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Feuerstadt P, Allegretti JR, Dubberke ER, Guo A, Harvey A, Yang M, Garcia-Horton V, Fillbrunn M, Tillotson G, Bancke LL, LaPlante K, Garey KW, Khanna S. Efficacy and Health-Related Quality of Life Impact of Fecal Microbiota, Live-jslm: A Post Hoc Analysis of PUNCH CD3 Patients at First Recurrence of Clostridioides difficile Infection. Infect Dis Ther 2024; 13:221-236. [PMID: 38236515 PMCID: PMC10828144 DOI: 10.1007/s40121-023-00907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/14/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) causes symptoms of varying severity and negatively impacts patients' health-related quality of life (HRQL). Despite antibiotic treatment, recurrence of CDI (rCDI) is common and imposes clinical and economic burdens on patients. Fecal microbiota, live-jslm (REBYOTA [RBL]) is newly approved in the USA for prevention of rCDI following antibiotic treatments. We analyzed efficacy and HRQL impact of RBL vs. placebo in patients at first rCDI using data from the phase 3 randomized, double-blind placebo-controlled clinical trial, PUNCH CD3. METHODS This post hoc analysis included patients at first rCDI fromPUNCH CD3. Treatment success (i.e., absence of diarrhea within 8 weeks post-treatment) was analyzed adjusting for baseline patient characteristics. HRQL was measured using the Clostridioides difficile Quality of Life Survey (Cdiff32); absolute scores and change from baseline in total and domain (physical, mental, and social) scores were summarized and compared between arms. Analyses were conducted for the trial's blinded phase only. RESULTS Among 86 eligible patients (32.8% of the overall trial population, RBL 53 [61.6%], placebo 33 [38.4%]), RBL-treated patients had significantly lower odds of recurrence (i.e., greater probability of treatment success) at week 8 vs. placebo (odds ratio 0.35 [95% confidence interval 0.13, 0.98]). Probability of treatment success at week 8 was 81% for RBL and 60% for placebo, representing 21% absolute and 35% relative increases for RBL (crude proportions 79.2% vs. 60.6%; relative risk 0.53, p = 0.06). Additionally, RBL was associated with significantly higher Cdiff32 total (change score difference 13.5 [standard deviation 5.7], p < 0.05) and mental domain (16.2 [6.0], p < 0.01) scores vs. placebo from baseline to week 8. CONCLUSION Compared to placebo, RBL demonstrated a significantly higher treatment success in preventing further rCDI and enhanced HRQL among patients at first recurrence, establishing RBL as an effective treatment to prevent further recurrences in these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03244644.
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Affiliation(s)
- Paul Feuerstadt
- Yale University School of Medicine, New Haven, CT, USA.
- PACT-Gastroenterology Center, 2200 Whitney Avenue Suite 330 & 360, Hamden, CT, 06518, USA.
| | | | | | - Amy Guo
- Ferring Pharmaceuticals, Inc, Parsippany, NJ, USA
| | - Adam Harvey
- Rebiotix, a Ferring Company, Roseville, MN, USA
| | - Min Yang
- Analysis Group, Inc., Boston, MA, USA
- University of Texas at Austin, Austin, TX, USA
| | | | | | | | | | - Kerry LaPlante
- University of Rhode Island, Kingston, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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McAlister O, Harvey A, McCartney B, Crawford P, Bond RR, Finlay DD, McEneaney D. Ventricular fibrillation waveform properties influenced by thoracic impedance guided chest compressions in a porcine model. Comput Methods Programs Biomed 2023; 241:107780. [PMID: 37651816 DOI: 10.1016/j.cmpb.2023.107780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Quantitative measures extracted from ventricular fibrillation (VF) waveform reflect the metabolic state of the myocardium and are associated with survival outcome. The quality of delivered chest compressions during cardiopulmonary resuscitation are also linked with survival. The aim of this research is to explore the viability and effectiveness of a thoracic impedance (TI) based chest compression (CC) guidance system to control CC depth within individual subjects and influence VF waveform properties. METHODS This porcine investigation includes an analysis of two protocols. CC were delivered in 2 min episodes at a constant rate of 110 CC min-1. Subject-specific CC depth was controlled using a TI-thresholding system where CC were performed according to the amplitude (ZRMS, 0.125 to 1.250 Ω) of a band-passed TI signal (ZCC). Protocol A was a retrospective analysis of a 12-porcine study to characterise the response of two VF waveform metrics: amplitude spectrum area (AMSA) and mean slope (MS), to varying CC quality. Protocol B was a prospective 12-porcine study to determine if changes in VF waveform metrics, due to CC quality, were associated with defibrillation outcome. RESULTS Protocol A: A directly proportional relationship was observed between ZRMS and CC depth applied within each subject (r = 0.90; p <0.001). A positive relationship was observed between ZRMS and both AMSA (p <0.001) and MS (p <0.001), where greater TI thresholds were associated with greater waveform metrics. PROTOCOL B MS was associated with return of circulation following defibrillation (odds ratio = 2.657; p = 0.043). CONCLUSION TI-thresholding was an effective way to control CC depth within-subjects. Compressions applied according to higher TI thresholds evoked an increase in AMSA and MS. The response in MS due to deeper CC resulted in a greater incidence of ROSC compared to shallow chest compressions.
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Affiliation(s)
- Olibhéar McAlister
- Ulster University, Belfast, UK; HeartSine Technologies Ltd., Belfast, UK.
| | | | - Ben McCartney
- Ulster University, Belfast, UK; HeartSine Technologies Ltd., Belfast, UK
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Alves-Lopes R, Lacchini S, Neves KB, Harvey A, Montezano AC, Touyz RM. Vasoprotective effects of NOX4 are mediated via polymerase and transient receptor potential melastatin 2 cation channels in endothelial cells. J Hypertens 2023; 41:1389-1400. [PMID: 37272080 PMCID: PMC10399938 DOI: 10.1097/hjh.0000000000003478] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND NOX4 activation has been implicated to have vasoprotective and blood pressure (BP)-lowering effects. Molecular mechanisms underlying this are unclear, but NOX4-induced regulation of the redox-sensitive Ca 2+ channel TRPM2 and effects on endothelial nitric oxide synthase (eNOS)-nitric oxide signalling may be important. METHOD Wild-type and LinA3, renin-expressing hypertensive mice, were crossed with NOX4 knockout mice. Vascular function was measured by myography. Generation of superoxide (O 2- ) and hydrogen peroxide (H 2 O 2 ) were assessed by lucigenin and amplex red, respectively, and Ca 2+ influx by Cal-520 fluorescence in rat aortic endothelial cells (RAEC). RESULTS BP was increased in NOX4KO, LinA3 and LinA3/NOX4KO mice. This was associated with endothelial dysfunction and vascular remodelling, with exaggerated effects in NOX4KO groups. The TRPM2 activator, ADPR, improved vascular relaxation in LinA3/NOX4KO mice, an effect recapitulated by H 2 O 2 . Inhibition of PARP and TRPM2 with olaparib and 2-APB, respectively, recapitulated endothelial dysfunction in NOX4KO. In endothelial cells, Ang II increased H 2 O 2 generation and Ca 2+ influx, effects reduced by TRPM2 siRNA, TRPM2 inhibitors (8-br-cADPR, 2-APB), olaparib and GKT137831 (NOX4 inhibitor). Ang II-induced eNOS activation was blocked by NOX4 and TRPM2 siRNA, GKT137831, PEG-catalase and 8-br-cADPR. CONCLUSION Our findings indicate that NOX4-induced H 2 O 2 production activates PARP/TRPM2, Ca 2+ influx, eNOS activation and nitric oxide release in endothelial cells. NOX4 deficiency impairs Ca 2+ homeostasis leading to endothelial dysfunction, an effect exacerbated in hypertension. We define a novel pathway linking endothelial NOX4/H 2 O 2 to eNOS/nitric oxide through PARP/TRPM2/Ca 2+ . This vasoprotective pathway is perturbed when NOX4 is downregulated and may have significance in conditions associated with endothelial dysfunction, including hypertension.
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Affiliation(s)
- Rheure Alves-Lopes
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Silvia Lacchini
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Karla B. Neves
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Adam Harvey
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Augusto C. Montezano
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Rhian M. Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Orenstein R, Hecht G, Harvey A, Tillotson G, Khanna S. Two-year durability of REBYOTA™ (RBL), a live biotherapeutic for the prevention of recurrent Clostridioides difficile infections. Open Forum Infect Dis 2023; 10:ofad456. [PMID: 37691735 PMCID: PMC10485881 DOI: 10.1093/ofid/ofad456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
| | - Gail Hecht
- Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, Maywood, IL, USA
| | - Adam Harvey
- Rebiotix Inc., a Ferring Company, Roseville, MN, USA
| | | | - Sahil Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Garey KW, Dubberke ER, Guo A, Harvey A, Yang M, García-Horton V, Fillbrunn M, Wang H, Tillotson GS, Bancke LL, Feuerstadt P. Effect of Fecal Microbiota, Live-Jslm (REBYOTA [RBL]) on Health-Related Quality of Life in Patients With Recurrent Clostridioides difficile Infection: Results From the PUNCH CD3 Clinical Trial. Open Forum Infect Dis 2023; 10:ofad383. [PMID: 37564743 PMCID: PMC10411038 DOI: 10.1093/ofid/ofad383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
Background Recurrence of Clostridioides difficile infection (rCDI) is common, prolonging disease morbidity and leading to poor quality of life. We evaluated disease-specific health-related quality of life (HRQL) in patients with rCDI treated with fecal microbiota, live-jslm (REBYOTA [RBL]; Rebiotix) versus placebo. Methods This was a secondary analysis of a randomized, double-blind, placebo-controlled phase 3 study (PUNCH CD3). The disease-specific Clostridioides difficile Quality of Life Survey (Cdiff32) was administered at baseline and at weeks 1, 4, and 8. Changes in Cdiff32 total and domain (physical, mental, social) scores from baseline to week 8 were compared between RBL and placebo and for responders and nonresponders. Results Findings were analyzed in a total of 185 patients (RBL, n = 128 [69.2%]; placebo, n = 57 [30.8%]) with available Cdiff32 data. Patients from both arms showed significant improvements in Cdiff32 scores relative to baseline across all outcomes and at all time points (all P < .001); RBL-treated patients showed significantly greater improvements in mental domain than those receiving placebo. In adjusted analyses, RBL-treated patients showed greater improvements than placebo in total score and physical and mental domains (all P < .05). Similar improvement in mental domain was observed among responders, while nonresponders showed numerical improvements with RBL but not placebo. Conclusions In a phase 3 double-blinded clinical trial, RBL-treated patients reported more substantial and sustained disease-specific HRQL improvements than placebo-treated patients. Clinical Trials Registration ClinicalTrials.gov NCT03244644 (https://clinicaltrials.gov/ct2/show/NCT03244644).
