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Maishman T, Sheikh H, Boger P, Kelly J, Cozens K, Bateman A, Davies S, Fay M, Sharland D, Jackson A. A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e225-e231. [PMID: 33402268 DOI: 10.1016/j.clon.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
AIMS Self-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy. MATERIALS AND METHODS A Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses. RESULTS Five of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2-72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6-not reached). CONCLUSION The high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.
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Fitzgerald J, Duffy N, Paulitti A, Vitrani F, Curcio F, Cattaruzzi G, Sfiligoj A, Jones D, Mclnerney V, Kelly J, Finnerty A, McDonagh K, McCabe U, Duggan M, Connolly L, Barry F. Application of a novel bioreactor system for automated expansion of adipose- derived mesenchymal stem cells under gmp-compliant conditions. Cytotherapy 2021. [DOI: 10.1016/s1465324921005922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kelly J, Patel A, Onadim I, Abisi S, Bell R, Tyrrell M, Sallam M, Salih M, Mayr M, Bradbury E, Cho J, Gworzdz A, Booth T, Smith A, Modarai B. O15: DISRUPTION OF THE BLOOD-SPINAL CORD BARRIER PREDICTS PERMANENT PARAPLEGIA AFTER THORACOABDOMINAL AORTIC ANEURYSM REPAIR. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Paraplegia post-thoracoabdominal aortic aneurysm (TAAA) repair remains both a devastating and poorly understood complication. We related temporal changes in cellular and protein composition of cerebrospinal fluid (CSF) to neurological outcomes after TAAA repair to gain mechanistic insights driving paraplegia.
Method
Patients undergoing TAAA repair (open or endovascular) with a CSF drain were prospectively recruited between 2016-2018. CSF was collected pre-operatively and 24-hourly until removal. Daily neurological examinations were performed by blinded neurologists to the study. CSF cell content was characterised by flow cytometry and proteome analysed by tandem-mass-tag proteomics. An in-vivo rat model was modified using 15 minutes of aortic occlusion to produce consistent paraplegia. Rats were analysed neuro-behaviourally and histologically.
Result
CSF was analysed from 52 patients (age: 70.27+/-11.4; 66% male; open (n=9), endovascular (n=43)). 12 developed paraplegia of whom 5 remained permanently-paraplegic. Demographics were comparable between paraplegics, those who recovered and without post-op neurology. Permanent paraplegia was associated with a significant infiltration of CSF CD45+ leucocytes (P<0.0001). Levels of ADVS-1 was >3-fold higher in permanent-paraplegics CSF versus those who recovered (P=0.0008). ADVS-1 >15ng/ml predicted permanent paraplegia with 100% specificity. Pre-treatment with ADVS-1 inhibition significantly improved walking (<0.001) and increased astrocytic staining in the lateral corticospinal, reticulospinal and rubrospinal tracts versus controls (P=0.03, 0.04, 0.04 respectively).
Conclusion
Permanent paraplegia is associated with shedding of ADVS-1 from parenchymal cord into CSF and blood/spinal-cord barrier disruption leading to cord oedema/leucocyte infiltration. Pre-treatment with ADVS-1 inhibition led to neurobehavioural and histological improvements offering translational hope for this devastating complication.
Take-home message
ADVS-1 is a novel biomarker of paraplegia where accurate biomarkers have proven challenging but more importantly it has proven a therapeutic target with genuine translational potential.
