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Anderson S, Snyder N, Bloom A, Brasile D, Gocial B, Orris J, Glassner M. Cumulus cell acetyl-CoA enrichment from acetate found to decrease with maternal age using a novel approach to measure metabolism in individual cumulus cell complexes. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anderson S, Sethuram R, Hartlein T, Brasile D, Gocial B, Glassner M, Orris J. Association between embryo quality and aneuploidy after a standardized controlled ovarian stimulation (COS) protocol. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Anderson S, Norris H, Hartlein T, Davies E, Brasile D, Gocial B, Orris J, Glassner M. A prospective randomized trial to compare recombinant follicle stimulating hormone (rFSH) versus highly purified human menotropin (HP-hMG) for controlled ovarian stimulation on blastocyst aneuploidy rates. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sethuram R, Brasile D, Gocial B, Glassner M, Orris J, Anderson S. Day 6 blastocysts have higher aneuploidy rates compared to day 5 blastocyts after standardized controlled ovarian stimulation protocol. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chartier L, Tran LT, Bolst D, Guatelli S, Pogossov A, Prokopovich DA, Reinhard MI, Perevertaylo V, Anderson S, Beltran C, Matsufuji N, Jackson M, Rosenfeld AB. MICRODOSIMETRIC APPLICATIONS IN PROTON AND HEAVY ION THERAPY USING SILICON MICRODOSIMETERS. RADIATION PROTECTION DOSIMETRY 2018; 180:365-371. [PMID: 29069515 DOI: 10.1093/rpd/ncx226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Indexed: 06/07/2023]
Abstract
Using the CMRP 'bridge' μ+ probe, microdosimetric measurements were undertaken out-of-field using a therapeutic scanning proton pencil beam and in-field using a 12C ion therapy field. These measurements were undertaken at Mayo Clinic, Rochester, USA and at HIMAC, Chiba, Japan, respectively. For a typical proton field used in the treatment of deep-seated tumors, we observed dose-equivalent values ranging from 0.62 to 0.99 mSv/Gy at locations downstream of the distal edge. Lateral measurements at depths close to the entrance and along the SOBP plateau were found to reach maximum values of 3.1 mSv/Gy and 5.3 mSv/Gy at 10 mm from the field edge, respectively, and decreased to ~0.04 mSv/Gy 120 mm from the field edge. The ability to measure the dose-equivalent with high spatial resolution is particularly relevant to healthy tissue dose calculations in hadron therapy treatments. We have also shown qualitatively and quantitively the effects critical organ motion would have in treatment using microdosimetric spectra. Large differences in spectra and RBE10 were observed for treatments where miscalculations of 12C ion range would result in critical structures being irradiated, showing the importance of motion management.
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Anderson S, Cohen AT, Melissari E, Scully MS, Kakkar VV. Loss of Heparin-Releasable Tissue Factor Pathway Inhibitor in Patients Undergoing PTCA. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Anderson S, Alsufyani N, Isaac A, Gazzaz M, El-Hakim H. Correlation between gonial angle and dynamic tongue collapse in children with snoring/sleep disordered breathing - an exploratory pilot study. J Otolaryngol Head Neck Surg 2018; 47:41. [PMID: 29866168 PMCID: PMC5987664 DOI: 10.1186/s40463-018-0285-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/20/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drug induced sleep endoscopy (DISE) is hoped to identify reasons of failure of adenotonsillectomy (AT) in treating pediatric sleep disordered breathing (SDB). Maxillomandibular disproportion has been studied as another association which may explain alternative pathogenesis of SDB. We aimed to explore the relation between the size of the gonial angle and inclination of the epiglottis measured from cone beam CT (CBCT) and tongue base collapse based on DISE in children with SDB. METHOD A retrospective chart review was conducted at a tertiary pediatric center. Children (6-17 years old) assessed at a multi-disciplinary Upper Airway Clinic, diagnosed with SDB and maxillo-mandibular disproportion (MMD), and who underwent DISE were eligible. Variables obtained from the electronic medical records of the clinic and prospective database included demographics, comorbidities, surgeries performed, investigations, DISE findings and CBCT findings. The gonial angle of subjects with and without tongue base collapse (TBC) on SNP were compared. RESULTS In total 29 patients (13 male, 8 female) age 6-17 (median= 9) were eligible for the study from January 2009 - July 2016. We included 11 subjects, and 10 comparators. The mean gonial angle of the TBC group was 139.3°± 7.6°, while that of the comparison group was 129.4°±3.5 (mean difference -9.937, 95% CI of -15.454 to - 4.421, P = 0.001, power of test 0.95). Additionally, the mean inclination of the epiglottis had a mild positive correlation (r=0.32, p<0.05) with the gonial angle, in the whole cohort. CONCLUSIONS This pilot study suggests that TBC may be mediated by a wider gonial angle in children with SDB patients. The posterior tilt of the epiglottis on CBCT may be a surrogate sign of TBC.