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Affiliation(s)
| | | | - Amy Guo
- Ferring Pharmaceuticals, Parsippany, New Jersey, USA
| | - Adam Harvey
- Rebiotix, a Ferring Company, Roseville, Minnesota, USA
| | - Min Yang
- Analysis Group Inc., Boston, Massachusetts, USA
| | | | | | | | | | | | - Paul Feuerstadt
- Yale University School of Medicine, New Haven, Connecticut, USA
- PACT-Gastroenterology Center, New Haven, Connecticut, USA
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Usman M, Rehman A, Saleem F, Abbas A, Eze VC, Harvey A. Synthesis of cyclic carbonates from CO 2 cycloaddition to bio-based epoxides and glycerol: an overview of recent development. RSC Adv 2023; 13:22717-22743. [PMID: 37502825 PMCID: PMC10370462 DOI: 10.1039/d3ra03028h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Anthropogenic carbon dioxide (CO2) emissions contribute significantly to global warming and deplete fossil carbon resources, prompting a shift to bio-based raw materials. The two main technologies for reducing CO2 emissions are capturing and either storing or utilizing it. However, while capture and storage have high reduction potential, they lack economic feasibility. Conversely, by utilizing the CO2 captured from streams and air to produce valuable products, it can become an asset and curb greenhouse gas effects. CO2 is a challenging C1-building block due to its high kinetic inertness and thermodynamic stability, requiring high temperature and pressure conditions and a reactive catalytic system. Nonetheless, cyclic carbonate production by reacting epoxides and CO2 is a promising green and sustainable chemistry reaction, with enormous potential applications as an electrolyte in lithium-ion batteries, a green solvent, and a monomer in polycarbonate production. This review focuses on the most recent developments in the synthesis of cyclic carbonates from glycerol and bio-based epoxides, as well as efficient methods for chemically transforming CO2 using flow chemistry and novel reactor designs.
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Affiliation(s)
- Muhammad Usman
- Department of Chemical and Polymer Engineering, University of Engineering and Technology Lahore, Faisalabad Campus Pakistan
- School of Engineering, Newcastle University Newcastle Upon Tyne NE1 7RU UK
| | - Abdul Rehman
- Department of Chemical and Polymer Engineering, University of Engineering and Technology Lahore, Faisalabad Campus Pakistan
- School of Engineering, Newcastle University Newcastle Upon Tyne NE1 7RU UK
| | - Faisal Saleem
- Department of Chemical and Polymer Engineering, University of Engineering and Technology Lahore, Faisalabad Campus Pakistan
- School of Engineering, Newcastle University Newcastle Upon Tyne NE1 7RU UK
| | - Aumber Abbas
- Songshan Lake Materials Laboratory, University Innovation Park Dongguan 523808 China
| | - Valentine C Eze
- School of Engineering, Newcastle University Newcastle Upon Tyne NE1 7RU UK
| | - Adam Harvey
- School of Engineering, Newcastle University Newcastle Upon Tyne NE1 7RU UK
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Lee C, Louie T, Bancke L, Guthmueller B, Harvey A, Feuerstadt P, Khanna S, Orenstein R, Dubberke ER. Safety of fecal microbiota, live-jslm (REBYOTA ™) in individuals with recurrent Clostridioides difficile infection: data from five prospective clinical trials. Therap Adv Gastroenterol 2023; 16:17562848231174277. [PMID: 37333464 PMCID: PMC10272687 DOI: 10.1177/17562848231174277] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/06/2023] [Indexed: 06/20/2023] Open
Abstract
Background Microbiota-based treatments reduce the incidence of recurrent Clostridioides difficile infections (rCDIs), but prospectively collected safety data needed to broaden patient access and protect public health have been limited. Objectives We provide cumulative safety data from five prospective clinical trials evaluating fecal microbiota, live-jslm (RBL) - the first microbiota-based live biotherapeutic product approved by the US Food and Drug Administration - for preventing rCDI in adults. Design Integrated safety analysis includes three phase II trials (PUNCH CD, PUNCH CD2, PUNCH Open-Label) and two phase III trials (PUNCH CD3, PUNCH CD3-OLS) of RBL. Methods Trial participants were at least 18 years of age with documented rCDI who completed standard-of-care antibiotic therapy before treatment with RBL. Assigned study treatment regimen was one or two doses of RBL (or placebo) administered rectally, depending on the trial design. In four of the five trials, participants with CDI recurrence within 8 weeks after RBL or placebo administration were eligible for treatment with open-label RBL. Treatment-emergent adverse events (TEAEs) were recorded for at least 6 months following last study treatment; in PUNCH CD2 and PUNCH Open-Label trials, TEAEs and serious TEAEs were collected through 12 and 24 months, respectively. Results Among the five trials, 978 participants received at least one dose of RBL (assigned treatment or after recurrence) and 83 participants received placebo only. TEAEs were reported in 60.2% of Placebo Only participants and 66.4% of RBL Only participants. Only abdominal pain, nausea, and flatulence were significantly higher in the RBL Only group compared with the Placebo Only group. Most TEAEs were mild or moderate in severity and were most frequently related to preexisting conditions. There were no reported infections for which the causative pathogen was traced to RBL. Potentially life-threatening TEAEs were infrequent (3.0% of participants). Conclusion Across five clinical trials, RBL was well tolerated in adults with rCDI. In aggregate, these data consistently demonstrated the safety of RBL.
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Affiliation(s)
- Christine Lee
- Medical Microbiologist and Researcher, Island Health, Clinical Professor, Department of Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC V6T 1Z3, Canada
- Island Medical Program University of British Columbia, University of Victoria, Victoria, BC, Canada
| | - Thomas Louie
- University of Calgary and Foothills Medical Center, Calgary, AB, Canada
| | - Lindy Bancke
- Rebiotix Inc., a Ferring Company, Roseville, MN, USA
| | | | - Adam Harvey
- Rebiotix Inc., a Ferring Company, Roseville, MN, USA
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8
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Feuerstadt P, Harvey A, Yoho DS, Garcia-Diaz JB, Knapple WL, Bancke L. Retrospective Analysis of the Safety and Efficacy of Fecal Microbiota, Live-jslm (REBYOTA TM) Administered Under Enforcement Discretion to Patients With Clostridioides difficile Infection. Open Forum Infect Dis 2023; 10:ofad171. [PMID: 37256213 PMCID: PMC10225279 DOI: 10.1093/ofid/ofad171] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/24/2023] [Indexed: 12/10/2023] Open
Abstract
Background Fecal microbiota, live-jslm (RBL; REBYOTA™), the first microbiota-based live biotherapeutic approved by the US Food and Drug Administration to prevent recurrent Clostridioides difficile infection (rCDI) in adults, has been evaluated in 5 prospective clinical trials. A retrospective analysis considered the safety and efficacy of RBL administered under US Food and Drug Administration enforcement discretion to patients with rCDI and broad eligibility criteria mimicking real-world practice. Methods We retrospectively identified adults with rCDI treated with RBL under enforcement discretion between November 1, 2015, and September 30, 2019, across 5 study sites. CDI diagnosis was based on site-specific practice. The primary safety set (PSS) included all patients who were naïve to previous RBL treatment and had continuously comprehensive medical records for 6 months following treatment. Results The primary treatment cohort had 94 patients; the PSS included 64 patients with common comorbidities receiving diverse chronic therapeutics. Most treatment-emergent adverse events were mild to moderate in severity and comparable between comorbidity subgroups and the overall population. There were no serious adverse events related to RBL or the administration procedure. In the PSS, 82.8% of RBL-treated patients responded at 8 weeks, of whom 88.7% had sustained response through 6 months. The number of RBL doses administered had no marked effect on outcome. Conclusions Together with prospective clinical trial outcomes, these findings support the efficacy and safety of RBL to prevent rCDI, with diagnostics and comorbidities representative of real-world clinical practice.
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Affiliation(s)
- Paul Feuerstadt
- Yale University School of Medicine; PACT Gastroenterology Center, Hamden, Connecticut, USA
| | - Adam Harvey
- Rebiotix (a Ferring Company), Roseville, Minnesota, USA
| | - David S Yoho
- Department of Gastroenterology, Mid-Atlantic Permanente Medical Group, Springfield, Virginia, USA
| | - Julia B Garcia-Diaz
- Department of Clinical Infectious Diseases Research and Medical Subspecialties, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Whitfield L Knapple
- Department of Gastroenterology, Arkansas Gastroenterology, North Little Rock, Arkansas, USA
| | - Lindy Bancke
- Rebiotix (a Ferring Company), Roseville, Minnesota, USA
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Broderick L, Tuohy G, Solymos O, Lakhani S, Staunton B, Ennis P, Clark N, Moppett IK, Chalissery A, Kilbride RD, Sweeney KJ, O'Brien D, O'Hare A, Harvey A, Larkin CM. Management of vagus nerve simulation therapy in the peri-operative period: Guidelines from the Association of Anaesthetists: Guidelines from the Association of Anaesthetists. Anaesthesia 2023; 78:747-757. [PMID: 37096456 DOI: 10.1111/anae.16012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 04/26/2023]
Abstract
Vagus nerve stimulation is a well-established treatment option for patients with drug-resistant epilepsy and has an expanding range of other clinical indications. Side effects of vagus nerve stimulation therapy include: cough; voice changes; vocal cord adduction; rarely, obstructive sleep apnoea; and arrhythmia. Patients with implanted vagus nerve stimulation devices may present for unrelated surgery and critical care to clinicians who are unfamiliar with their function and safe management. These guidelines have been formulated by multidisciplinary consensus based on case reports, case series and expert opinion to support clinicians in the management of patients with these devices. The aim is to provide specific guidance on the management of vagus nerve stimulation devices in the following scenarios: the peri-operative period; peripartum period; during critical illness; and in the MRI suite. Patients should be aware of the importance of carrying their personal vagus nerve stimulation device magnet with them at all times to facilitate urgent device deactivation if necessary. We advise that it is generally safer to formally deactivate vagus nerve stimulation devices before general and spinal anaesthesia. During periods of critical illness associated with haemodynamic instability, we also advise cessation of vagus nerve stimulation and early consultation with neurology services.
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Affiliation(s)
| | - G Tuohy
- Rotunda Hospital, Dublin, Ireland
| | - O Solymos
- St Vincent's University Hospital, Dublin, Ireland
| | - S Lakhani
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - P Ennis
- Beaumont Hospital, Dublin, Ireland
| | - N Clark
- Bristol Children's Hospital, Bristol, UK
| | | | | | | | | | | | - A O'Hare
- Beaumont Hospital, Dublin, Ireland
| | - A Harvey
- Royal Cornwall Hospital Trust, Cornwall, UK
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Saleem F, Khoja AH, Sharif R, Rehman A, Naqvi SR, Qazi UY, Zhang K, Harvey A. Synergistic effect of plasma power and temperature on the cracking of toluene in the N 2 based product gas. Heliyon 2023; 9:e14237. [PMID: 36950658 PMCID: PMC10025038 DOI: 10.1016/j.heliyon.2023.e14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023] Open
Abstract
In this research, a dielectric barrier discharge (DBD) reactor is used to study the cracking of the toluene into C1-C6 hydrocarbons. The combined effect of parameters such as temperature (20-400 °C) and plasma power (10-40 W) was investigated to evaluate the DBD reactor performance. The main gaseous products from the decomposition of toluene include lower hydrocarbon (C1-C6). The cracking of toluene increases with power at all temperatures (20-400 °C). On the otherhand, it decreases from 92.8 to 73.1% at 10 W, 97.2 to 80.5% at 20, 97.5 to 86.5% at 30 W, and 98.4 to 93.7% at 40 W with raising the temperature from 20 to 400 °C. Nonetheless, as the temperature and plasma input power increase, the methane yield increases. At 40 W, the maximum methane yield was 5.1%. At 10 and 20 W, the selectivity to C2 increases as the temperature rises up to 400 °C. At 30 and 40 W, it began to drop after 300 °C due to the formation of methane and the yield of methane increases significantly beyond this temperature.