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Teoh T, Powell J, Kelly J, McDonnell C, Whelan R, O'Connell N, Dunne C. Outcomes of point-of-care testing for influenza in the emergency department of a tertiary referral hospital in Ireland. J Hosp Infect 2021; 110:45-51. [DOI: 10.1016/j.jhin.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
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Iyengar A, Han J, Helmers M, Smood B, Patrick W, Kelly J, Moss N, Najjar S, Houston B, Tedford R, Shore S, Vorovich E, Hsich E, Alexander K, Chaudhry S, Vidula H, Kilic A, Genuardi M, Birati E, Atluri P. The Effect of Body Mass Index on Presentation of COVID-19 amongst Heart Transplant Recipients: A Multi-Institutional Study. J Heart Lung Transplant 2021. [PMCID: PMC7979420 DOI: 10.1016/j.healun.2021.01.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Characteristics and outcomes of heart transplant (HT) recipients who contract coronavirus (SARS-CoV-2) have been poorly described. The current study was undertaken to better understand the risk obesity may pose in this patient population Methods A prospectively-maintained Trans-CoV-VAD Registry containing HT recipients at 11 participating institutions who presented with SARS-CoV-2 were reviewed. Presenting characteristics, hospitalization rates, ventilator & intensive care unit usage, and mortality were queried. Patients were grouped by body mass index (BMI) into obese (BMI≥30 k/m2) and non-obese cohorts (BMI<30 kg/m2). Comparisons between groups were made utilizing chi-squared, Fisher's exact, and Mann-Whitney U-tests. Multivariable logistic regression models were utilized Results Across all centers, 85 HT recipients who tested positive for SARS-CoV-2 were identified, of whom 26 (31%) were obese. Median time from HT to diagnosis was 4.6 (1.8-13.8) years. No differences in age (57 vs 60 p 0.85) or female gender (31% vs 24% p 0.5) were noted between obese and non-obese patients. On presentation, obese patients were more symptomatic with higher rates of cough (76% vs 48% p 0.02), dyspnea (62% vs 41% p 0.09), diarrhea (60% vs 35% p 0.03), and headache (35% vs 14% p 0.03). No differences in rates of admission (62% vs 64% p 0.8), ICU presentation (44% vs 35% p 0.6) or need for mechanical ventilation were noted (38% vs 22% p 0.2). More secondary infections were noted amongst obese patients (32% vs 13% p 0.04). On follow-up, mortality was similar between groups (12% vs 9% p 0.7). On multivariable modeling, BMI was not associated with increased adjusted odds of hospital/ICU admission or mechanical ventilation (p>0.10) Conclusion Acute presentations of SARS-CoV-2 amongst HT recipients carry significantly higher mortality over the general population. Obesity appears to impact presenting symptoms and secondary infections, but does not strongly impact ICU requirements or mortality
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McEwen M, Kafri D, Chen Z, Atalaya J, Satzinger KJ, Quintana C, Klimov PV, Sank D, Gidney C, Fowler AG, Arute F, Arya K, Buckley B, Burkett B, Bushnell N, Chiaro B, Collins R, Demura S, Dunsworth A, Erickson C, Foxen B, Giustina M, Huang T, Hong S, Jeffrey E, Kim S, Kechedzhi K, Kostritsa F, Laptev P, Megrant A, Mi X, Mutus J, Naaman O, Neeley M, Neill C, Niu M, Paler A, Redd N, Roushan P, White TC, Yao J, Yeh P, Zalcman A, Chen Y, Smelyanskiy VN, Martinis JM, Neven H, Kelly J, Korotkov AN, Petukhov AG, Barends R. Removing leakage-induced correlated errors in superconducting quantum error correction. Nat Commun 2021; 12:1761. [PMID: 33741936 PMCID: PMC7979694 DOI: 10.1038/s41467-021-21982-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/23/2021] [Indexed: 11/30/2022] Open
Abstract
Quantum computing can become scalable through error correction, but logical error rates only decrease with system size when physical errors are sufficiently uncorrelated. During computation, unused high energy levels of the qubits can become excited, creating leakage states that are long-lived and mobile. Particularly for superconducting transmon qubits, this leakage opens a path to errors that are correlated in space and time. Here, we report a reset protocol that returns a qubit to the ground state from all relevant higher level states. We test its performance with the bit-flip stabilizer code, a simplified version of the surface code for quantum error correction. We investigate the accumulation and dynamics of leakage during error correction. Using this protocol, we find lower rates of logical errors and an improved scaling and stability of error suppression with increasing qubit number. This demonstration provides a key step on the path towards scalable quantum computing.
