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Trethewey R, Esliger D, Petherick E, Evans R, Greening N, James B, Kingsnorth A, Morgan M, Orme M, Sherar L, Singh S, Toms N, Steiner M. Influence of muscle mass in the assessment of lower limb strength in COPD: validation of the prediction equation. Thorax 2017; 73:587-589. [PMID: 28866643 DOI: 10.1136/thoraxjnl-2016-209870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 11/03/2022]
Abstract
Absence of established reference values limits application of quadriceps maximal voluntary contraction (QMVC) measurement. The impact of muscle mass inclusion in predictions is unclear. Prediction equations encompassing gender, age and size with (FFM+) and without (FFM-), derived in healthy adults (n=175), are presented and compared in two COPD cohorts recruited from primary care (COPD-PC, n=112) and a complex care COPD clinic (COPD-CC, n=189). Explained variance was comparable between the prediction models (R2: FFM+: 0.59, FFM-: 0.60) as were per cent predictions in COPD-PC (88.8%, 88.3%). However, fat-free mass inclusion reduced the prevalence of weakness in COPD, particularly in COPD-CC where 11.9% fewer were deemed weak.
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Adams J, Morgan M, Unett D, Whittle B. 5019Comparative receptor pharmacology, pre-clinical efficacy and pharmacokinetics of a novel, next-generation prostacyclin receptor agonist, ralinepag (APD811), in humans and rats. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Horton EJ, Mitchell KE, Johnson-Warrington V, Apps LD, Sewell L, Morgan M, Taylor RS, Singh SJ. Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial. Thorax 2017; 73:29-36. [PMID: 28756402 DOI: 10.1136/thoraxjnl-2016-208506] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Standardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD. METHODS A total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units. RESULTS There was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: -0.24, 95% CI -0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks. CONCLUSIONS The standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation. TRIAL REGISTRATION NUMBER ISRCTN81189044.
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Nordanstig J, Pettersson M, Morgan M, Falkenberg M, Kumlien C. Assessment of Minimum Important Difference and Substantial Clinical Benefit with the Vascular Quality of Life Questionnaire-6 when Evaluating Revascularisation Procedures in Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2017; 54:340-347. [PMID: 28754429 DOI: 10.1016/j.ejvs.2017.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient reported outcomes are increasingly used to assess outcomes after peripheral arterial disease (PAD) interventions. VascuQoL-6 (VQ-6) is a PAD specific health-related quality of life (HRQoL) instrument for routine clinical practice and clinical research. This study assessed the minimum important difference for the VQ-6 and determined thresholds for the minimum important difference and substantial clinical benefit following PAD revascularisation. MATERIALS AND METHODS This was a population-based observational cohort study. VQ-6 data from the Swedvasc Registry (January 2014 to September 2016) was analysed for revascularised PAD patients. The minimum important difference was determined using a combination of a distribution based and an anchor-based method, while receiver operating characteristic curve analysis (ROC) was used to determine optimal thresholds for a substantial clinical benefit following revascularisation. RESULTS A total of 3194 revascularised PAD patients with complete VQ-6 baseline recordings (intermittent claudication (IC) n = 1622 and critical limb ischaemia (CLI) n = 1572) were studied, of which 2996 had complete VQ-6 recordings 30 days and 1092 a year after the vascular intervention. The minimum important difference 1 year after revascularisation for IC patients ranged from 1.7 to 2.2 scale steps, depending on the method of analysis. Among CLI patients, the minimum important difference after 1 year was 1.9 scale steps. ROC analyses demonstrated that the VQ-6 discriminative properties for a substantial clinical benefit was excellent for IC patients (area under curve (AUC) 0.87, sensitivity 0.81, specificity 0.76) and acceptable in CLI (AUC 0.736, sensitivity 0.63, specificity 0.72). An optimal VQ-6 threshold for a substantial clinical benefit was determined at 3.5 scale steps among IC patients and 4.5 in CLI patients. CONCLUSIONS The suggested thresholds for minimum important difference and substantial clinical benefit could be used when evaluating VQ-6 outcomes following different interventions in PAD and in the design of clinical trials.