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Affiliation(s)
- Faisal Saleem
- Chemical and Polymer Engineering Department, UET Lahore, Faisalabad Campus, Pakistan
- Corresponding author.
| | - Asif Hussain Khoja
- Fossil Fuels Laboratory, Department of Thermal Energy Engineering, U.S-Pakistan Centre for Advanced Studies in Energy (USPCAS-E), National University of Sciences & Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Rabia Sharif
- Chemical and Polymer Engineering Department, UET Lahore, Faisalabad Campus, Pakistan
| | - Abdul Rehman
- Chemical and Polymer Engineering Department, UET Lahore, Faisalabad Campus, Pakistan
| | - Salman Raza Naqvi
- School of Chemical & Materials Engineering, National University of Sciences & Technology, 44000, Islamabad, Pakistan
| | - Umair Yaqub Qazi
- Department of Chemistry, College of Science, University of Hafr Al Batin, Kingdom of Saudi Arabia
| | - Kui Zhang
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom
| | - Adam Harvey
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom
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Tillotson G, Archbald-Pannone L, Johnson S, Ng S, Ando M, Harvey A, Bancke L, Feuerstadt P. Microbiota-Based Live Biotherapeutic RBX2660 for the Reduction of Recurrent Clostridioides difficile Infection in Older Adults With Underlying Comorbidities. Open Forum Infect Dis 2023; 10:ofac703. [PMID: 36686631 PMCID: PMC9846189 DOI: 10.1093/ofid/ofac703] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Background Advanced age and underlying comorbidities are associated with greater rates of recurrence in patients with Clostridioides difficile infection (CDI). Reducing the likelihood of recurrence through treatment with an antimicrobial followed by a microbiota replacement therapy can decrease the burden of this infection and improve patient outcomes. We report the efficacy and safety of RBX2660, a microbiota-based live biotherapeutic, in older adults with recurrent CDI, grouped by comorbidities. Methods In this post hoc subgroup analysis of the PUNCH CD3 trial, we assessed outcomes in older adults (age ≥65 years) grouped by Charlson Comorbidity Index severity scores at screening (moderate [3-4] and severe [≥5]) and by the presence of underlying cardiac, renal, or gastrointestinal disorders. Results RBX2660 treatment success rates in older adults with comorbidities were consistent across subgroups and similar to those in the total RBX2660-treated population. A greater percentage of RBX2660-treated older adults remained free of CDI recurrence through 8 weeks following treatment compared with placebo-treated participants in all but 2 subgroups assessed. Across all subgroups, most treatment-emergent adverse events (TEAEs) were mild or moderate in severity and related to a preexisting condition. None of the serious or life-threatening TEAEs that occurred were related to RBX2660 or its administration. Occurrence of TEAEs did not cluster in any subgroup. Conclusions RBX2660 is efficacious and safe in older adults with recurrent CDI and underlying comorbidities.
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Affiliation(s)
- Glenn Tillotson
- Correspondence: Glenn Tillotson, PhD, GST Micro, 327 Plantation Road, North, VA 23128, USA ()
| | - Laurie Archbald-Pannone
- Department of Internal Medicine and Infectious Diseases, University of Virginia Hospital, Charlottesville, Virginia, USA
| | - Stuart Johnson
- Department of Infectious Diseases, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Samson Ng
- Medical Affairs, Ferring Pharmaceuticals, Parsippany, New Jersey, USA
| | | | - Adam Harvey
- Clinical Research Department, Rebiotix Inc, a Ferring Company, Roseville, Minnesota, USA
| | - Lindy Bancke
- Clinical Research Department, Rebiotix Inc, a Ferring Company, Roseville, Minnesota, USA
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Feuerstadt P, Dubberke ER, Guo A, Harvey A, Yang M, García-Horton V, Fillbrunn M, Tillotson GS, Bancke L, Garey KW. 522. Significant Improvement in Health-Related Quality of Life (HRQL) with RBX2660: Results from a Phase 3 Randomized, Placebo-Controlled Trial in Recurrent Clostridioides Difficile Infection (PUNCH CD3). Open Forum Infect Dis 2022. [PMCID: PMC9751853 DOI: 10.1093/ofid/ofac492.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Recurrence of Clostridioides difficile infection (rCDI) is common - up to 35% of patients may recur. RBX2660 is a microbiota restoration therapy to reduce rCDI. Here we report 8 weeks HRQL results using the Clostridioides difficile Health-related Quality-of-Life Questionnaire (Cdiff32), a disease-specific instrument, from PUNCH CD3 (a randomized, double-blinded, placebo-controlled RBX2660 Phase 3 trial, NCT03244644). Methods Cdiff32 includes three domains (physical, mental, and social) and a total score (all range from 0 to 100 [100 best possible]). Changes in Cdiff32 from baseline to week 8 were compared between RBX2660 and placebo (PBO) using unadjusted and adjusted analyses controlling for baseline score, demographic and disease characteristics. Per trial protocol, missing data were imputed via last observation carried forward (LOCF); as-observed data were also analyzed. Patients experiencing recurrence after blinded treatment received open-label RBX2660 per physician discretion; these participants were excluded unless, per LOCF, data were available from the blinded period for week 8 use. Results A total of 206 patients (140 RBX2660, 66 PBO) were included, with similar age (mean±SD) 61.1±16.9 yrs (RBX2660) and 57.3±16.4 yrs (PBO) and baseline Cdiff32 scores. More than half of the patients had multiple comorbidities. Cdiff32 scores improved significantly from baseline to weeks 1, 4, and 8 for both arms, with greater improvements for RBX2660 through week 8 (Figs. 1 & 2). At week 8, statistical differences were found for mental domain (unadjusted: 8.01±3.64; adjusted: 7.07, 95% confidence interval: [0.28, 13.86], both P< 0.05) and total score (adjusted: 6.11, [0.14, 12.08], P< 0.05), all favoring RBX2660. Results were similar for the as-observed analyses, with the adjusted physical domain also statistically favoring RBX2660.
![]() ![]() Conclusion Most patients in this study reported improved HRQL. Improvements were observed in both arms, but RBX2660-treated patients had more robust and sustained improvements with statistically significant differences in Cdiff32 scores. This study suggests that microbiome restoration therapy might positively affect HRQL; future research may link these improvements directly with microbiota changes. Disclosures Paul Feuerstadt, MD, FACG, AGAF, Ferring/Rebiotix Pharmaceuticals: Advisor/Consultant|Ferring/Rebiotix Pharmaceuticals: Grant/Research Support|Merck and Co: Advisor/Consultant|SERES Therapeutics: Advisor/Consultant|SERES Therapeutics: Grant/Research Support|Takeda Pharmaceuticals: Advisor/Consultant Erik R. Dubberke, MD, MSPH, Abbott: Advisor/Consultant|Ferring: Advisor/Consultant|Ferring: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Seres: Advisor/Consultant|Summit: Advisor/Consultant|Synthetic Biologics: Grant/Research Support Amy Guo, PhD, Ferring Pharmaceuticals: Employee Adam Harvey, PhD, Ferring Pharmaceuticals: Employment Min Yang, MD, PhD, Analysis Group, Inc.: I am an employee of Analysis Group, Inc., which has received consulting fees from Ferring for the conduct of this study. Viviana García-Horton, PhD, Analysis Group, Inc.: Employee of Analysis Group, Inc., which received consulting fees from Ferring for the conduct of this study. Mirko Fillbrunn, PhD, Analysis Group, Inc.: I am an employee of Analysis Group, Inc., which has received consulting fees from Ferring for the conduct of this study. Glenn S. Tillotson, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support|Spero Pharmaceuticals: Advisor/Consultant|Taro Pharmaceuticals: Advisor/Consultant Lindy Bancke, PharmD, Rebiotix, a Ferring Company: Employee Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|cidara: Advisor/Consultant|cidara: Grant/Research Support|Paratek: Grant/Research Support|Seres Health: Grant/Research Support|Summit: Grant/Research Support.
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Affiliation(s)
- Paul Feuerstadt
- Yale University School of Medicine/PACT-Gastroenterology Center, Westport, Connecticut
| | | | - Amy Guo
- Ferring Pharmaceuticals, parsippany, New Jersey
| | - Adam Harvey
- Ferring Pharmaceuticals, parsippany, New Jersey
| | - Min Yang
- Analysis Group, Inc., Boston, Massachusetts
| | | | | | | | - Lindy Bancke
- Rebiotix, a Ferring Company, Roseville, Minnesota
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Tillotson GS, Feuerstadt P, Archbald-Pannone L, Archbald-Pannone L, Johnson S, Ng S, Ando M, Harvey A. 236. Treatment of Recurrent Clostridioides difficile Infection With RBX2660 in Patients ≥ 65 Years Old With Underlying Comorbidities. Open Forum Infect Dis 2022. [PMCID: PMC9751783 DOI: 10.1093/ofid/ofac492.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Disruptions to gut microbiota composition can result in dysbiosis and subsequent intestinal colonization by opportunistic pathogens such as Clostridioides difficile.1,2 The incidence of Clostridioides difficile infection (CDI) in persons ≥ 65 years old is greater than in those < 65 years old,3 with 1 in 11 CDI patients ≥ 65 years old dying within 1 month of diagnosis.4 We report the efficacy and safety of RBX2660, a microbiota-based live biotherapeutic, in patients with recurrent CDI (rCDI) who were ≥ 65 years old with comorbidities. This is a subgroup analysis of the PUNCH CD3 trial (NCT03244644), a prospective, multicenter, randomized, double-blind, placebo-controlled phase 3 trial. Methods Participants enrolled in PUNCH CD3 were ≥ 18 years old with documented rCDI who completed standard-of-care antibiotic therapy prior to treatment with RBX2660 or placebo. Treatment success was defined as remaining recurrence-free 8 weeks after intervention. In this subgroup analysis, we assessed outcomes of participants ≥ 65 years old with underlying cardiac disorders, chronic kidney disease (CKD), and gastrointestinal (GI) disorders. The treatment-emergent adverse events (TEAEs) were summarized for the double-blind treatment period within 8 weeks and censored if a patient received open-label RBX2660 after CDI recurrence. Results In the modified intent-to-treat population, 119 of 262 participants (45%) were ≥ 65 years old. Of these 119 participants, 42% had a cardiac disorder, 19% had CKD, and 61% had a GI disorder; the respective RBX2660 treatment success rates were 69%, 68%, and 67% (Figure 1). In the total safety population, the overall incidence of TEAEs was 52% with RBX2660 treatment compared to 44% with placebo treatment; mild events accounted for most of the difference (40% vs 30%) (Table 1). The overall incidence of TEAEs was 51% in RBX2660-treated participants ≥ 65 years old and 61%, 68%, and 51% in those participants with a cardiac disorder, CKD, or GI disorder, respectively. Most TEAEs were mild or moderate in severity and related to a pre-existing condition.
![]() ![]() Conclusion RBX2660 is safe and efficacious across a range of medically complex patients and consistently reduced rCDI in adults ≥ 65 years old, regardless of baseline comorbidities. Disclosures Glenn S. Tillotson, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support|Spero Pharmaceuticals: Advisor/Consultant|Taro Pharmaceuticals: Advisor/Consultant Paul Feuerstadt, MD, FACG, AGAF, Ferring/Rebiotix Pharmaceuticals: Advisor/Consultant|Ferring/Rebiotix Pharmaceuticals: Grant/Research Support|Merck and Co: Advisor/Consultant|SERES Therapeutics: Advisor/Consultant|SERES Therapeutics: Grant/Research Support|Takeda Pharmaceuticals: Advisor/Consultant Stuart Johnson, M.D., Ferring Pharmaceuticals: Membership on Ferring Publication Steering Committee|Ferring Pharmaceuticals: Employee|Summit Plc: Advisor/Consultant Adam Harvey, PhD, Ferring Pharmaceuticals: Employment.