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Kessler R, Shah M, Anderson S, Meltzer D, Mokhlesi B, Knutson K, Arora V. 0727 Understanding Sleep and Activity in Patients Discharged from the Hospital. Sleep 2018. [DOI: 10.1093/sleep/zsy061.726] [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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Nichols-Obande IS, Anderson S, Bush B, Gray C, Ehlen JC, Jones MI, Ananaba G, Okere CO, Brager A, Paul K. 0075 Nitrergic Neurons of the Dorsal Raphe Nucleus Encode Information About Stress Duration. Sleep 2018. [DOI: 10.1093/sleep/zsy061.074] [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] Open
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McLachlan E, Anderson S, Hawkes D, Saville M, Arabena K. Completing the cervical screening pathway: Factors that facilitate the increase of self-collection uptake among under-screened and never-screened women, an Australian pilot study. ACTA ACUST UNITED AC 2018; 25:e17-e26. [PMID: 29507491 DOI: 10.3747/co.25.3916] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objectives To examine factors that enhance under-screened and never-screened women's completion of the self-collection alternative pathway of the Renewed National Cervical Screening Program (ncsp) in Victoria, Australia. Background With the Australian ncsp changing, starting on 1 December 2017, the Medical Services Advisory Committee (msac) recommended implementing human papillomavirus (hpv) testing using a self-collected sample for under-screened and never-screened populations. In response, a multi-agency group implemented an hpv self-collection pilot project to trial self-collection screening pathways for eligible women. Methods Quantitative data were collected on participation rates and compliance rates with follow-up procedures across three primary health care settings. Forty women who self-collected were interviewed in a semi-structured format, and seven agency staff completed in-depth interviews. Qualitative data were used to identify and understand clinical and personal enablers that assisted women to complete self-collection cervical screening pathways successfully. Results Eighty-five per cent (10 women) of participants who tested positive for hpv successfully received their results and completed follow-up procedures as required. Two remaining participants also received hpv-positive results. However, agencies were unable to engage them in follow-up services and procedures. The overall participation rate in screening (self-collection or Pap test) was 85.7% (84 women), with 79 women self-collecting. Qualitative data indicated that clear explanations on self-collection, development of trusting, empathetic relationships with health professionals, and recognition of participants' past experiences were critical to the successful completion of the self-collection pathway. When asked about possible inhibitors to screening and to following up on results and appointments, women cited poor physical and mental health, as well as financial and other structural barriers. Conclusion A well-implemented process, led by trusted, knowledgeable, and engaged health care professionals who can provide appropriate support and information, can assist under-screened and never-screened women to complete the hpv self-collection pathway successfully.