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Davido B, Moussiegt A, Dinh A, Senard O, Deconinck L, Auzel O, Repesse X, Sirol M, Morgan M, Salomon J. Contribution of echocardiography in the diagnosis of definitive infective endocarditis: the infectious disease specialist’s point of view. Eur J Clin Microbiol Infect Dis 2017; 36:2329-2334. [DOI: 10.1007/s10096-017-3064-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/04/2017] [Indexed: 01/22/2023]
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Monaghan N, Morgan M. What proportion of caries into dentine at age 5 is present at age 3? COMMUNITY DENTAL HEALTH 2017; 34:93-96. [PMID: 28573839 DOI: 10.1922/cdh_4042morgan04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/17/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the proportion of decay at age 5 in Wales presenting by and after age 3 years from geographical and deprivation perspectives. BASIC RESEARCH DESIGN Retrospective analysis of data from independent cross-sectional studies of 3-year-olds in early 2013 and 5-year-olds in school year 2014/5. This includes novel graphical presentation of caries at age 3 and estimated 3-5 caries increment at age 5. SETTING AND PARTICIPANTS NHS oral health surveillance programme in Wales examining children in nurseries at age 3 and in schools two years later. MAIN OUTCOME MEASURES %d₃mft⟩0 at ages 3 and 5 years, plus estimated 3-5 caries increments for these two indices. Data are analysed using index of deprivation and Health Board population density (as a proxy for rurality). RESULTS In most Health Boards and all deprivation quintiles there is a larger proportion of caries into dentine presenting between ages 3-5 than by age 3. In rural Health Boards the proportion of caries present by age 3 is much smaller. In one Health Board more caries presents by age 3 than after. In rural Health Boards the current prevention activity has potential to push reported caries prevalence at age 5 below 10%. In urban Health Boards action by age 5 will be required to push caries prevalence significantly below 20%. CONCLUSIONS Findings from this analysis suggest need for earlier prevention activity in some Health Boards in Wales.
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Hussein A, Das M, Chaturvedi V, Asfour I, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D. 1362Prospective use of ablation index targets improves clinical outcomes following ablation for atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux157.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maille B, Hussein A, Chaturvedi V, Morgan M, Ronayne C, Snowdon R, Gupta D. P330Reverse remodelling of the left atrium occurs early after catheter ablation for persistent atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux141.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Monk BJ, Brady MF, Aghajanian C, Lankes HA, Rizack T, Leach J, Fowler JM, Higgins R, Hanjani P, Morgan M, Edwards R, Bradley W, Kolevska T, Foukas P, Swisher EM, Anderson KS, Gottardo R, Bryan JK, Newkirk M, Manjarrez KL, Mannel RS, Hershberg RM, Coukos G. A phase 2, randomized, double-blind, placebo- controlled study of chemo-immunotherapy combination using motolimod with pegylated liposomal doxorubicin in recurrent or persistent ovarian cancer: a Gynecologic Oncology Group partners study. Ann Oncol 2017; 28:996-1004. [PMID: 28453702 PMCID: PMC5406764 DOI: 10.1093/annonc/mdx049] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A phase 2, randomized, placebo-controlled trial was conducted in women with recurrent epithelial ovarian carcinoma to evaluate the efficacy and safety of motolimod-a Toll-like receptor 8 (TLR8) agonist that stimulates robust innate immune responses-combined with pegylated liposomal doxorubicin (PLD), a chemotherapeutic that induces immunogenic cell death. PATIENTS AND METHODS Women with ovarian, fallopian tube, or primary peritoneal carcinoma were randomized 1 : 1 to receive PLD in combination with blinded motolimod or placebo. Randomization was stratified by platinum-free interval (≤6 versus >6-12 months) and Gynecologic Oncology Group (GOG) performance status (0 versus 1). Treatment cycles were repeated every 28 days until disease progression. RESULTS The addition of motolimod to PLD did not significantly improve overall survival (OS; log rank one-sided P = 0.923, HR = 1.22) or progression-free survival (PFS; log rank one-sided P = 0.943, HR = 1.21). The combination was well tolerated, with no synergistic or unexpected serious toxicity. Most patients experienced adverse events of fatigue, anemia, nausea, decreased white blood cells, and constipation. In pre-specified subgroup analyses, motolimod-treated patients who experienced injection site reactions (ISR) had a lower risk of death compared with those who did not experience ISR. Additionally, pre-treatment in vitro responses of immune biomarkers to TLR8 stimulation predicted OS outcomes in patients receiving motolimod on study. Immune score (tumor infiltrating lymphocytes; TIL), TLR8 single-nucleotide polymorphisms, mutational status in BRCA and other DNA repair genes, and autoantibody biomarkers did not correlate with OS or PFS. CONCLUSIONS The addition of motolimod to PLD did not improve clinical outcomes compared with placebo. However, subset analyses identified statistically significant differences in the OS of motolimod-treated patients on the basis of ISR and in vitro immune responses. Collectively, these data may provide important clues for identifying patients for treatment with immunomodulatory agents in novel combinations and/or delivery approaches. TRIAL REGISTRATION Clinicaltrials.gov, NCT 01666444.
