavioural sanctions (OR 0.8, CI 0.65-0.98). Improved outcomes were associated with granting of take away methadone (OR 1.34 CI 1.1-1.62). with an indication of improved outcomes associated with alcohol positive urines (OR 1.34 CI 0.95-1.9) and increased duration of clinic attendance (OR 1.21 CI 0.99-1.47). On multiple regression analysis low dose methadone (0.07 CI 0.01-0.33) prescribing remained negatively associated with urine heroin outcomes.
Collapse
|