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Gates DA, Anderson D, Anderson S, Zarnstorff M, Spong DA, Weitzner H, Neilson GH, Ruzic D, Andruczyk D, Harris JH, Mynick H, Hegna CC, Schmitz O, Talmadge JN, Curreli D, Maurer D, Boozer AH, Knowlton S, Allain JP, Ennis D, Wurden G, Reiman A, Lore JD, Landreman M, Freidberg JP, Hudson SR, Porkolab M, Demers D, Terry J, Edlund E, Lazerson SA, Pablant N, Fonck R, Volpe F, Canik J, Granetz R, Ware A, Hanson JD, Kumar S, Deng C, Likin K, Cerfon A, Ram A, Hassam A, Prager S, Paz-Soldan C, Pueschel MJ, Joseph I, Glasser AH. Stellarator Research Opportunities: A Report of the National Stellarator Coordinating Committee. JOURNAL OF FUSION ENERGY 2018. [DOI: 10.1007/s10894-018-0152-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Saville M, Hawkes D, Mclachlan E, Anderson S, Arabena K. Self-collection for under-screened women in a National Cervical Screening Program: pilot study. Curr Oncol 2018; 25:e27-e32. [PMID: 29507492 PMCID: PMC5832287 DOI: 10.3747/co.25.3915] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Commencing 1 December 2017, Australia introduced human papillomavirus (hpv)-based cervical screening. As part of this Australian renewed National Cervical Screening Program (ncsp) women who are either never- or under-screened and who refuse a practitioner collected sample will be able to collect their own sample for cervical screening. The aim of this study is to examine the quantitative results of a pilot study into the acceptability of the self-collection alternative pathway. METHODS Eligible participants were offered the opportunity to collect their own sample. Those who agreed were given a flocked swab and an instruction sheet and took their own sample in an area of the health care clinic that afforded them adequate privacy. These samples were then given to clinic staff who returned them to Victorian Cytology Service (vcs) Pathology for hpv nucleic acid testing. RESULTS Of 98 eligible women, seventy-nine undertook self-collection for hpv-based cervical screening. Seventy-seven produced valid results, 14 were positive for oncogenic hpv, with 10 undertaking follow-up. Three women were found to have cervical squamous abnormalities with two of those being high-grade intraepithelial squamous lesions. CONCLUSION The pilot study for self-collection for cervical screening produced quantitative data that were similar to that already reported in the literature, but had a much higher rate of acceptance compared with self-collection programs based in the home.
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Vetter M, Bosco A, Anderson S, Breen K, Romero C, Steele M, Chiodo V, Boye S, Hauswirth W, Tomlinson S. Contribution of microglia and complement activation to glaucoma progression. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.03621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Johnston EL, Warner BD, Digby-Bell JL, Unsworth N, Anderson S, Sanderson JD, Arkir Z, Irving PM. Utilisation of anti-TNF levels in a UK tertiary IBD centre. Frontline Gastroenterol 2017; 8:189-195. [PMID: 28839908 PMCID: PMC5558278 DOI: 10.1136/flgastro-2016-100739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To ascertain how anti-tumour necrosis factor (TNF) drug and anti-drug antibody levels testing is used in a 'real-world' setting to optimise inflammatory bowel disease (IBD) treatment. DESIGN Retrospective cohort study of prospectively collected patient data. SETTING Tertiary IBD centre in London, UK. PATIENTS All patients at Guy's and St Thomas' Hospitals on anti-TNF who had levels measured between the start of testing in 2012 and October 2014. INTERVENTIONS Anti-TNF drug and anti-drug antibody levels as part of routine monitoring. MAIN OUTCOME MEASURES Indication for measuring levels and changes in management made as a result of the levels. RESULTS 330 infliximab levels were carried out in 199 patients and 143 adalimumab levels were carried out in 103 patients. Levels were primarily done in those with evidence of loss of response; 37% of infliximab levels and 52% of adalimumab levels. Levels resulted in a change in management in 26% of patients in infliximab group and 25% of patients in adalimumab group; however, this was greater in those with loss of response, 62% and 61% respectively. Anti-drug antibodies were detected in 7% of patients. CONCLUSIONS Our early experience has demonstrated that measuring anti-TNF drug and anti-drug antibody levels can be useful in the optimisation of IBD management. In an increasing number of patients, particularly those with evidence of loss of response, it allows early decisions to be made regarding changing therapy. It also offers the potential for significant cost-saving by preventing pointless dose escalation in the context of therapeutic levels or when high-level anti-drug antibodies are present.