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Janjua A, Dyer J, Spindler H, Sterne J, Cohen S, Morgan M, Christmas A, Bharat Shah M, Das A, Walker D. Video Analysis System as a Tool to Improve the Quality of Basic Emergency
Obstetric and Neonatal Care through Simulation Training in Bihar,
India. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Noyan F, Zimmermann K, Hardtke-Wolenski M, Knoefel A, Schulde E, Geffers R, Hust M, Huehn J, Galla M, Morgan M, Jokuszies A, Manns MP, Jaeckel E. Prevention of Allograft Rejection by Use of Regulatory T Cells With an MHC-Specific Chimeric Antigen Receptor. Am J Transplant 2017; 17:917-930. [PMID: 27997080 DOI: 10.1111/ajt.14175] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 01/25/2023]
Abstract
CD4+ CD25high FOXP3+ regulatory T cells (Tregs) are involved in graft-specific tolerance after solid organ transplantation. However, adoptive transfer of polyspecific Tregs alone is insufficient to prevent graft rejection even in rodent models, indicating that graft-specific Tregs are required. We developed a highly specific chimeric antigen receptor that recognizes the HLA molecule A*02 (referred to as A2-CAR). Transduction into natural regulatory T cells (nTregs) changes the specificity of the nTregs without alteration of their regulatory phenotype and epigenetic stability. Activation of nTregs via the A2-CAR induced proliferation and enhanced the suppressor function of modified nTregs. Compared with nTregs, A2-CAR Tregs exhibited superior control of strong allospecific immune responses in vitro and in humanized mouse models. A2-CAR Tregs completely prevented rejection of allogeneic target cells and tissues in immune reconstituted humanized mice in the absence of any immunosuppression. Therefore, these modified cells have great potential for incorporation into clinical trials of Treg-supported weaning after allogeneic transplantation.
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Tran P, Huynh E, Hamood A, de Souza A, Mehta D, Moeller K, Moeller C, Morgan M, Reid TW. The ability of a colloidal silver gel wound dressing to kill bacteria in vitro and in vivo. J Wound Care 2017; 26:S16-S24. [DOI: 10.12968/jowc.2017.26.sup4.s16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chaplin E, Hewitt S, Apps L, Bankart J, Pulikottil-Jacob R, Boyce S, Morgan M, Williams J, Singh S. Interactive web-based pulmonary rehabilitation programme: a randomised controlled feasibility trial. BMJ Open 2017; 7:e013682. [PMID: 28363923 PMCID: PMC5387978 DOI: 10.1136/bmjopen-2016-013682] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/10/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine if an interactive web-based pulmonary rehabilitation (PR) programme is a feasible alternative to conventional PR. DESIGN Randomised controlled feasibility trial. SETTING Participants with a diagnosis of chronic obstructive pulmonary disease were recruited from PR assessments, primary care and community rehabilitation programmes. Patients randomised to conventional rehabilitation started the programme according to the standard care at their referred site on the next available date. PARTICIPANTS 103 patients were recruited to the study and randomised: 52 to conventional rehabilitation (mean (±SD) age 66 (±8) years, Medical Research Council (MRC) 3 (IQR2-4)); 51 to the web arm (mean (±SD) age 66 (±10) years, MRC 3 (IQR2-4)). Participants had to be willing to participate in either arm of the trial, have internet access and be web literate. INTERVENTIONS Patients randomised to the web-based programme worked through the website, exercising and recording their progress as well as reading educational material. Conventional PR consisted of twice weekly, 2 hourly sessions (an hour for exercise training and an hour for education). OUTCOME MEASURES Recruitment rates, eligibility, patient preference and dropout and completion rates for both programmes were collected. Standard outcomes for a PR assessment including measures of exercise capacity and quality of life questionnaires were also evaluated. RESULTS A statistically significant improvement (p≤0.01) was observed within each group in the endurance shuttle walk test (WEB: mean change 189±211.1; PR classes: mean change 184.5±247.4 s) and Chronic Respiratory disease Questionnaire-Dyspnoea (CRQ-D; WEB: mean change 0.7±1.2; PR classes: mean change 0.8±1.0). However, there were no significant differences between the groups in any outcome. Dropout rates were higher in the web-based programme (57% vs 23%). CONCLUSIONS An interactive web-based PR programme is feasible and acceptable when compared with conventional PR. Future trials maybe around choice-based PR programmes for select patients enabling stratification of patient care. TRIAL REGISTRATION NUMBER ISRCTN03142263; Results.