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Affiliation(s)
| | - Paul Feuerstadt
- Yale University School of Medicine/PACT-Gastroenterology Center, Westport, Connecticut
| | | | | | - Stuart Johnson
- Hines VA Hospital and Loyola University Medical Center, Hines, Illinois
| | - Samson Ng
- Ferring Pharmaceuticals, Parsippany, New Jersey
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Geiller HEB, Harvey A, Jones RE, Grimstead JW, Cleal K, Hendrickson EA, Baird DM. ATRX modulates the escape from a telomere crisis. PLoS Genet 2022; 18:e1010485. [PMID: 36350851 PMCID: PMC9678338 DOI: 10.1371/journal.pgen.1010485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/21/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Telomerase activity is the principal telomere maintenance mechanism in human cancers, however 15% of cancers utilise a recombination-based mechanism referred to as alternative lengthening of telomeres (ALT) that leads to long and heterogenous telomere length distributions. Loss-of-function mutations in the Alpha Thalassemia/Mental Retardation Syndrome X-Linked (ATRX) gene are frequently found in ALT cancers. Here, we demonstrate that the loss of ATRX, coupled with telomere dysfunction during crisis, is sufficient to initiate activation of the ALT pathway and that it confers replicative immortality in human fibroblasts. Additionally, loss of ATRX combined with a telomere-driven crisis in HCT116 epithelial cancer cells led to the initiation of an ALT-like pathway. In these cells, a rapid and precise telomeric elongation and the induction of C-circles was observed; however, this process was transient and the telomeres ultimately continued to erode such that the cells either died or the escape from crisis was associated with telomerase activation. In both of these instances, telomere sequencing revealed that all alleles, irrespective of whether they were elongated, were enriched in variant repeat types, that appeared to be cell-line specific. Thus, our data show that the loss of ATRX combined with telomere dysfunction during crisis induces the ALT pathway in fibroblasts and enables a transient activation of ALT in epithelial cells.
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Affiliation(s)
- Helene E. B. Geiller
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Adam Harvey
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Rhiannon E. Jones
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Julia W. Grimstead
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kez Cleal
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Eric A. Hendrickson
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Duncan M. Baird
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
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Tribe HC, Docherty S, Kelsall N, Harvey A. The influence of the patient's health-state compared with time to surgery on the outcomes following hip fracture surgery: a longitudinal study of 4,791 patients. Ann R Coll Surg Engl 2022. [PMID: 36239963 DOI: 10.1308/rcsann.2022.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION This study investigated whether the health-state of hip fracture patients or the time to surgery had a greater effect on outcomes. METHODS Of the 5,120 patients admitted with a fragility hip fracture, 4,791 (93.6%) were included in the analysis. Patients operated after 36 hours were initially group by length of delay (36-48 hours and >48 hours) and then regrouped by delay cause (medical and administrative). Patients operated within 36 hours were the comparative group. Data were collected at admission, discharge, 120 days and 365 days post discharge. RESULTS Multivariate logistic regression analysis revealed that the patients who were delayed over 36 hours, owing to medical causes, had a higher mortality at all studied time points, but the patients who were delayed owing to administrative causes had no increase in mortality. Analysis by time to surgery revealed that patients operated after 36 and 48 hours had a higher mortality at discharge only. Medically delayed patients were less likely to return to their premorbid level of residence at discharge. Older, male patients had a higher risk of inferior outcomes. Postoperative length of stay was significantly greater in the >48-hour delay group and the medical delay group. All delay groups had a significantly higher rate of reoperation within 30 days compared with the no-delay group. CONCLUSIONS The health-state of the hip fracture patient had a greater impact on the outcome in contrast to time to surgery. This study concurs that hip fracture patients should receive surgery within the timeframe of current guidelines, but medically unwell patients have relatively worse outcomes and should receive enhanced clinical attention.
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Affiliation(s)
- H C Tribe
- University Hospitals Dorset NHS Foundation Trust, UK
| | - S Docherty
- Bournemouth University Clinical Research Unit, UK
| | - N Kelsall
- University Hospitals Dorset NHS Foundation Trust, UK
| | - A Harvey
- University Hospitals Dorset NHS Foundation Trust, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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McAlister O, Harvey A, Kernaghan A, Torney H, McEneaney D, Adgey J. P093 The effect of thoracic impedance on shock success during public access defibrillation. Resuscitation 2022. [PMCID: PMC9179051 DOI: 10.1016/s0300-9572(22)00503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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McAlister O, Harvey A, McCartney B, Kernaghan A, Morais S, Bond R, Finlay D. P091 Challenges of blood pressure monitoring during chest compressions. Resuscitation 2022. [DOI: 10.1016/s0300-9572(22)00501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ali MM, Ahmed SMR, Aqar DY, Gheni SA, Abdullah GH, Mahmood MA, Habeeb OA, Harvey A, N. Phan A. Use of Dolomite Catalyst in Biodiesel Production via Transesterification of Waste Cooking Oil in Oscillatory Baffled Reactor. AIChE J 2022. [DOI: 10.1002/aic.17751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mudheher M. Ali
- Chemical Engineering Department Tikrit University Tikrit Iraq
| | | | - Dhia Y. Aqar
- Studies and Economic Affairs Division Iraqi National Oil Company Baghdad Iraq
| | - Saba A. Gheni
- Chemical Engineering Department Tikrit University Tikrit Iraq
| | | | - Marwan A. Mahmood
- Environmental Engineering Department Ondokuz Mayıs University Samson Turkey
| | | | - Adam Harvey
- School of Engineering Newcastle University Newcastle UK
| | - Anh N. Phan
- School of Engineering Newcastle University Newcastle UK
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Hockaday J, Harvey A, Velasquez-Orta S. A comparative analysis of the adsorption kinetics of Cu2+ and Cd2+ by the microalgae Chlorella vulgaris and Scenedesmus obliquus. ALGAL RES 2022. [DOI: 10.1016/j.algal.2022.102710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dahiru UH, Saleem F, Zhang K, Harvey A. Plasma-assisted removal of methanol in N 2, dry and humidified air using a dielectric barrier discharge (DBD) reactor. RSC Adv 2022; 12:10997-11007. [PMID: 35425072 PMCID: PMC8989026 DOI: 10.1039/d2ra01097f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
In this work, a non-thermal plasma dielectric barrier discharge (DBD) was used to remove methanol from ambient air. The effects of carrier gases (N2, dry and humidified air), power (2-10 W), inlet concentration (260-350 ppm), and residence time (1.2-3.3 s) were investigated to evaluate the performance of the plasma DBD reactor in terms of removal efficiency, product selectivity and reduction of unwanted by-products at ambient temperature and atmospheric pressure. It was found that the conversion of methanol increased with power and residence time regardless of the carrier gas used. However, the removal efficiency decreased with the increasing concentration of CH3OH. Almost complete removal of methanol (96.7%) was achieved at 10 W and a residence time of 3.3 s in dry air. The removal efficiency of methanol followed a sequence of dry air > humidified air > N2 carrier gas. This was due to the action of the O radical in dry air, which dominates the decomposition process of the plasma system. The introduction of water vapour into the DBD system decreased the removal efficiency but had a number of significant advantages: increased CO2 selectivity and yield of H2, it significantly reduced the formation of O3, CO and higher hydrocarbons. These influences are probably due to the presence of potent OH radicals, and the conversion pathways for the various effects are proposed. It is important to note that no solid residue was formed in the DBD reactor in any carrier gas. Overall, this research indicates that methanol can be almost completely removed with the correct operating parameters (96.7% removal; 10 W; 3.3 s) and shows that humidification of the gas stream is beneficial.
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Affiliation(s)
- Usman H Dahiru
- Department of Chemical Engineering, School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK .,Raw Materials Research and Development Council, Federal Ministry of Science and Technology Abuja Nigeria
| | - Faisal Saleem
- Department of Chemical Engineering, School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK .,Department of Chemical and Polymer Engineering, University of Engineering and Technology Lahore, Faisalabad Campus Pakistan
| | - Kui Zhang
- Department of Chemical Engineering, School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK
| | - Adam Harvey
- Department of Chemical Engineering, School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK
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Cord C, Javernick-Will A, Buhungiro E, Harvey A, Jordan E, Lockwood H, Linden K. Pathways to consumer demand and payment for professional rural water infrastructure maintenance across low-income contexts. Sci Total Environ 2022; 815:152906. [PMID: 34998778 DOI: 10.1016/j.scitotenv.2021.152906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
Systems for regular, preventive maintenance of infrastructure are needed to ensure safe water access globally. Emerging and growing across rural sub-Saharan Africa, professionalized maintenance arrangements feature legal, regulated service providers who maintain infrastructure in exchange for consumer payment through contracts. However, little is understood about the conditions that enable service providers to retain consumer contracts, an important component of their sustainability that indicates consistent demand and payment. This paper uses fuzzy-set Qualitative Comparative Analysis to identify combinations of operational, natural, physical, political, and social conditions enabling high contract retention across 22 implementation cases in Uganda, uncovering 2 pathways to success. In both pathways, consistent expansion by the service provider normalizes concepts such as tariff payment and local government participation increases trust and accountability between the service provider and consumers. The predominant pathway features one additional condition, coordinated sector aid, ensuring consistent implementation and mitigating harmful dependencies. The alternative pathway relies on large user communities and ease of access to those communities to counteract uncoordinated aid. Thus, operational, social, and political conditions may be sufficient to enable high contract retention irrespective of natural and physical conditions. This paper uncovers the combined efforts required of service providers, service authorities, international donors, and local aid actors to ensure the sustainable maintenance of rural water infrastructure for reliable safe water access.
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Affiliation(s)
- Caleb Cord
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, UCB 428, Boulder, CO 80309-0428, USA.
| | - Amy Javernick-Will
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, UCB 428, Boulder, CO 80309-0428, USA.
| | | | - Adam Harvey
- Whave Solutions, P.O. Box 72305, Clock Tower Post Office, Kampala, Uganda.
| | | | - Harold Lockwood
- Aguaconsult, 4 Pearl Walk, Cooks Shipyard, Wivenhoe, Colchester CO7 9GS, United Kingdom.
| | - Karl Linden
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, UCB 428, Boulder, CO 80309-0428, USA.
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Orenstein R, Dubberke ER, Khanna S, Lee CH, Yoho D, Johnson S, Hecht G, DuPont HL, Gerding DN, Blount KF, Mische S, Harvey A. Durable reduction of Clostridioides difficile infection recurrence and microbiome restoration after treatment with RBX2660: results from an open-label phase 2 clinical trial. BMC Infect Dis 2022; 22:245. [PMID: 35279084 PMCID: PMC8917640 DOI: 10.1186/s12879-022-07256-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Effective treatment options for recurrent Clostridioides difficile infection (rCDI) are limited, with high recurrence rates associated with the current standard of care. Herein we report results from an open-label Phase 2 trial to evaluate the safety, efficacy, and durability of RBX2660—a standardized microbiota-based investigational live biotherapeutic—and a closely-matched historical control cohort.