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Ray-Chaudhuri E, Khoshnaw H, Anderson S, Brown T, Kumar S. 51EVALUATION OF A MULTIDISCIPLINARY EXERCISE AND EDUCATIONAL PROGRAMME FOR OLDER PEOPLE IN A DAY HOSPITAL SETTING. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.51] [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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Dixon A, Steinman H, Anderson S, Nirenberg A, Dixon J, Sladden M. Authors' response to a reply to: Re: Routine usage of sentinel node biopsy in melanoma management must cease. Br J Dermatol 2017; 177:579-580. [PMID: 28456138 DOI: 10.1111/bjd.15626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dixon A, Steinman H, Anderson S, Nirenberg A, Dixon J. Routine usage of sentinel node biopsy in melanoma management must cease. Br J Dermatol 2016; 175:1340-1341. [DOI: 10.1111/bjd.14769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
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Anderson S, Shannon K, Li J, Lee Y, Chettiar J, Goldenberg S, Krüsi A. Condoms and sexual health education as evidence: impact of criminalization of in-call venues and managers on migrant sex workers access to HIV/STI prevention in a Canadian setting. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:30. [PMID: 27855677 PMCID: PMC5114757 DOI: 10.1186/s12914-016-0104-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
Background Despite a large body of evidence globally demonstrating that the criminalization of sex workers increases HIV/STI risks, we know far less about the impact of criminalization and policing of managers and in-call establishments on HIV/STI prevention among sex workers, and even less so among migrant sex workers. Methods Analysis draws on ethnographic fieldwork and 46 qualitative interviews with migrant sex workers, managers and business owners of in-call sex work venues in Metro Vancouver, Canada. Results The criminalization of in-call venues and third parties explicitly limits sex workers’ access to HIV/STI prevention, including manager restrictions on condoms and limited onsite access to sexual health information and HIV/STI testing. With limited labour protections and socio-cultural barriers, criminalization and policing undermine the health and human rights of migrant sex workers working in –call venues. Conclusions This research supports growing evidence-based calls for decriminalization of sex work, including the removal of criminal sanctions targeting third parties and in-call venues, alongside programs and policies that better protect the working conditions of migrant sex workers as critical to HIV/STI prevention and human rights.
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Tikkakoski T, Leppänen M, Turunen J, Anderson S, Södervik H. Percutaneous transcatheter renal embolization with absolute ethanol for uncontrolled nephrotic syndrome: Case reports. Acta Radiol 2016. [DOI: 10.1080/028418501127346288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To retrospectively evaluate renal ethanol embolization in 2 patients with uncontrolled nephrotic syndrome. Material and Methods: Three kidneys in 2 patients with uncontrolled nephrotic syndrome were embolized with absolute ethanol. The embolization technique, patient outcome and complications were analyzed retrospectively. Results: The treatment was successful in both patients, with angiography-verified exclusion of blood flow to the renal arteries. Elimination of proteinuria was achieved in both patients and their body weight decreased by 25 and 10 kg, respectively. Hospitalization and protein substitution were no longer needed. No complications occurred. Conclusion: Permanent bilateral ethanol embolization of the renal arteries is a feasible method of managing a treatment-resistant nephrotic syndrome in selected patients. Non-target embolization can be avoided by using a balloon occlusion catheter.