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Morgan M, Heffernan A, Benhabib F, Wagner S, Hewavitharana AK, Shaw PN, Cabot PJ. The efficacy of Dynorphin fragments at the κ, μ and δ opioid receptor in transfected HEK cells and in an animal model of unilateral peripheral inflammation. Peptides 2017; 89:9-16. [PMID: 28049031 DOI: 10.1016/j.peptides.2016.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/20/2016] [Accepted: 12/30/2016] [Indexed: 11/16/2022]
Abstract
Dynorphin 1-17 is an endogenous peptide that is released at sites of inflammation by leukocytes, binding preferentially to κ-opioid receptors (KOP) to mediate nociception. We have previously shown that dynorphin 1-17 is rapidly biotransformed to smaller peptide fragments in inflamed tissue homogenate. This study aimed to determine the efficacy and potency of selected dynorphin fragments produced in an inflamed environment at the KOP, μ and δ-opioid receptors (MOP and DOP respectively) and in a model of inflammatory pain. Functional activity of Dynorphin 1-17 and fragments (1-6, 1-7 and 1-9) were screened over a range of concentrations against forskolin stimulated human embryonic kidney 293 (HEK) cells stably transfected with one of KOP, MOP or DOP. The analgesic activity of dynorphin 1-7 in a unilateral model of inflammatory pain was subsequently tested. Rats received unilateral intraplantar injections of Freund's Complete Adjuvant to induce inflammation. After six days rats received either dynorphin 1-7, 1-17 or the selective KOP agonist U50488H and mechanical allodynia determined. Dynorphin 1-7 and 1-9 displayed the greatest activity across all receptor subtypes, while dynorphin 1-7, 1-9 and 1-17 displaying a potent activation of both KOP and DOP evidenced by cAMP inihibition. Administration of dynorphin 1-7 and U50488H, but not dynorphin 1-17 resulted in a significant increase in paw pressure threshold at an equimolar dose suggesting the small peptide dynorphin 1-7 mediates analgesia. These results show that dynorphin fragments produced in an inflamed tissue homogenate have changed activity at the opioid receptors and that dynorphin 1-7 mediates analgesia.
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Ridsdale L, Philpott SJ, Krooupa AM, Morgan M. People with epilepsy obtain added value from education in groups: results of a qualitative study. Eur J Neurol 2017; 24:609-616. [PMID: 28181344 PMCID: PMC5396134 DOI: 10.1111/ene.13253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Background and purpose Having epilepsy requires individuals to learn about self‐management. So far, trials of self‐management courses have not included in‐depth qualitative evaluations of how the learning method influences participants’ perceptions and behaviour. We aimed to interview participants who had attended a course, as part of a randomized controlled trial, to examine: (i) their perceptions of what they valued and negative aspects of the intervention, and (ii) whether and in what ways they continued to make use of the training. Methods Twenty participants were selected within 6 months of undertaking a course from the larger randomized controlled trial conducted in England. Semi‐structured interviews were based on a topic guide. Results Participants’ characteristics were representative of the clinical and demographic characteristics of the trial group. Their mean age was 44 years, half were male, and three‐quarters had had epilepsy for over 10 years and had experienced one or more seizures in the previous month. Participants valued the opportunity to meet ‘people like them’. Structured learning methods encouraged them to share and compare feelings and experience. Specific benefits included: overcoming the sense of ‘being alone’ and improving self‐acceptance through meeting people with similar experience. Over half reported that this, and comparison of attitudes and experience, helped them to improve their confidence to talk openly, and make changes in health behaviours. Conclusions People feel socially isolated in long‐term poorly controlled epilepsy. They gain confidence and self‐acceptance from interactive groups. Expert‐facilitated courses that encourage experiential learning can help people learn from each other, and this may enhance self‐efficacy and behaviour change.