Methods
This prospective, multicenter, open-label Phase 2 study enrolled patients who had experienced either ≥ 2 recurrences of CDI, treated by standard-of-care antibiotic therapy, after a primary CDI episode, or ≥ 2 episodes of severe CDI requiring hospitalization. Participants received up to 2 doses of RBX2660 rectally administered with doses 7 days apart. Treatment success was defined as the absence of CDI diarrhea without the need for retreatment for 8 weeks after completing study treatment. A historical control group with matched inclusion and exclusion criteria was identified from a retrospective chart review of participants treated with standard-of-care antibiotics for recurrent CDI who matched key criteria for the study. The primary objective was to compare treatment success of RBX2660 to the historical control group. A key secondary outcome was the safety profile of RBX2660, including adverse events and CDI occurrence through 24 months after treatment. In addition, fecal samples from RBX2660-treated participants were sequenced to evaluate microbiome composition and functional changes from before to after treatment.
Results
In this Phase 2 open-label clinical trial, RBX2660 demonstrated a 78.9% (112/142) treatment success rate compared to a 30.7% (23/75) for the historical control group (p < 0.0001; Chi-square test). Post-hoc analysis indicated that 91% (88/97) of evaluable RBX2660 responders remained CDI occurrence-free to 24 months after treatment demonstrating durability. RBX2660 was well-tolerated with mostly mild to moderate adverse events. The composition and diversity of RBX2660 responders’ fecal microbiome significantly changed from before to after treatment to become more similar to RBX2660, and these changes were durable to 24 months after treatment.
Conclusions
In this Phase 2 trial, RBX2660 was safe and effective for reducing rCDI recurrence as compared to a historical control group. Microbiome changes are consistent with restorative changes implicated in resisting C. difficile recurrence.
Clinical Trials Registration NCT02589847 (10/28/2015)
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McCartney B, Harvey A, Kernaghan A, Morais S, McAlister O, Crawford P, Biglarbeigi P, Bond R, Finlay D, McEneaney D. Pediatric defibrillation shocks alone do not cause heart damage in a porcine model. Resusc Plus 2022; 9:100203. [PMID: 35146463 PMCID: PMC8816722 DOI: 10.1016/j.resplu.2022.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
AEDs utilize specific low energy pediatric modes to reduce myocardial damage. This study applied various shocks in sinus rhythm without cardiac instrumentation. Isolated clinically relevant shock sequences do not result in myocardial damage. Typical variations in pediatric shocks did not affect safety and efficacy. These results may inform future pediatric resuscitation guidelines.
Aim Automated external defibrillators (AEDs) use various shock protocols with different characteristics when deployed in pediatric mode. The aim of this study is to assess and compare the safety and efficacy of different AED pediatric protocols using novel experimental approaches. Methods Two defibrillation protocols (A and B) were assessed across two studies: Protocol A: escalating (50–75–90 J) defibrillation waveform with higher voltage, shorter duration and equal phase durations. Protocol B; non-escalating (50–50–50 J) defibrillation waveform with lower voltage, longer duration and unequal phase durations. Experiment 1: Isolated shock damage was assessed following shocks to 12 anesthetized pigs. Animals were randomized into two groups, receiving three shocks from Protocol A (50–75–90 J) or B (50–50–50 J). Cardiac function, cardiac troponin I (cTnI), creatine phosphokinase (CPK) and histopathology were analyzed. Experiment 2: Defibrillation safety and efficacy were assessed through shock success, ROSC, ST-segment deviation and contractility following 16 randomized shocks from protocol A or B delivered to 10 anesthetized pigs in VF. Results Experiment 1: No clinically meaningful difference in cTnI, CPK, ST-segment deviation, ejection fraction or histopathological damage was observed following defibrillation with either protocol. No difference was observed between protocols at any timepoint. Experiment 2: all defibrillation types demonstrated shock success and ROSC ≥ 97.5%. Post-ROSC contractility was similar between protocols. Conclusions There is no evidence that administration of clinically relevant shock sequences, without experimental confounders, result in significant myocardial damage in this model of pediatric resuscitation. Typical variations in AED pediatric mode settings do not affect defibrillation safety and efficacy.
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Humadi JI, Gheni SA, Ahmed SMR, Harvey A. Dimensionless evaluation and kinetics of rapid and ultradeep desulfurization of diesel fuel in an oscillatory baffled reactor. RSC Adv 2022; 12:14385-14396. [PMID: 35733914 PMCID: PMC9149686 DOI: 10.1039/d2ra01663j] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
The oxidative desulfurization (ODS) of dibenzothiophene in diesel fuel cut using a homogeneous liquid catalytic system in a novel reactor is presented.
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Affiliation(s)
| | - Saba A. Gheni
- Chemical Engineering Department, Tikrit University, Iraq
| | | | - Adam Harvey
- Process Intensification Group, School of Engineering, Newcastle University, UK
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26
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Hassan AA, Gheni SA, Ahmed SM, Abdullah GH, Harvey A. Aromatic Free Fenton Process for Rapid Removal of Phenol from Refinery Wastewater in an Oscillatory Baffled Reactor. ARAB J CHEM 2021. [DOI: 10.1016/j.arabjc.2021.103635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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27
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Morais S, McAlister O, Kernaghan A, Harvey A, Owens P, Idris A, Adgey J. Does patient age and BMI affect temporal changes in depth-force relationship during CPR? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
A strong non-linear relationship exists between chest compression (CC) force and depth during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest events. A decrease in the depth-force (DF) relationship over time and cumulative number of CC has been described for both human and animal subjects. The effect of patient demographics such as age and body mass index (BMI) in the DF relationship during CPR is not as widely explored.
Purpose
The aim of the present study was to analyse the temporal effect of patient demographics (i.e. age and BMI) in the DF relationship during the performance of CPR.
Methods
Data were collected from a first responder group based in Texas, USA. Responders were instructed to use a CPR depth feedback device (Laerdal CPRmeter) and an automated external defibrillator (AED; HeartSine SAM 350P) when attending sudden cardiac arrest events. The AED was configured with a shock protocol separated by 2-minute episodes of CPR and rescuer CC depth and rate were guided by the CPR depth feedback device. Patient demographic data was captured at the cardiac arrest scene.
CC depth and force data were extracted from Laerdal CPRmeter and processed for 171 patient events. The depth-force ratio (DFR) was calculated as mean depth local maxima divided by mean force local maxima (mm/kgf). Data processing and statistical analyses were performed with R version 3.7.3.
Patient age was available for 169 events (median (IQR) = 63 (53–76) years). Age was categorised in two groups: 18–64 (n=87) and 65+ years (n=82). Patient BMI was estimated for 149 patients (median (IQR) = 25.84 (22.58–31.05) kg/m2). BMI was categorised as: Underweight (gUW, BMI <18.5, n=13), Normal (gN, 18.5 ≤ BMI <25, n=54), Overweight (gOW, 25 ≤ BMI <30, n=37) and Obese (gOB, BMI ≥30, n=45).
Results
No statistically significant differences in mean event duration were found in the age groups (t-test, p=0.368) or the BMI groups (ANOVA, p=0.309).
A multiple linear regression model was applied to the data to assess the effect of time and age or BMI on the DFR. At the beginning of the events, no statistically significant differences were found in DFR between age groups (p=0.092). Time had no effect on the change in DFR for 18–64 age group (p=0.110) but the rate of change between the 18–64 and 65+ age groups was significantly different (p<0.010).
For BMI and using gN as reference, there were significant differences in DFR between all BMI groups except gUW at the beginning of the events. Time had a significant effect in DFR during events for gUW, gN and gOB (p<0.050), but no common trend in temporal change was identified.
Conclusions
Temporal changes in DFR appear to be significantly affected by patient age. Tailoring CC force or depth to patient demographics during CPR events may be required for some patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): HeartSine Technologies Ltd, Belfast, UK
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Affiliation(s)
- S Morais
- HeartSine Technologies Ltd, Belfast, United Kingdom
| | - O McAlister
- HeartSine Technologies Ltd, Belfast, United Kingdom
| | - A Kernaghan
- HeartSine Technologies Ltd, Belfast, United Kingdom
| | - A Harvey
- HeartSine Technologies Ltd, Belfast, United Kingdom
| | - P Owens
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - A Idris
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - J Adgey
- Royal Victoria Hospital, Belfast Heart Centre, Belfast, United Kingdom
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Harvey A, Brown MEL, Byrne MHV, Ashcroft J, Wan JCM, Alexander L, Schindler N, Brassett C. 729 “I Don’t Feel Like I’m Learning How to Be A Doctor:” The Impact of Disruptions Due to Covid-19 On Professional Identity Formation in UK Medical Students. Br J Surg 2021. [PMCID: PMC8524597 DOI: 10.1093/bjs/znab259.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Professional identity formation (PIF) is a priority of medical training. Covid-19 caused disruption to medical education. We ask how this disruption impacted PIF through the lens of the activities performed – or not performed – by medical students during the first wave of the covid-19 pandemic, and perceptions of conflicts between activities. Method A pragmatic survey was distributed in spring 2020. Thematic analysis was performed of qualitative responses to two open questions. A social constructivist approach linked participants’ comments to PIF theory. Results We analysed 928 responses. Three themes surrounding students’ activities during covid-19 and their impact on identity were constructed: Conflict arose at the intersections between these themes. Students noted lack of clinical exposure was detrimental, implicitly recognising that aspects of PIF require the clinical environment. Participants were keen to volunteer but struggled with balancing academic work. Participants worried about risk to their households and the wider community and wanted their skills to add value in the clinical environment. Volunteers felt frustrated when they were unable to perform tasks aligning with their identity as a future doctor. An exception was participants who worked as interim FY1s, aligned with the role of an FY1. Conclusions Medical students feel a duty to help during crises. Conflict arises when different aspects of their identity demand different actions. Care must be taken to nurture PIF during periods of disruption.
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Affiliation(s)
- A Harvey
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - M E L Brown
- Hull York Medical School, Health Professions Education Unit, Hull York, United Kingdom
| | - M H V Byrne
- University of Oxford, Department of Urology, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - J Ashcroft
- University of Cambridge, Department of Surgery. Cambridge University Hospitals Trust, Cambridge, United Kingdom
| | - J C M Wan
- Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - L Alexander
- Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - N Schindler
- Norfolk and Norwich University Hospitals Foundation Trust, Paediatric Department, Norwich, United Kingdom
| | - C Brassett
- University of Cambridge, Department of Physiology, Development and Neuroscience, Cambridge, United Kingdom
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Alves-Lopes R, Montezano AC, Neves KB, Harvey A, Rios FJ, Skiba DS, Arendse LB, Guzik TJ, Graham D, Poglitsch M, Sturrock E, Touyz RM. Selective Inhibition of the C-Domain of ACE (Angiotensin-Converting Enzyme) Combined With Inhibition of NEP (Neprilysin): A Potential New Therapy for Hypertension. Hypertension 2021; 78:604-616. [PMID: 34304582 PMCID: PMC8357049 DOI: 10.1161/hypertensionaha.121.17041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Rhéure Alves-Lopes
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | - Augusto C. Montezano
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | - Karla B. Neves
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | - Adam Harvey
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | - Francisco J. Rios
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | - Dominik S. Skiba
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | - Lauren B. Arendse
- Institute of Infectious Disease and Molecular Medicine and Division of Medical Biochemistry, University of Cape Town, South Africa (L.B.A., E.S.)
| | - Tomasz J. Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | - Delyth Graham
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
| | | | - Edward Sturrock
- Institute of Infectious Disease and Molecular Medicine and Division of Medical Biochemistry, University of Cape Town, South Africa (L.B.A., E.S.)
| | - Rhian M. Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.A.-L., A.C.M., K.B.N., A.H., F.J.R., D.S.S., T.J.G., D.G., R.M.T.)