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Levitt EE, Syan SK, Sousa S, Costello MJ, Rush B, Samokhvalov AV, McCabe RE, Kelly J, MacKillop J. Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation. Addict Behav 2021; 112:106649. [PMID: 32979691 DOI: 10.1016/j.addbeh.2020.106649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Substance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not feasible clinically. Efficient psychometrically-validated screening tools exist for commonly comorbid conditions, but cutoff accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cutoff scores in an inpatient SUD treatment setting. METHOD Participants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cutoff scores on the screening tool against the interview-based diagnosis. RESULTS Area under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59-0.80), GAD-7 = 0.74 (95% CI = 0.63-0.84), and PCL-5 = 0.79 (95% CI = 0.66-0.91). The optimal accuracy cutoff scores based on sensitivity and specificity were: PHQ-9 ≥ 16, GAD-7 ≥ 9, the PCL-5 ≥ 42. CONCLUSIONS In general, the candidate screeners performed acceptably in this population. However, the optimal cutoff scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cutoff values is warranted. PUBLIC HEALTH SIGNIFICANCE This study provides modified screening cutoff scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Miah S, Collins J, Sridhar A, Kelkar A, Hines J, Kelly J, Shah N, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Foxen B, Neill C, Dunsworth A, Roushan P, Chiaro B, Megrant A, Kelly J, Chen Z, Satzinger K, Barends R, Arute F, Arya K, Babbush R, Bacon D, Bardin JC, Boixo S, Buell D, Burkett B, Chen Y, Collins R, Farhi E, Fowler A, Gidney C, Giustina M, Graff R, Harrigan M, Huang T, Isakov SV, Jeffrey E, Jiang Z, Kafri D, Kechedzhi K, Klimov P, Korotkov A, Kostritsa F, Landhuis D, Lucero E, McClean J, McEwen M, Mi X, Mohseni M, Mutus JY, Naaman O, Neeley M, Niu M, Petukhov A, Quintana C, Rubin N, Sank D, Smelyanskiy V, Vainsencher A, White TC, Yao Z, Yeh P, Zalcman A, Neven H, Martinis JM. Demonstrating a Continuous Set of Two-Qubit Gates for Near-Term Quantum Algorithms. PHYSICAL REVIEW LETTERS 2020; 125:120504. [PMID: 33016760 DOI: 10.1103/physrevlett.125.120504] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/27/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Quantum algorithms offer a dramatic speedup for computational problems in material science and chemistry. However, any near-term realizations of these algorithms will need to be optimized to fit within the finite resources offered by existing noisy hardware. Here, taking advantage of the adjustable coupling of gmon qubits, we demonstrate a continuous two-qubit gate set that can provide a threefold reduction in circuit depth as compared to a standard decomposition. We implement two gate families: an imaginary swap-like (iSWAP-like) gate to attain an arbitrary swap angle, θ, and a controlled-phase gate that generates an arbitrary conditional phase, ϕ. Using one of each of these gates, we can perform an arbitrary two-qubit gate within the excitation-preserving subspace allowing for a complete implementation of the so-called Fermionic simulation (fSim) gate set. We benchmark the fidelity of the iSWAP-like and controlled-phase gate families as well as 525 other fSim gates spread evenly across the entire fSim(θ,ϕ) parameter space, achieving a purity-limited average two-qubit Pauli error of 3.8×10^{-3} per fSim gate.
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Payne L, Harris P, Ghio D, Slodkowska-Barabasz J, Sutcliffe M, Kelly J, Stroud M, Little P, Yardley L, Morrison L. Beliefs about inevitable decline among home-living older adults at risk of malnutrition: a qualitative study. J Hum Nutr Diet 2020; 33:841-851. [PMID: 32840942 DOI: 10.1111/jhn.12807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Approximately 14% of free-living adults aged ≥65 years are at risk of malnutrition. Malnutrition screen and treat interventions in primary care are few, show mixed results, and the advice given is not always accepted and followed. We need to better understand the experiences and contexts of older adults when aiming to develop interventions that are engaging, optimally persuasive and relevant. METHODS Using the Person-based Approach, we carried out 23 semi-structured interviews with purposively selected adults ≥65 years with chronic health or social conditions associated with malnutrition risk. Thematic analysis informed the development of key principles to guide planned intervention development. RESULTS We found that individuals' beliefs about an inevitable decline in appetite and eating in older age compound the many and varied physical and physiological barriers that they experience. Also, we found that expectations of decline in appetite and physical ability may encourage resignation, reduce self-efficacy to overcome barriers, and reduce motivation to address weight loss and/or recognise it as an issue that needs to be addressed. Fear of loss of independence may also reduce the likelihood of asking general practitioners for advice. CONCLUSIONS The key findings identified include a sense of resignation, multiple different barriers to eating and a need for independence, each underpinned by the expectation of a decline in older adulthood. Interventions need to address misperceptions about the inevitability of decline, highlight how and why diet recommendations are somewhat different from recommendations for the general population, and suggest easy ways to increase food intake that address common barriers.