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Cai L, Long C, Iqbal A, Casertano M, Karki B, Nakarmi K, Anderson S, Patell J, Chang J, Rai S. Lessons from the establishment of Nepal's first skin bank. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Soran A, Nesbitt L, Mamounas EP, Lembersky B, Bryant J, Anderson S, Brown A, Passarello M. Centralized medical monitoring in phase III clinical trials: the National Surgical Adjuvant Breast and Bowel Project (NSABP) experience. Clin Trials 2016; 3:478-85. [PMID: 17060221 DOI: 10.1177/1740774506070747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is a need for data quality assurance procedures in phase III cancer trials. At the National Surgical Adjuvant Breast and Bowel Project (NSABP) ‘real-time’ systems have been developed for quality assurance and study monitoring: (1) manual review and triage of data forms by data managers at the time of submission; (2) computerized edit checking of all submitted data forms; (3) systematic review of eligibility, treatment compliance and toxicity in the first 100 patients of a new protocol; (4) prospective centralized medical review of all reported serious adverse events, treatment failures, second primary cancers and deaths; (5) quarterly review and approval of study summary data files by project statistician; and (6) on-site auditing. Purpose To assess the utility of an additional final comprehensive review of all patient records to confirm eligibility, disease status and vital status prior to manuscript submission. Methods Four phase III NSABP studies, which had been monitored using the triagebased quality assurance program described above, were selected for analysis ( n = 7972). Charts for 5965 patients were identified that had not been previously medically reviewed for protocol events of recurrence, second primary cancer or death. Submitted source documents and data forms of these 5965 NSABP patient records underwent medical review to verify patient eligibility, disease status and vital status. Results This final comprehensive review found no additional treatment failures or deaths, identified seven additional cases of ineligibility, was time-intensive requiring enormous use of expensive resources, and was therefore judged not to add significantly to the integrity of the database. Limitations Our findings are influenced by the procedures the NSABP employs for quality assurance and study monitoring for Phase III clinical trials and may have limited generalizability to other settings. Conclusion In the presence of multiple quality assurance and data monitoring systems, the rare discrepancies found between the data forms and source documentation does not support the routine use of a final comprehensive chart review for phase III trials at the NSABP Biostatistical Center.
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Li B, Yu H, Jara H, Soto J, Anderson S. WE-FG-206-12: Enhanced Laws Textures: A Potential MRI Surrogate Marker of Hepatic Fibrosis in a Murine Model. Med Phys 2016. [DOI: 10.1118/1.4957942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hartle A, McCormack T, Carlisle J, Anderson S, Pichel A, Beckett N, Woodcock T, Heagerty A. The measurement of adult blood pressure and management of hypertension before elective surgery: Joint Guidelines from the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society. Anaesthesia 2016; 71:326-37. [PMID: 26776052 PMCID: PMC5066735 DOI: 10.1111/anae.13348] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/23/2023]
Abstract
This guideline aims to ensure that patients admitted to hospital for elective surgery are known to have blood pressures below 160 mmHg systolic and 100 mmHg diastolic in primary care. The objective for primary care is to fulfil this criterion before referral to secondary care for elective surgery. The objective for secondary care is to avoid spurious hypertensive measurements. Secondary care should not attempt to diagnose hypertension in patients who are normotensive in primary care. Patients who present to pre-operative assessment clinics without documented primary care blood pressures should proceed to elective surgery if clinic blood pressures are below 180 mmHg systolic and 110 mmHg diastolic.