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30
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Saleem F, Rehman A, Ahmad F, Khoja AH, Javed F, Zhang K, Harvey A. Removal of toluene as a toxic VOC from methane gas using a non-thermal plasma dielectric barrier discharge reactor. RSC Adv 2021; 11:27583-27588. [PMID: 35480659 PMCID: PMC9037792 DOI: 10.1039/d1ra04772h] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Methane is the main component of biogas, which could be used as a renewable energy source for electricity, source of heat, and biofuel production after upgrading from biogas. It also contains toxic compounds which cause environmental and human health problems. Therefore, in this work, the removal of a toxic compound (toluene) from methane gas was studied using a dielectric barrier discharge (DBD) reactor. It was observed that the removal of the toxic compound could be achieved from methane carrier gas using a dielectric barrier discharge reactor, and it depends on plasma input power. The maximum removal of the toxic compound was 85.9% at 40 W and 2.86 s. The major gaseous products were H2 and lower hydrocarbons (LHC) and the yield of these products also increases with input power. In the current study, the yield of gaseous products depends on the decomposition of toxic compounds and methane, because the decomposition of methane also produces H2 and lower hydrocarbons. The percentage yield of H2 increases from 0.43-4.74%. Similarly, the yield of LHC increases from 0.56-7.54% under the same reaction conditions. Hence, input power promoted the decomposition of the toxic compound and enhanced the yield of gaseous products.
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Affiliation(s)
- Faisal Saleem
- School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK .,Department of Chemical and Polymer Engineering, University of Engineering and Technology Faisalabad Campus Lahore Pakistan
| | - Abdul Rehman
- School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK .,Department of Chemical and Polymer Engineering, University of Engineering and Technology Faisalabad Campus Lahore Pakistan
| | - Farhan Ahmad
- Department of Chemical Engineering, University of Engineering and Technology Lahore Pakistan
| | - Asif Hussain Khoja
- Fossil Fuels Laboratory, Department of Thermal Energy Engineering, U.S.-Pakistan Centre for Advanced Studies in Energy (USPCAS-E), National University of Sciences & Technology (NUST) Sector H-12 Islamabad 44000 Pakistan
| | - Farhan Javed
- Department of Chemical and Polymer Engineering, University of Engineering and Technology Faisalabad Campus Lahore Pakistan
| | - Kui Zhang
- School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK
| | - Adam Harvey
- School of Engineering, Newcastle University Newcastle upon Tyne NE1 7RU UK
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31
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Gafni E, Harvey A, Jaroszewicz A, Solari OS, Landolin J, Barbirou M, Miller A, Tonellato PJ, Kundaje A, Jeffrey SS, Curtis C, Sledge GW, Giresi P, Boley N. Abstract 2105: Cell-free DNA fragments inform epigenomic mechanisms for early detection of breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Chromatin accessibility and cell-free DNA fragmentation patterns can be used to identify epigenomic mechanisms (Sharma et al. 2010) and infer cell-types contributing to cfDNA in pathological states such as cancer (Snyder et al. 2016; Ulz et al. 2017). We describe results from a novel blood-based cell-free DNA (cfDNA) assay using epigenomic signatures that have high sensitivity for detecting early stages of breast cancer, a cancer type that is characterized by low tumor burden (Phallen et al. 2017). We present the results from a prospective, case-control study demonstrating improved sensitivity to the screening mammogram and other published blood-based assays.
Methods: Assay performance was evaluated using a case-control study design enrolling 123 total subjects (58% Healthy, 18% Stage I, 13% Stage II, 11% Stage III). Cases were defined as subjects with a confirmatory diagnosis of invasive breast cancer, at any stage, by tissue biopsy. Controls were composed of subjects with either a negative finding by mammography (BI-RADS 1 or 2) or self-declared cancer-free. Whole blood samples were collected in Streck BCT tubes and shipped to a central laboratory for processing. Total cell-free DNA was extracted from plasma and prepped for next-generation sequencing. Sequencing libraries were enriched using a custom panel targeting genomic regions with distinct epigenomic activity in breast cancer. We trained a neural net to predict regulatory events in each of these regions, and then identified those events that were predictive of the presence of breast cancer. Final classification was performed by logistic regression over the predicted regulatory events.
Results: Performance was tested using a held-out test set and achieved an overall sensitivity of 92.5% (95% CI: 88.1%, 97%) at specificity of 88.9% with an overall AUC of 95.8%. Performance of screening mammography is reported to be 86.9% (95% CI: 86.3%, 87.6%) sensitive at 88.9% specificity on data obtained from six Breast Cancer Surveillance Consortium (BCSC) registries on 792808 women (Lehman et al. 2017).
Conclusion: These results support the utility for detecting epigenomic signals from cell-free DNA to enhance early detection of breast cancer. A prospective breast cancer screening study in a larger cohort is needed to further validate performance.
Citation Format: Erik Gafni, Adam Harvey, Artur Jaroszewicz, Omid Shams Solari, Jane Landolin, Mouadh Barbirou, Amanda Miller, Peter J. Tonellato, Anshul Kundaje, Stefanie S. Jeffrey, Christina Curtis, George W. Sledge, Paul Giresi, Nathan Boley. Cell-free DNA fragments inform epigenomic mechanisms for early detection of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2105.
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Affiliation(s)
- Erik Gafni
- 1Ravel Biotechnology Inc., San Francisco, CA
| | - Adam Harvey
- 1Ravel Biotechnology Inc., San Francisco, CA
| | | | | | | | - Mouadh Barbirou
- 2Biomedical Informatics, University of Missouri, Columbia, MO
| | - Amanda Miller
- 2Biomedical Informatics, University of Missouri, Columbia, MO
| | | | | | | | | | | | - Paul Giresi
- 1Ravel Biotechnology Inc., San Francisco, CA
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32
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Harvey A, Hou L, Davidson-Kelly K, Schaefer RS, Hong S, Mangin JF, Overy K, Roberts N. Increased representation of the non-dominant hand in pianists demonstrated by measurement of 3D morphology of the central sulcus. Psychoradiology 2021; 1:66-72. [PMID: 38665358 PMCID: PMC10939323 DOI: 10.1093/psyrad/kkab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 04/28/2024]
Abstract
Background Post-mortem and magnetic resonance imaging (MRI) studies of the central sulcus, as an indicator of motor cortex, have shown that in the general population there is greater representation of the dominant compared to the non-dominant hand. Studies of musicians, who are highly skilled in performing complex finger movements, have suggested this dominance is affected by musical training, but methods and findings have been mixed. Objective In the present study, an automated image analysis pipeline using a 3D mesh approach was applied to measure central sulcus (CS) asymmetry on MR images obtained for a cohort of right-handed pianists and matched controls. Methods The depth, length, and surface area (SA) of the CS and thickness of the cortical mantle adjacent to the CS were measured in each cerebral hemisphere by applying the BrainVISA Morphologist 2012 software pipeline to 3D T1-weighted MR images of the brain obtained for 15 right-handed pianists and 14 controls, matched with respect to age, sex, and handedness. Asymmetry indices (AIs) were calculated for each parameter and multivariate analysis of covariance (MANCOVA), and post hoc tests were performed to compare differences between the pianist and control groups. Results A one-way MANCOVA across the four AIs, controlling for age and sex, revealed a significant main effect of group (P = 0.04), and post hoc analysis revealed that while SA was significantly greater in the left than the right cerebral hemisphere in controls (P < 0.001), there was no significant difference between left and right SA in the pianists (P = 0.634). Independent samples t-tests revealed that the SA of right CS was significantly larger in pianists compared to controls (P = 0.015), with no between-group differences in left CS. Conclusions Application of an image analysis pipeline to 3D MR images has provided robust evidence of significantly increased representation of the non-dominant hand in the brain of pianists compared to age-, sex-, and handedness-matched controls. This finding supports prior research showing structural differences in the central sulcus in musicians and is interpreted to reflect the long-term motor training and high skill level of right-handed pianists in using their left hand.
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Affiliation(s)
- Adam Harvey
- Reid School of Music, Alison House, 12 Nicolson Square, University of Edinburgh, EH8 9DF, UK
- School of Clinical Sciences, The Queen's Medical Research Institute (QMRI), University of Edinburgh, EH16 4TJ, UK
| | - Lewis Hou
- School of Clinical Sciences, The Queen's Medical Research Institute (QMRI), University of Edinburgh, EH16 4TJ, UK
| | | | - Rebecca S Schaefer
- Health, Medical and Neuropsychology Unit, Institute for Psychology, Leiden University, Leiden, The Netherlands
- Academy of Creative and Performing Arts, Leiden University, Leiden, The Netherlands
| | - Sujin Hong
- Neuropolitics Research Lab and Edinburgh Imaging, School of Social and Political Science, University of Edinburgh, EH8 9LN, UK
| | - Jean-François Mangin
- Université Paris-Saclay, CEA, Centre National de la Recherche Scientifique (CNRS), Neurospin, Baobab, Gif-sur-Yvette, France
| | - Katie Overy
- Reid School of Music, Alison House, 12 Nicolson Square, University of Edinburgh, EH8 9DF, UK
| | - Neil Roberts
- School of Clinical Sciences, The Queen's Medical Research Institute (QMRI), University of Edinburgh, EH16 4TJ, UK
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33
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Byrne M, Ashcroft J, Alexander L, Wan J, Harvey A. 986 A Systematic Review of Medical Student Willingness to Volunteer and Preparedness for Pandemics and Disasters. Br J Surg 2021. [PMCID: PMC8135845 DOI: 10.1093/bjs/znab134.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction We aimed to identify motivators and barriers to volunteering during a disaster and knowledge and medical school curriculum of disaster and pandemic medicine. Method We systematically searched the literature on 28/6/2020, following PRISMA guidelines. Results A total of 37 studies met inclusion criteria including 11,168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%), and five evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD = 21.7%, n = 2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (P<.001). We identified a number of modifiable barriers which may contribute to this difference. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD = 15.1%, n = 2985). Conclusions There is a large number of students who are willing to volunteer during pandemics. However, they are likely to be under-prepared for these roles due to poor overall knowledge and limited teaching. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. Medical schools need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared for these roles.
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Affiliation(s)
- M Byrne
- University of Cambridge, Department of Surgery. Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - J Ashcroft
- University of Cambridge, Department of Surgery. Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - L Alexander
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - J Wan
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - A Harvey
- King's College London, London, United Kingdom
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34
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Byrne M, Ashcroft J, Wan J, Alexander L, Harvey A, Schindler N, Brassett C. 967 COVID READY Study: Cross-Sectional Survey of Medical Students Volunteering During the Coronavirus Pandemic (COVID-19) In the United Kingdom. Br J Surg 2021. [PMCID: PMC8135849 DOI: 10.1093/bjs/znab135.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction We aimed to identify the willingness, attitudes, and practice of medical students towards volunteering in a clinical capacity during the COVID-19 pandemic. Method We distributed a cross-sectional survey from 2/5/2020 to 14/6/2020 to all medical students at UK medical schools. Results A total of 1145 medical students from 36 medical schools completed the questionnaire. 82.7% of students were willing to volunteer, but only 34.3% had volunteered. The strongest predictors of willingness to volunteer on multiple linear regression were the beliefs that volunteering to work would benefit their medical education (estimate=0.35±0.03, adjusted P < 0.001) and that they would have a positive impact (estimate=0.33±0.03, adjusted P < 0.001). The majority of students were willing to take up a clinical role and were confident in having the necessary skills, but there was a discrepancy between the role’s students were comfortable performing and those they were assigned. Thematic analysis of the issue’s students would face when volunteering identified five themes: safety, professional practice, pressure to volunteer, finances and logistics, and education. Conclusions This study identifies areas for consideration from those responsible for workforce planning, healthcare provision, and student safety. We provide recommendations to facilitate a volunteering process that is safer for students, staff, and patients.