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Carmona FD, Vaglio A, Mackie SL, Hernández-Rodríguez J, Monach PA, Castañeda S, Solans R, Morado IC, Narváez J, Ramentol-Sintas M, Pease CT, Dasgupta B, Watts R, Khalidi N, Langford CA, Ytterberg S, Boiardi L, Beretta L, Govoni M, Emmi G, Bonatti F, Cimmino MA, Witte T, Neumann T, Holle J, Schönau V, Sailler L, Papo T, Haroche J, Mahr A, Mouthon L, Molberg Ø, Diamantopoulos AP, Voskuyl A, Brouwer E, Daikeler T, Berger CT, Molloy ES, O’Neill L, Blockmans D, Lie BA, Mclaren P, Vyse TJ, Wijmenga C, Allanore Y, Koeleman BP, Barrett JH, Cid MC, Salvarani C, Merkel PA, Morgan AW, González-Gay MA, Martín J, Callejas JL, Caminal-Montero L, Corbera-Bellalta M, de Miguel E, López JBD, García-Villanueva MJ, Gómez-Vaquero C, Guijarro-Rojas M, Hidalgo-Conde A, Marí-Alfonso B, Berriochoa AM, Zapico AM, Martínez-Taboada VM, Miranda-Filloy JA, Monfort J, Ortego-Centeno N, Pérez-Conesa M, Prieto-González S, Raya E, Fernández RR, Sánchez-Martín J, Sopeña B, Tío L, Unzurrunzaga A, Gough A, Isaacs JD, Green M, McHugh N, Hordon L, Kamath S, Nisar M, Patel Y, Yee CS, Stevens R, Nandi P, Nandagudi A, Jarrett S, Li C, Levy S, Mollan S, Salih A, Wordsworth O, Sanders E, Roads E, Gill A, Carr L, Routledge C, Culfear K, Nugaliyadde A, James L, Spimpolo J, Kempa A, Mackenzie F, Fong R, Peters G, Rowbotham B, Masqood Z, Hollywood J, Gondo P, Wood R, Martin S, Rashid LH, Robinson JI, Morgan M, Sorensen L, Taylor J, Carette S, Chung S, Cuthbertson D, Forbess LJ, Gewurz-Singer O, Hoffman GS, Koening CL, Maksimowicz-McKinnon KM, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Spiera RF, Sreih A, Warrington KJ, Weisman M. A Genome-wide Association Study Identifies Risk Alleles in Plasminogen and P4HA2 Associated with Giant Cell Arteritis. Am J Hum Genet 2017; 100:64-74. [PMID: 28041642 DOI: 10.1016/j.ajhg.2016.11.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Giant cell arteritis (GCA) is the most common form of vasculitis in individuals older than 50 years in Western countries. To shed light onto the genetic background influencing susceptibility for GCA, we performed a genome-wide association screening in a well-powered study cohort. After imputation, 1,844,133 genetic variants were analyzed in 2,134 case subjects and 9,125 unaffected individuals from ten independent populations of European ancestry. Our data confirmed HLA class II as the strongest associated region (independent signals: rs9268905, p = 1.94 × 10-54, per-allele OR = 1.79; and rs9275592, p = 1.14 × 10-40, OR = 2.08). Additionally, PLG and P4HA2 were identified as GCA risk genes at the genome-wide level of significance (rs4252134, p = 1.23 × 10-10, OR = 1.28; and rs128738, p = 4.60 × 10-9, OR = 1.32, respectively). Interestingly, we observed that the association peaks overlapped with different regulatory elements related to cell types and tissues involved in the pathophysiology of GCA. PLG and P4HA2 are involved in vascular remodelling and angiogenesis, suggesting a high relevance of these processes for the pathogenic mechanisms underlying this type of vasculitis.