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Neafsey DE, Juraska M, Bedford T, Benkeser D, Valim C, Griggs A, Lievens M, Abdulla S, Adjei S, Agbenyega T, Agnandji ST, Aide P, Anderson S, Ansong D, Aponte JJ, Asante KP, Bejon P, Birkett AJ, Bruls M, Connolly KM, D'Alessandro U, Dobaño C, Gesase S, Greenwood B, Grimsby J, Tinto H, Hamel MJ, Hoffman I, Kamthunzi P, Kariuki S, Kremsner PG, Leach A, Lell B, Lennon NJ, Lusingu J, Marsh K, Martinson F, Molel JT, Moss EL, Njuguna P, Ockenhouse CF, Ogutu BR, Otieno W, Otieno L, Otieno K, Owusu-Agyei S, Park DJ, Pellé K, Robbins D, Russ C, Ryan EM, Sacarlal J, Sogoloff B, Sorgho H, Tanner M, Theander T, Valea I, Volkman SK, Yu Q, Lapierre D, Birren BW, Gilbert PB, Wirth DF. Genetic Diversity and Protective Efficacy of the RTS,S/AS01 Malaria Vaccine. N Engl J Med 2015; 373:2025-2037. [PMID: 26488565 PMCID: PMC4762279 DOI: 10.1056/nejmoa1505819] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The RTS,S/AS01 vaccine targets the circumsporozoite protein of Plasmodium falciparum and has partial protective efficacy against clinical and severe malaria disease in infants and children. We investigated whether the vaccine efficacy was specific to certain parasite genotypes at the circumsporozoite protein locus. METHODS We used polymerase chain reaction-based next-generation sequencing of DNA extracted from samples from 4985 participants to survey circumsporozoite protein polymorphisms. We evaluated the effect that polymorphic positions and haplotypic regions within the circumsporozoite protein had on vaccine efficacy against first episodes of clinical malaria within 1 year after vaccination. RESULTS In the per-protocol group of 4577 RTS,S/AS01-vaccinated participants and 2335 control-vaccinated participants who were 5 to 17 months of age, the 1-year cumulative vaccine efficacy was 50.3% (95% confidence interval [CI], 34.6 to 62.3) against clinical malaria in which parasites matched the vaccine in the entire circumsporozoite protein C-terminal (139 infections), as compared with 33.4% (95% CI, 29.3 to 37.2) against mismatched malaria (1951 infections) (P=0.04 for differential vaccine efficacy). The vaccine efficacy based on the hazard ratio was 62.7% (95% CI, 51.6 to 71.3) against matched infections versus 54.2% (95% CI, 49.9 to 58.1) against mismatched infections (P=0.06). In the group of infants 6 to 12 weeks of age, there was no evidence of differential allele-specific vaccine efficacy. CONCLUSIONS These results suggest that among children 5 to 17 months of age, the RTS,S vaccine has greater activity against malaria parasites with the matched circumsporozoite protein allele than against mismatched malaria. The overall vaccine efficacy in this age category will depend on the proportion of matched alleles in the local parasite population; in this trial, less than 10% of parasites had matched alleles. (Funded by the National Institutes of Health and others.).
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Kavi L, Gamble J, Dastagir N, Gilbert K, Furniss G, Rosengarten J, Shunmugam S, Signy J, Umar F, Providência R, Almeida T, Newton J, Nuttall M, Opie-Moran M, Low DA, Nicholson L, Toora D, Caldow E, Gregory K, Khiani R, Herring N, Foley P, Ginks M, Rajappan K, Bashir Y, Betts T, Salinet J, Li X, Vanheusden F, Almeida T, Chu G, Stafford P, Schlindwein F, Ng G, Hogarth A, MacDonald W, Lewis N, Tan L, Tayebjee M, Villaquiran J, Newcombe D, Lines I, Dalrymple-Hay M, Haywood G, Chui K, Dima S, Panagiotou C, Maharatna K, Curzen N, Morgan J, Veasey R, Sugihara C, Anderson S, Furniss S, Sulke N, Puri N, Steele J, Furniss S, Sulke A, Patel N, Veasey R, Taylor R, Stegemann B, Marshall H, Flannigan S, Leyva F, Rogers D, Cobb V, Babu G, Mann I, Bronis K, Posdziech V, Lambiase P, Ahsan S, Segal O, Lowe M, Rowland E, Khan F, Chow A, Chu G, Salinet J, Vanheusden F, Li X, Tuan J, Stafford P, Schlindwein F, Ng GA. Posters 159Misdiagnosed, misbelieved and misdirected; largest uk study casts doubt on some long held but poorly validated assumptions about the pots population and suggests improvements in care pathways and service provision60An acute comparison of different strategies for targeting the left ventricular lead for cardiac resynchronisation therapy61Relationship of phase singularities and high dominant frequency regions during persistent atrial fibrillation in humans62Restoration of sinus rhythm results in early and late improvements in the functional reserve of the heart following direct current cardioversion of persistent af: fresh-af63Non-concomitant hybrid ablation using the estech cobra device for the treatment of longstanding persistent atrial fibrillation: an initial single-centre experience64Artificial intelligence outperforms manual ecg scoring in the detection of arrhythmia substrate65Single centre experience and outcome of persistent af ablation using nmarq catheter: 2 year follow up66The growing burden of atrial fibrillation and management at a typical district general hospital67Haemodynamic effects of single-vein, simultaneous, multipoint pacing compared with bipolar pacing in patients undergoing cardiac resynchronisation therapy68Is multisite pacing of interest in cardiac resynchronization therapy? teachings from a long-term follow-up of a cohort of patients implanted with triventricular pacing systems69Differences in fractionated electrogram detection: a direct quantitative comparison between navx and carto: Table 1. Europace 2015. [DOI: 10.1093/europace/euv329] [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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