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Affiliation(s)
- M Byrne
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
- University of Cambridge, Department of Physiology, Development and Neuroscience, Cambridge, United Kingdom
| | - J Ashcroft
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Wan
- University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Alexander
- University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Harvey
- King’s College London GKT School of Medical Education, London, United Kingdom
| | - N Schindler
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
- University of Cambridge, Institute of Continuing Education, Cambridge, United Kingdom
| | - C Brassett
- University of Cambridge, Department of Physiology, Development and Neuroscience, Cambridge, United Kingdom
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35
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Rehman A, Saleem F, Javed F, Qutab H, Eze VC, Harvey A. Kinetic study for styrene carbonate synthesis via CO2 cycloaddition to styrene oxide using silica-supported pyrrolidinopyridinium iodide catalyst. J CO2 UTIL 2021. [DOI: 10.1016/j.jcou.2020.101379] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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36
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Hain-Saunders N, Harvey A, Riley T. Wild horses and horse manure as reservoirs for Clostridiodes difficile in Australia. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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37
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Hain-Saunders N, Harvey A, Riley T. Wild horses and horse manure as reservoirs for Clostridiodes difficile in Australia. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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38
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Alves-Lopes R, Neves KB, Harvey A, Montezano AC, Touyz RM. Abstract MP29: Activation Of Transient Receptor Potential Melastatin 2 (trpm2) Cation Channel Contributes To Nox4-induced Protective Effects In Endothelial Cells. Hypertension 2020. [DOI: 10.1161/hyp.76.suppl_1.mp29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
NOX4-induced H
2
O
2
production promotes vasodilation and is cardiovascular protective. H
2
O
2
also regulates TRPM2, a redox-sensitive channel that regulates Ca
2
influx. eNOS is a Ca
2+
-dependent enzyme, and hypertension-associated endothelial dysfunction involves eNOS inactivation. As NOX4-derived H
2
O
2
regulates TRPM2 and consequently Ca
2+
influx, we questioned whether downregulation of the H
2
O
2
-TRPM2-Ca
2+
axis in endothelial cells may contributes to impaired vascular relaxation in hypertension. WT and TTRhRen hypertensive mice were crossed with Nox4 KO mice. Vascular function was studied in mesenteric resistance arteries by wire myography. Ca
2+
influx was assessed by fluorescence microscopy in aortic endothelial cells, eNOS activation and TRPM2 expression were assessed by immunoblotting and immunohistochemistry, respectively. Blood pressure in TTRhRen (130.3±7.0 mmHg) and TTRhRen/NOX4 KO mice (141.3±18 mmHg) was significantly increased compared to control mice (98.1±8.0 mmHg). Endothelium-dependent relaxation was impaired in TTRhRen mice (Emax: WT 83.5±4.03
vs
TTRhRen 59.1±3.5), effects worsened by NOX4 KO (37.9±5.4), p<0.05. Activation of TRPM2 with ADPR, improved vascular relaxation in TTRhRen/NOX4 KO mice (75.9±7.7); an effect also achieved with H
2
O
2
incubation (74.2±15.4), p<0.05. Ang II stimulated H
2
O
2
generation (% of control: 138.23±9.04) followed by Ca
2+
influx (AUC - Ca
2+
: 19401.25±1940.21), an important regulator of eNOS. These processes were reduced by TRPM2 inhibition (AUC - Ca
2+
: 8-br-cADPR 15232.2±1052.0; Olaparib 14260±843.2 and 2-APB 13095.2±277.4, p<0.05) and by the NOX1/4 inhibitor GKT137831 (AUC - Ca
2+
: Ang II 107357±1940.2 vs GKT 15067.5±255.6, p<0.05). Activation of eNOS (Ser1177) by Ang II in endothelial cells was blocked by PEG-catalase, GKT137831, and the TRPM2 inhibitor 8-br-cADPR. TRPM2 inhibitors also increased MAPK expression in endothelial cells. In conclusion, endothelial dysfunction in TTRhRen/NOX4 KO mice involves impaired TRPM2 activation. Reduced bioavailability of H
2
O
2
due to Nox4 downregulation is a major driver of this process. We identify a new axis in endothelial cells involving Nox4-H
2
O
2
-mediated activation of TRPM2-Ca
2+
-eNOS signalling which is vasoprotective.
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Affiliation(s)
| | | | - Adam Harvey
- UNIVERSITY OF GLASGOW, Glasgow, United Kingdom
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Torney H, McAlister O, Harvey A, Kernaghan A, Funston R, McCartney B, Davis L, Bond R, McEneaney D, Adgey J. Real-world insight into public access defibrillator use over five years. Open Heart 2020; 7:openhrt-2020-001251. [PMID: 32513668 PMCID: PMC7282393 DOI: 10.1136/openhrt-2020-001251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Public access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a retrospective observational cohort study, describing real-world PAD utilisation over a 5-year period. METHODS Data were collected between October 2012 and October 2017. Responders voluntarily submitted electronic data downloaded from HeartSine PADs, and patient demographics and other details using a case report form in exchange for a replacement battery and electrode pack. RESULTS Data were collected for 977 patients (692 males, 70.8%; 255 females, 26.1%; 30 unknown, 3.1%). The mean age (SD) was 59 (18) years (range <1 year to 101 years). PAD usage occurred most commonly in homes (n=328, 33.6%), followed by public places (n=307, 31.4%) and medical facilities (n=128, 13.1%). Location was unknown in 40 (4.09%) events. Shocks were delivered to 354 patients. First shock success was 312 of 350 patients where it could be determined (89.1%, 95% CI 85.4% to 92.2%). Patients with reported response times ≤5 min were more likely to survive to hospital admission (89/296 (30.1%) vs 40/250 (16.0%), p<0.001). Response time was unknown for 431 events. CONCLUSION This is the first study to report global PAD usage in voluntarily submitted, unselected real-world cases and demonstrates the real-world effectiveness of PADs, as confirmed by first shock success.
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Affiliation(s)
- Hannah Torney
- Ulster University, Newtownabbey, Northern Ireland, UK .,HeartSine Technologies Ltd, Belfast, UK
| | - Olibhéar McAlister
- Ulster University, Newtownabbey, Northern Ireland, UK.,HeartSine Technologies Ltd, Belfast, UK
| | | | - Amy Kernaghan
- Ulster University, Newtownabbey, Northern Ireland, UK.,HeartSine Technologies Ltd, Belfast, UK
| | | | | | | | - Raymond Bond
- Ulster University, Newtownabbey, Northern Ireland, UK
| | - David McEneaney
- Cardiovascular Research Unit, Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, UK
| | - Jennifer Adgey
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
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40
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Benz C, Harvey A, Middleton A, Elliott A. WS07.3 Managing exacerbations in young people with cystic fibrosis through Hospital in the Home physiotherapy via Telehealth. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Alfano CA, Bower J, Harvey A, Beidel D, Sharp C, Palmer CA. 0939 Anxiety Symptoms Moderate the Effects of Sleep Loss on Children’s Emotions. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
An abundance of cross-sectional research links inadequate sleep with poor emotional health, but experimental studies in children are rare. Further, the impact of sleep loss is not uniform across individuals, and pre-existing anxiety might potentiate the effects of poor sleep on children’s emotional functioning.
Methods
N=53 children (mean age 9.0 years; 56% female) completed multi-modal, emotional assessments in the lab when rested and after two nights of sleep restriction (7h and 6h in bed, respectively). Sleep was monitored with polysomnography and actigraphy. Subjective reports of affect and arousal, psychophysiological reactivity, and objective emotional expression were examined during two emotional processing tasks, including one where children were asked to suppress their emotional responses.
Results
After sleep restriction, deleterious alterations were observed in children’s affect and their emotional reactivity, expression, and regulation. These effects were primarily limited to positive emotional stimuli. The presence of anxiety symptoms moderated most of the alterations in emotional processing observed after sleep restriction.
Conclusion
Results suggest inadequate sleep preferentially impacts positive compared to negative emotion in pre-pubertal children and that pre-existing anxiety symptoms amplify these effects. Implications for children’s everyday socio-emotional lives and long-term affective risk are highlighted.
Support
NIMH grant #R21MH099351
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Affiliation(s)
| | - J Bower
- DeMontfort University, Leicester, UNITED KINGDOM
| | - A Harvey
- University of California, Berkeley, Berkeley, CA
| | - D Beidel
- University of Central Florida, Orlando, FL
| | - C Sharp
- University of Houston, Houston, TX
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Mackle C, Bond R, Torney H, Mcbride R, Mclaughlin J, Finlay D, Biglarbeigi P, Brisk R, Harvey A, Mceneaney D. A Data-Driven Simulator for the Strategic Positioning of Aerial Ambulance Drones Reaching Out-of-Hospital Cardiac Arrests: A Genetic Algorithmic Approach. IEEE J Transl Eng Health Med 2020; 8:1900410. [PMID: 32399316 PMCID: PMC7210790 DOI: 10.1109/jtehm.2020.2987008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
Objective: The Internet of Things provide solutions for many societal challenges including the use of unmanned aerial vehicles to assist in emergency situations that are out of immediate reach for traditional emergency services. Out of hospital cardiac arrest (OHCA) can result in death with less than 50% of victims receiving the necessary emergency care on time. The aim of this study is to link real world heterogenous datasets to build a system to determine the difference in emergency response times when having aerial ambulance drones available compared to response times when depending solely on traditional ambulance services and lay rescuers who would use nearby publicly accessible defibrillators to treat OHCA victims. Method: The system uses the geolocations of public accessible defibrillators and ambulance services along with the times when people are likely to have a cardiac arrest to calculate response times. For comparison, a Genetic Algorithm has been developed to determine the strategic number and positions of drone bases to optimize OHCA emergency response times. Conclusion: Implementation of a nationwide aerial drone network may see significant improvements in overall emergency response times for OHCA incidents. However, the expense of implementation must be considered.