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Trethewey R, Esliger D, Petherick E, Evans R, Greening N, James B, Kingsnorth A, Morgan M, Orme M, Singh S, Sherar L, Toms N, Steiner M. P47 The influence of muscle mass in the assessment of lower limb strength in copd. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Orme M, Weedon A, Esliger D, Saukko P, Morgan M, Steiner M, Downey J, Singh S, Sherar L. Study protocol for Chronic Obstructive Pulmonary Disease-Sitting and ExacerbAtions Trial (COPD-SEAT): a randomised controlled feasibility trial of a home-based self-monitoring sedentary behaviour intervention. BMJ Open 2016; 6:e013014. [PMID: 27697880 PMCID: PMC5073551 DOI: 10.1136/bmjopen-2016-013014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/03/2016] [Accepted: 09/05/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION An acute exacerbation of chronic obstructive pulmonary disease (COPD) marks a critical life event, which can lower patient quality of life and ability to perform daily activities. Patients with COPD tend to lead inactive and highly sedentary lifestyles, which may contribute to reductions in functional capacity. Targeting sedentary behaviour (SB) may be more attainable than exercise (at a moderate-to-vigorous intensity) for behaviour change in patients following an exacerbation. This study aims to evaluate the feasibility and acceptability of a 2-week at-home intervention providing education and self-monitoring to reduce prolonged periods of SB in patients with COPD discharged following an acute exacerbation. METHODS AND ANALYSIS Patients will be randomised into 1 of 3 conditions: usual care (control), education or education+feedback. The education group will receive information and suggestions about reducing long periods of sitting. The education+feedback group will receive real-time feedback on their sitting time, stand-ups and step count at home through an inclinometer linked to a smart device app. The inclinometer will also provide vibration prompts to encourage movement when the wearer has been sedentary for too long. Data will be collected during hospital admission and 2 weeks after discharge. Qualitative interviews will be conducted with patients in the intervention groups to explore patient experiences. Interviews with healthcare staff will also be conducted. All data will be collected January to August 2016. The primary outcomes are feasibility and acceptability, which will be assessed by qualitative interviews, uptake and drop-out rates, reasons for refusing the intervention, compliance, app usage and response to vibration prompts. ETHICS AND DISSEMINATION The research ethics committee East Midlands Leicester-Central has provided ethical approval for the conduct of this study. The results of the study will be disseminated through appropriate conference proceedings and peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN13790881; Pre-results.
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Christopher R, Morgan M, Ferry J, Rege B, Tang Y, Kristensen A, Shanahan W. Single- and Multiple-dose Pharmacokinetics of a Lorcaserin Extended-release Tablet. Clin Ther 2016; 38:2227-2238.e4. [DOI: 10.1016/j.clinthera.2016.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 01/16/2023]
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Furniss G, Opel A, Hussein A, Pearman C, Grace A, Connelly D, Orlowski A, Banerjee A, McNicholas T, Providencia R, Montañes M, Providencia R, Panagopoulos D, Tomlinson D, Dalrymple-Hay M, Haywood G, Butler A, Ang R, Ullah W, Schwartz R, Fannon M, Finlay M, Hunter R, Schilling R, Das M, Asfour I, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D, Todd D, King R, Hall M, Modi S, Mediratta N, Gupta D, Reddy V, Neuzil P, Willems S, Verma A, Heck P, Schilling R, Lambiase P, Hall M, Nicholl B, McQueenie R, Jani BD, McKeag N, Gallacher K, Mair F, Heaton D, Macdonald J, Burnell J, Ryan R, Marshall T, Sutton C, O'Callaghan S, Kenny R, Karim N, Srinivasan N, Ferreira M, Goncalves L, Lambiase P, Toledano M, Field E, Walsh H, Maguire K, Cervi E, Kaski J, Perez Tome M, Pantazis A, Elliott P, Lambiase P, Segal O. ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS? Europace 2016. [DOI: 10.1093/europace/euw272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Varanasi S, Wright I, Hussain W, Bowers R, Slater T, Sengupta A, Porter B, Hussein A, Chu G, Siddiqui M, Man S, Somani R, Sandilands A, Stafford P, Ng G, Luther V, Young Kim M, Benfield A, Tanner M, Lefroy D, Koa-Wing M, Lim P, Linton N, Davies D, Peters N, Kanagaratnam P, Moore P, Whinnett Z, Thakrar D, Iacovides S, Paisey J, Balasubramaniam R, Sopher SM, Saunderson C, Moyles C, Blackburn Y, Morley C, Jamil H, Schlosshan D, Kearney M, Witte K, Lambden C, Woodcock T, Matthew D, Hashmy S, Kaur M, Kaba A, Grant R, Unger-Graeber B, Khan S, Das M, Wynn G, Morgan M, Waktare J, Hall M, Modi S, Snowdon R, Todd D, Gupta D. MODERATED POSTERS (1)43P WAVE DURATION & SPECTRAL ANALYSIS OF SIGNAL AVERAGED P WAVE: CAN THIS PREDICT RECURRENCE OF PARAOXYSMAL ATRIAL FIBRILLATION AFTER PULMONARY VEIN SIOLATION? A PROSPECTIVE STUDY44ATP INDUCED SLOW VF - A MECHANISM TO EXPLAIN THE ASSOCIATION BETWEEN ATP AND INCREASED MORTALITY45THE USE OF A HANDHELD DEVICE IN IDENTIFYING ATRIAL FIBRILLATION PATIENTS DURING FLU VACCINATION CLINICS46DELIVERY OF A FULL EP SERVICE FROM A DISTRICT GENERAL HOSPITAL SETTING: OUTCOMES FROM A SINGLE CENTRE47THE PREVALENCE OF SODIUM AND FLUID DEPLETION IN PATIENTS WITH RECURRENT SYNCOPE OF PRESUMED HYPOTENSIVE ORIGIN: A SINGLE CENTRE EXPERIENCE48ECHOCARDIOGRAPHY AND RISK STRATIFICATION FOR ICD IMPLANTATION AFTER ST-ELEVATION MYOCARDIAL INFARCTION:OPPORTUNITIES FOR IMPROVEMENT49THE QUALITY AND OUTCOMES FRAMEWORK DATA UNDERESTIMATES AF PREVALENCE AND OVERESTIMATES RATES OF APPROPRIATE THROMBOEMBOLIC PROPHYLAXIS50THE RELATIONSHIP BETWEEN THE EFFECTIVE REFRACTORY PERIOD OF RECONNECTED PULMONARY VEINS AT REPEAT ELECTROPHYSIOLOGY STUDY AND RECURRENCE OF ATRIAL TACHYCARRHYTHMIA BEYOND ONE MONTH AFTER PULMONARY VEIN ISOLATION. Europace 2016. [DOI: 10.1093/europace/euw268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morgan M, Singh S, Rochester C. Introduction. Chron Respir Dis 2016. [DOI: 10.1191/1479972306cd016xx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gambetta-Tessini K, Mariño R, Morgan M, Anderson V. Coping strategies and the Salutogenic Model in future oral health professionals. BMC MEDICAL EDUCATION 2016; 16:224. [PMID: 27562194 PMCID: PMC5000445 DOI: 10.1186/s12909-016-0740-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Attention to the role of context in shaping individuals' coping strategies is necessary. This study used the Salutogenic Model (SM) as a framework to identify the coping strategies of oral health profession students from three countries. METHODS Students from Australia, New Zealand and Chile were invited to participate in this cross-sectional study, and were given a questionnaire including socio-demographics, the Perceived Stress Scale, The SOC-13 and the Brief COPE. Descriptive analysis, correlation analysis and profile analysis were computed using SPSS v 20.0. RESULTS Eight-hundred and ninety-seven valid questionnaires were returned, achieving a 44 % response rate. The coping dimension that the participants most commonly reported using was "Active Coping" with a mean value of 5.9 ± 1.5. Chilean respondents reported higher stress levels (19.8 vs. 17.7) and a lower Sense of Coherence (55.6 vs. 58.0) compared to Australian/New Zealand participants (p < 0.001). The SOC was positively correlated with active coping (p < 0.01) and positive reframing (p < 0.01). Profile analysis showed that when the differences in responses by sex were accounted for, there was no significant effect by country on the coping strategies used (p < 0.32). CONCLUSION This initial investigation provides insights into the students' coping strategies and the validity of the SM. Students reporting high SOC scores where those who demonstrated the use of active coping and positive reframing as strategies to deal with stressful situations, which indicates the accuracy of the theoretical framework of the SM in health education environments. The results also suggest that a distinctive coping strategy pattern may apply to all participants, regardless of their country and sex.
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Romo A, Morgan M, Christmas A, Jacob A, Frank H, Dyer J, Spindler H, Walker D. Improving quality of obstetric and neonatal care through midwife
mentoring and simulation training in Bihar, India: mentor knowledge
assessments. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.064] [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] Open
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