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Abdollah F, Shahait M, Dalela D, Kelly J, Vapiwala N, Lee D. External validation of genomic classifier based risk-stratification tool to identify candidates for adjuvant radiation therapy in patients with prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vasdev N, Tamhankar A, Adshead J, Catto J, Kelly J, Thurairaja R. Radical cystectomy (open, laparoscopic and robotic) in 12625 patients in England: National trends and peri-operative outcomes from Hospital Episode Statistics data. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tan W, Marchese M, Sridhar A, Hellawell G, Mossanen M, Fowler S, Colquhoun A, Kelly J, Trinh QD. Defining factors associated with quality surgery following radical cystectomy: Analysis of the British Association of Urological Surgeons (BAUS) cystectomy audit. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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De Groote R, Nathan A, De Bleser E, Pavan N, Sridhar A, Kelly J, Sooriakumaran P, Briggs T, Nathan S. Techniques and Outcomes of Salvage Robot-Assisted Radical Prostatectomy (sRARP). Eur Urol 2020; 78:885-892. [PMID: 32461073 DOI: 10.1016/j.eururo.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/03/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Salvage Robot-Assisted Radical Prostatectomy (sRARP) has been described as feasible treatment for the management of localised prostate cancer (PCa) recurrence after primary treatment. However, no large reports have published cancer and quality outcomes. OBJECTIVE To report perioperative, functional and oncologic outcomes of sRARP in patients with localised PCa recurrence. DESIGN, SETTING, AND PARTICIPANTS We retrospectively evaluated 106 patients with local recurrence eligible for sRARP. SURGICAL PROCEDURE Surgery was performed using the DaVinci Si system similar to the standard approach but with adaptation to the primary treatment. MEASUREMENTS Peri-operative outcomes included 90-day complication rate. Functional outcomes included rates of incontinence and erectile dysfunction. Oncological outcomes included tumour staging, margin rate and recurrence. RESULTS AND LIMITATIONS Primary treatment was High Intensity Focused Ultrasound (HIFU) in 59 (56%) patients, 27 (25%) radiotherapy, 10 (9%) seed brachytherapy, 8 (8%) solitary androgen deprivation therapy (ADT), one (1%) cryotherapy and one (1%) electroporation / Nanoknife. Median follow-up was 2.1 years. 90-day complication rate was 8%. At two years or more, 50% were fully continent and 33% were socially continent. Continence rates tended to be better after focal compared to whole-gland treatments. Erectile dysfunction was present in 95%. Positive surgical margin rate was 39%. Biochemical recurrence occurred in 13% and local or metastatic recurrence in 11%. CONCLUSIONS sRARP is technically more challenging but is a feasible option in high-volume centres for treatment of recurrent PCa. Patients should be counselled that functional outcomes are inferior to primary RARP. Adjustment of surgical technique according to the primary treatment is key for good surgical outcomes. PATIENT SUMMARY We report our experience with sRARP for the management of localised PCa recurrence after primary treatment. This represents a feasible approach with acceptable peri-operative complications and cancer outcomes. Functional outcomes are inferior to RARP in the primary setting.
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Fernando A, Benepal T, Thillai K, Minton O, Kelly J, Breeze L, Broom C, Gosling N. Corrigendum to Cancer, mental health and end of life simulation (CAMhELS): A novel effectiveness evaluation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bauman J, Panick J, Galloway T, Ridge J, McShane M, Chwistek M, Collins M, Kinczewski L, Murphy K, Welsh M, Farren M, Clark M, Kelly J, Schuster K, Stokes L, Amrhein S, Bender F, Egleston B, El-jawahri A, Fang C. A Pilot Study of a Comprehensive Palliative Care Intervention to Improve Symptoms and Coping During Curative-Intent Chemoradiation in Patients with Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Iyengar A, Han J, Helmers M, Altshuler P, Kelly J, Chung J, Smood B, Acker M, Birati E, Atluri P. Impact of Changes in the US Heart Allocation System on Waitlist Mortality and Listing Practices. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gire N, Chaudhry I, Naeem F, Duxbury J, Riley M, McKeown M, Taylor C, Taylor P, Emsley R, Caton N, Kelly J, Kingdon D, Husain N. TechCare: Mobile-assessment and therapy for psychosis: An intervention for clients within the early intervention service. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.2274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionIn the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.ObjectiveTo develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.AimThe aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.MethodsThe study consists of both qualitative and quantitative components. The study will be run across three strands:– qualitative work;– test run and intervention refinement;– feasibility trial.ResultsPreliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.ConclusionsResearch in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hartopp A, Kelly J. Chronic pain after breast surgery - still many unanswered questions. Anaesthesia 2020; 75:415-416. [PMID: 32022919 DOI: 10.1111/anae.14971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tscharke M, Kind K, Kelly J, Len J. 190 Effect of TCM-199 and synthetic oviductal fluid medium supplemented with varying hormone concentrations on invitro maturation of canine oocytes. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Invitro oocyte maturation (IVM) in the domestic canine is yet to be optimized, with low rates of cumulus-oocyte complexes (COCs) reaching MII. This limits the progression of assisted reproductive technologies, which could benefit breeding programs for assistance dogs and endangered Canidae. Canine oocyte maturation differs from that in other mammals, with the ovulation of a COC in the germinal vesicle stage and nuclear maturation occurring in the oviduct. Because of this, the environment in which a canine COC matures is unlike that of other mammals, meaning that IVM protocols cannot be readily adapted. The aim of the current work was to determine (1) the effects of varying concentrations of FSH, human chorionic gonadotrophin (hCG), and oestradiol (E2) during IVM on meiotic resumption and nuclear maturation of canine COCs; and (2) the optimal medium base, either synthetic oviductal fluid (SOF) or tissue culture medium-199 (TCM). Reproductive tracts of bitches (6 months to 7 years of age) were collected from veterinary clinics within 2h of routine spaying. Ovaries were sliced using a scalpel blade, releasing the COCs into aspiration medium. The COCs were randomly allocated to a maturation medium consisting of one of the hormones at two concentrations (FSH: 5 or 10µgmL−1; hCG: 5 or 10IUmL−1; E2: 1 or 5µgmL−1) and for both SOF and TCM base. Each hormone was tested individually for a replicate of eight animals per hormone (total of 12 experimental groups; 24 animals). The COCs were cultured for 72h in their allocated medium and then denuded and stained with Hoechst 33258. Fluorescence microscopy was used to determine nuclear maturation stage. Nuclear maturation rates to MII were analysed using a general linear model with pairwise comparison (SPSS version 25; SPSS Inc./IBM Corp.) with each individual animal acting as a replicate. Canine COCs matured in a SOF-based media had higher rates of meiotic resumption (MI and MII) (SOF: 38.68%, n=515; TCM: 25.78%, n=542; P<0.05) and number reaching MII (SOF: 7.54%; TCM: 4.39%; P<0.05) compared with TCM-based medium. Resumption of meiosis and nuclear maturation to MII did not differ between media with differing E2 or hCG concentrations. The use of FSH at 10µgmL−1 in SOF medium decreased resumption of meiosis (8.57%) and MII rates (0%) compared with 5µgmL−1 FSH in SOF (29.41% and 3.92%, respectively; P<0.05). In summary, our data indicated that higher concentrations of FSH during IVM have a negative effect on meiotic resumption and maturation to MII, whereas canine COCs resume meiosis and mature to MII in higher rates in a SOF-based medium compared with a TCM base. An IVM medium that replicates the invivo environment in which canine COCs mature is beneficial. However, rates of IVM canine oocytes reaching maturity are low, signifying that future research must investigate a greater range of hormone concentrations and combinations to better mimic invivo conditions to assess the possible benefits for canine IVM.
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Pennington M, Ring H, Howlett J, Smith C, Redley M, Murphy C, Hook R, Platt A, Gilbert N, Jones E, Kelly J, Pullen A, Mander A, Donaldson C, Rowe S, Wason J, Irvine F. The impact of an epilepsy nurse competency framework on the costs of supporting adults with epilepsy and intellectual disability: findings from the EpAID study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1391-1400. [PMID: 31397022 PMCID: PMC7613974 DOI: 10.1111/jir.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The development of a nurse-led approach to managing epilepsy in adults with an intellectual disability (ID) offers the potential of improved outcomes and lower costs of care. We undertook a cluster randomised trial to assess the impact on costs and outcomes of the provision of ID nurses working to a designated epilepsy nurse competency framework. Here, we report the impact of the intervention on costs. METHOD Across the United Kingdom, eight sites randomly allocated to the intervention recruited 184 participants and nine sites allocated to treatment as usual recruited 128 participants. Cost and outcome data were collected mainly by telephone interview at baseline and after 6 months. Total costs at 6 months were compared from the perspective of health and social services and society, with adjustments for pre-specified participant and cluster characteristics at baseline including costs. Missing data were imputed using multiple imputation. Uncertainty was quantified by bootstrapping. RESULTS The intervention was associated with lower per participant costs from a health and social services perspective of -£357 (2014/2015 GBP) (95% confidence interval -£986, £294) and from a societal perspective of -£631 (95% confidence interval -£1473, £181). Results were not sensitive to the exclusion of accommodation costs. CONCLUSIONS Our findings suggest that the competency framework is unlikely to increase the cost of caring for people with epilepsy and ID and may reduce costs.