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Affiliation(s)
- Conor Mackle
- 1School of ComputingUlster UniversityNewtownabbeyBT37 0QBU.K
| | - Raymond Bond
- 1School of ComputingUlster UniversityNewtownabbeyBT37 0QBU.K
| | - Hannah Torney
- 1School of ComputingUlster UniversityNewtownabbeyBT37 0QBU.K.,2HeartSine Technologies Ltd.BelfastBT3 9EDU.K
| | - Ronan Mcbride
- 3Southern Health and Social Care TrusPortadownBT63 5QQU.K
| | | | - Dewar Finlay
- 4School of EngineeringUlster UniversityNewtownabbeyBT37 0QBU.K
| | | | - Rob Brisk
- 5Department of CardiologyCraigavon Area HospitalPortadownBT63 5QQU.K
| | - Adam Harvey
- 2HeartSine Technologies Ltd.BelfastBT3 9EDU.K
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Kelleher J, Dickinson A, Cain S, Hu Y, Bates N, Harvey A, Ren J, Zhang W, Moreton FC, Muir KW, Ward C, Touyz RM, Sharma P, Xu Q, Kimber SJ, Wang T. Patient-Specific iPSC Model of a Genetic Vascular Dementia Syndrome Reveals Failure of Mural Cells to Stabilize Capillary Structures. Stem Cell Reports 2019; 13:817-831. [PMID: 31680059 PMCID: PMC6893064 DOI: 10.1016/j.stemcr.2019.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/04/2019] [Accepted: 10/05/2019] [Indexed: 12/13/2022] Open
Abstract
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is the most common form of genetic stroke and vascular dementia syndrome resulting from mutations in NOTCH3. To elucidate molecular mechanisms of the condition and identify drug targets, we established a patient-specific induced pluripotent stem cell (iPSC) model and demonstrated for the first time a failure of the patient iPSC-derived vascular mural cells (iPSC-MCs) in engaging and stabilizing endothelial capillary structures. The patient iPSC-MCs had reduced platelet-derived growth factor receptor β, decreased secretion of the angiogenic factor vascular endothelial growth factor (VEGF), were highly susceptible to apoptotic insults, and could induce apoptosis of adjacent endothelial cells. Supplementation of VEGF significantly rescued the capillary destabilization. Small interfering RNA knockdown of NOTCH3 in iPSC-MCs revealed a gain-of-function mechanism for the mutant NOTCH3. These disease mechanisms likely delay brain repair after stroke in CADASIL, contributing to the brain hypoperfusion and dementia in this condition, and will help to identify potential drug targets.
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Affiliation(s)
- Joseph Kelleher
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, The University of Manchester, Manchester, UK
| | - Adam Dickinson
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Cain
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Division of Cell Matrix Biology and Regenerative Medicine, The University of Manchester, Manchester, UK
| | - Yanhua Hu
- Cardiovascular Division, BHF Centre, King's College London, London, UK
| | - Nicola Bates
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Division of Cell Matrix Biology and Regenerative Medicine, The University of Manchester, Manchester, UK
| | - Adam Harvey
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jianzhen Ren
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, The University of Manchester, Manchester, UK
| | - Wenjun Zhang
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, The University of Manchester, Manchester, UK
| | - Fiona C Moreton
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Christopher Ward
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rhian M Touyz
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway University of London (ICR2UL), London, UK
| | - Qingbo Xu
- Cardiovascular Division, BHF Centre, King's College London, London, UK
| | - Susan J Kimber
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Division of Cell Matrix Biology and Regenerative Medicine, The University of Manchester, Manchester, UK.
| | - Tao Wang
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, The University of Manchester, Manchester, UK.
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Orenstein R, Mische S, Mische S, Blount K, Blount K, Bancke L, Su X, Walsh D, Harvey A, Gonzalez C, Gerding DN, Gerding DN. LB5. A Long-Time Coming: Final 2-year Analysis of Efficacy, Durability, and Microbiome Changes in a Controlled Open-Label Trial of Investigational Microbiota-Based Drug RBX2660 for Recurrent Clostridioides difficile Infections. Open Forum Infect Dis 2019. [PMCID: PMC6810069 DOI: 10.1093/ofid/ofz415.2488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Recurrent Clostridioides difficile infection (rCDI) is an urgent public health threat associated with significant mortality and medical cost. Microbiota therapy is gaining acceptance as a strategy to reduce rCDI recurrence. We present the final 24-month analysis of clinical safety, efficacy, and microbiome restoration from a Phase 2 open-label trial of RBX2660 for prevention of CDI recurrence. Methods Participants with multi-recurrent CDI received <2 doses of RBX2660 delivered via enema 7 days apart in this multicenter, open-label Phase 2 study. Efficacy was defined as the absence of CDI recurrence through 56 days after the last dose and was compared with 8-week recurrence-free rates for a historical control cohort that received standard-of-care antibiotic therapy. Fisher exact test compared the proportion of treatment participants who were CDI-free by age and sex. Durability was defined as continued absence of CDI episodes beyond 8 weeks. Safety and durability assessments occurred at 3, 6, 12, and 24 months. Participant stool samples were collected prior to and for up to 720 days after treatment, and microbiome changes were assessed by shallow shotgun sequencing. Results The efficacy of RBX2660 to prevent rCDI at 8 weeks (78.9%; 112/142) was higher than the CDI-free rate in the historical control group (30.7%, 23/75; P < 0.0001). Age and sex did not impact efficacy. Among participants who achieved treatment success at 8 weeks and were evaluable for long-term durability (n = 95), 8 experienced a new CDI episode by the 24-month follow-up for an overall durability of 91.6%. The safety profile was consistent with previous reports for RBX2660. In total, 503 stool samples from 110 treatment responders were analyzed. Within 7 days of treatment, the relative abundance of Bacteroidia and Clostridia remained shifted higher than pre-treatment levels while Gammaproteobacteria and Bacilli declined sharply after treatment, and these changes persisted to at least 24 months. Conclusion RBX2660, a microbiota-based drug, was safe and efficacious for preventing rCDI with clinical durability to 24 months after treatment, independent of age or sex, and RBX2660 durability associated with durable microbiome shifts from pre-treatment to a healthier composition. ![]()
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Disclosures Robert Orenstein, DO, Rebiotix Inc. (Advisor or Review Panel member), Sarah Mische, PhD, Rebiotix Inc. (Employee), Ken Blount, PhD, Rebiotix Inc. (Employee), Lindy Bancke, PharmD, Rebiotix Inc. (Employee), Xin Su, MD, MSci, Rebiotix Inc. (Employee), Dana Walsh, PhD, Rebiotix Inc. (Employee), Adam Harvey, PhD, Rebiotix Inc. (Employee), Carlos Gonzalez, MS, Rebiotix Inc. (Consultant), Dale N. Gerding, MD, Rebiotix Inc. (Board Member).
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Affiliation(s)
| | | | | | | | | | | | - Xin Su
- Rebiotix Inc., Roseville, Minnesota
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Torney H, Harvey A, McAlister O, Bond R, Finlay D, Magee J, McEneaney D, Adgey J. Assessing the effect of lay-rescuer gender on chest compression quality when using an automated external defibrillator in a simulated sudden cardiac arrest. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McCartney B, McAlister O, Torney H, Davis L, Gregson R, Crawford P, Clutton E, Funston R, Harvey A. Impedance cardiogram directed chest compression feedback in a porcine model of paediatric sudden cardiac arrest is associated with high levels of end-tidal carbon dioxide, shock success and ROSC. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rehman A, López Fernández AM, Gunam Resul M, Harvey A. Highly selective, sustainable synthesis of limonene cyclic carbonate from bio-based limonene oxide and CO2: A kinetic study. J CO2 UTIL 2019. [DOI: 10.1016/j.jcou.2018.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ford TJ, Rocchiccioli P, Good R, McEntegart M, Eteiba H, Watkins S, Shaukat A, Lindsay M, Robertson K, Hood S, Yii E, Sidik N, Harvey A, Montezano AC, Beattie E, Haddow L, Oldroyd KG, Touyz RM, Berry C. Systemic microvascular dysfunction in microvascular and vasospastic angina. Eur Heart J 2018; 39:4086-4097. [PMID: 30165438 PMCID: PMC6284165 DOI: 10.1093/eurheartj/ehy529] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/17/2018] [Accepted: 08/23/2018] [Indexed: 12/20/2022] Open
Abstract
Aims Coronary microvascular dysfunction and/or vasospasm are potential causes of ischaemia in patients with no obstructive coronary artery disease (INOCA). We tested the hypothesis that these patients also have functional abnormalities in peripheral small arteries. Methods and results Patients were prospectively enrolled and categorised as having microvascular angina (MVA), vasospastic angina (VSA) or normal control based on invasive coronary artery function tests incorporating probes of endothelial and endothelial-independent function (acetylcholine and adenosine). Gluteal biopsies of subcutaneous fat were performed in 81 subjects (62 years, 69% female, 59 MVA, 11 VSA, and 11 controls). Resistance arteries were dissected enabling study using wire myography. Maximum relaxation to ACh (endothelial function) was reduced in MVA vs. controls [median 77.6 vs. 98.7%; 95% confidence interval (CI) of difference 2.3-38%; P = 0.0047]. Endothelium-independent relaxation [sodium nitroprusside (SNP)] was similar between all groups. The maximum contractile response to endothelin-1 (ET-1) was greater in MVA (median 121%) vs. controls (100%; 95% CI of median difference 4.7-45%, P = 0.015). Response to the thromboxane agonist, U46619, was also greater in MVA (143%) vs. controls (109%; 95% CI of difference 13-57%, P = 0.003). Patients with VSA had similar abnormal patterns of peripheral vascular reactivity including reduced maximum relaxation to ACh (median 79.0% vs. 98.7%; P = 0.03) and increased response to constrictor agonists including ET-1 (median 125% vs. 100%; P = 0.02). In all groups, resistance arteries were ≈50-fold more sensitive to the constrictor effects of ET-1 compared with U46619. Conclusions Systemic microvascular abnormalities are common in patients with MVA and VSA. These mechanisms may involve ET-1 and were characterized by endothelial dysfunction and enhanced vasoconstriction. Clinical trial registration ClinicalTrials.gov registration is NCT03193294.
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Adam Harvey
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Augusto C Montezano
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Elisabeth Beattie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Laura Haddow
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
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Harvey A, Mielke N, Grimstead JW, Jones RE, Nguyen T, Mueller M, Baird DM, Hendrickson EA. PARP1 is required for preserving telomeric integrity but is dispensable for A-NHEJ. Oncotarget 2018; 9:34821-34837. [PMID: 30410680 PMCID: PMC6205175 DOI: 10.18632/oncotarget.26201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/15/2018] [Indexed: 01/07/2023] Open
Abstract
Poly-ADP ribose polymerase 1 (PARP1) is clinically important because of its synthetic lethality with breast cancer allele 1 and 2 mutations, which are causative for inherited breast and ovarian cancers. Biochemically, PARP1 is a single-stranded DNA break repair protein that is needed for preserving genomic integrity. In addition, PARP1 has been implicated in a veritable plethora of additional cellular pathways and thus its precise contribution(s) to human biology has remained obscure. To help address this deficiency, we utilized gene editing to construct genetically-null PARP1 human cancer cells. We found a minor role for PARP1 in an alternative form of DNA double-strand break (DSB) repair, but only when these cells were deficient for the classical form of DSB repair. Despite being proficient for DSB repair, however, cell cycle progression defects and elevated endogenous DNA damage signaling were observed. These deficiencies were instead linked to telomere defects, where PARP1 -/- cells had short telomeres that co-localized with markers of endogenous DNA damage and were compromised in their ability to escape a telomere-driven crisis. Our data suggest that while PARP1 does not participate significantly in DNA DSB repair itself, it does prevent the incidence of telomeric DSBs, which, in turn, can drive genomic instability.
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Affiliation(s)
- Adam Harvey
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
| | - Nicholas Mielke
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
| | - Julia W. Grimstead
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Rhiannon E. Jones
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Thanh Nguyen
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
| | - Matthew Mueller
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
| | - Duncan M. Baird
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Eric A. Hendrickson
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
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McCartney B, Davis L, Torney H, McAlister O, Crawford P, Funston R, Harvey A. The use of end-tidal carbon dioxide to evaluate CPR depth requirement in a porcine model of paediatric sudden cardiac arrest: Are current depth guidelines excessive? Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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