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Barends R, Quintana CM, Petukhov AG, Chen Y, Kafri D, Kechedzhi K, Collins R, Naaman O, Boixo S, Arute F, Arya K, Buell D, Burkett B, Chen Z, Chiaro B, Dunsworth A, Foxen B, Fowler A, Gidney C, Giustina M, Graff R, Huang T, Jeffrey E, Kelly J, Klimov PV, Kostritsa F, Landhuis D, Lucero E, McEwen M, Megrant A, Mi X, Mutus J, Neeley M, Neill C, Ostby E, Roushan P, Sank D, Satzinger KJ, Vainsencher A, White T, Yao J, Yeh P, Zalcman A, Neven H, Smelyanskiy VN, Martinis JM. Diabatic Gates for Frequency-Tunable Superconducting Qubits. PHYSICAL REVIEW LETTERS 2019; 123:210501. [PMID: 31809160 DOI: 10.1103/physrevlett.123.210501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 06/10/2023]
Abstract
We demonstrate diabatic two-qubit gates with Pauli error rates down to 4.3(2)×10^{-3} in as fast as 18 ns using frequency-tunable superconducting qubits. This is achieved by synchronizing the entangling parameters with minima in the leakage channel. The synchronization shows a landscape in gate parameter space that agrees with model predictions and facilitates robust tune-up. We test both iswap-like and cphase gates with cross-entropy benchmarking. The presented approach can be extended to multibody operations as well.
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Proescholdt C, Kelly J. EP1.06-04 Differences in Health State Preference Values for Malignant Pleural Mesothelioma and Glioblastoma Multiforme. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Proescholdt C, Kelly J, Weinberg U. P2.06-15 Clinical Value Scores of TTFields Treatment of Unresectable Malignant Pleural Mesothelioma Using the ASCO and ESMO Framework. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kelly J, Proescholdt C. P08.06 Clinical value scores for treatment of newly diagnosed glioblastoma with TTFields. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
High quality and value of recommended treatments is of specific importance in cancer care. ESMO, ASCO and NCCN have developed tools intended to help assessing the clinical value of cancer treatments in a standardised way, allowing for a comparative discussion. Tumor treating fields (TTFields) is a novel, device based cancer treatment, that was recently demonstrated to be effective in newly diagnosed glioblastoma (GBM). This new modality augments the treatments discussed with glioblastoma patients today.
MATERIAL AND METHODS
ESMO and ASCO frameworks each calculate a score for the clinical value of a cancer treatment, called Magnitude of Clinical Benefit Scale (MCBS) by ESMO and the Net Health Benefit (NHB) by ASCO. NCCN self reports “evidence blocks” which are assessed by clinician panels and were recently published for the first line treatment of newly diagnosed GBM with TTFields. We apply and compare the ESMO, ASCO and NCCN tools for TTFields treatment of newly diagnosed GBM.
RESULTS
The resulting ASCO NHB score for TTFields treatment of newly diagnosed GBM is 56. ESMO MCBS scores for TTFields in GBM are resulting in A/5, these being the highest achievable scores for this framework. All frameworks value the increase in overall survival by TTFields and the moderate toxicity profile. ESMO additionally values quality of life, while ASCO values palliation and treatment free intervals. NCCN’s specific focus is on the quality and consistency of the evidence. NCCN evidence blocks also contain an affordability score.
CONCLUSION
All three frameworks consider the clinical efficacy of a treatment and it’s toxicity profile in their clinical value assessment. Beyond that, their respective focus is on slightly different aspects and their definition of clinical value therefore varies in detail. However, all value scores suggest that TTFields treatment of newly diagnosed GBM provides a substantial clinical benefit. The high ESMO and ASCO scores are based on the significantly extended progression free and overall survival for TTFields treated patients, without adding systemic toxicities. The NCCN evidence blocks strongly support the NCCN category 1 recommendation for the use of TTFields in newly diagnosed GBM.
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