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Ortega Z, Douglas P, Hanna PR, Garrett G, Clarke A, Cunningham E, Suárez L. Characterization of PLA Sheets Prepared by Stretching under Different Conditions: Influence of Reprocessing and Establishing Optimal Conditions. Materials (Basel) 2023; 16:5114. [PMID: 37512389 PMCID: PMC10386445 DOI: 10.3390/ma16145114] [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] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Polylactide (PLA) is one of the most commonly used biomaterials nowadays, with many recognized benefits, particularly in the packaging and single-use products industries. However, little research has been conducted on its stretching behavior. This work investigates the optimal conditions of biaxial stretching of injection-molded PLA samples produced under different processing conditions (pressure, drying, and pre-processing by extrusion, to simulate a recycling step). The injection-molded samples were characterized to determine their mechanical, thermal and thermo-mechanical behavior, water absorption, thermal behavior, and crystallization kinetics. The extruded samples showed reduced thermal stability, lower viscosity, decreased mechanical properties, and higher crystallization rates due to thermal degradation. However, the stretched samples provided similar properties regardless of the materials pre-processing. Regarding the assessment of the biaxial stretching process, processing at lower temperatures provides the films with a higher yield and breaking strength, while the time and strain rates have little influence on such properties. It was then determined that 82 °C is the optimal temperature for stretching the PLA samples. An increase in the stretch ratio provided a higher elastic modulus and higher values of opacity due to an increased crystallinity induced by stress during the process. Films as thin as 50 μm can be obtained by biaxially stretching injection-molded preforms, producing a deformation over 150% and acquiring good mechanical properties: about 90 MPa for the yield and a breaking strength and elastic modulus of 4000 MPa.
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Affiliation(s)
- Zaida Ortega
- Departamento de Ingeniería de Procesos, Universidad de Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain
| | - Paula Douglas
- Polymer Processing Research Centre, School of Mechanical and Aerospace Engineering, Ashby Building, Queen's University of Belfast, Belfast BT9 5AH, Northern Ireland, UK
| | - Paul R Hanna
- Polymer Processing Research Centre, School of Mechanical and Aerospace Engineering, Ashby Building, Queen's University of Belfast, Belfast BT9 5AH, Northern Ireland, UK
| | - Graham Garrett
- Polymer Processing Research Centre, School of Mechanical and Aerospace Engineering, Ashby Building, Queen's University of Belfast, Belfast BT9 5AH, Northern Ireland, UK
| | - Alan Clarke
- Polymer Processing Research Centre, School of Mechanical and Aerospace Engineering, Ashby Building, Queen's University of Belfast, Belfast BT9 5AH, Northern Ireland, UK
| | - Eoin Cunningham
- School of Mechanical and Aerospace Engineering, Ashby Building, Queen's University Belfast, Belfast BT9 5AH, Northern Ireland, UK
| | - Luis Suárez
- Departamento de Ingeniería Mecánica, Universidad de Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain
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2
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Lim Y, Dahapute A, Clarke A, Hutton M, Selbi W. Delayed tension pneumocephalus and pneumorrhacis after routine cervical spine surgery treated successfully without burr holes. Ann R Coll Surg Engl 2023. [PMID: 37381753 DOI: 10.1308/rcsann.2023.0037] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Tension pneumocephalus (TP) after spinal surgery is very rare with only a few cases reported in the English literature. Most cases of TP occur rapidly after spinal surgery. Traditionally, TP is managed using burr holes to relieve intracranial pressure. However, our case highlights a rare delayed presentation of TP and pneumorrhacis 1 month after routine cervical spine surgery. It is to our knowledge the first case of TP after spinal surgery to be treated using dural repair and supportive care. A 75-year-old woman presented with TP after having routine cervical decompression and stabilisation for cervical myelopathy. She re-presented 1 month after her initial operation with a leaking wound and altered mental status, which deteriorated rapidly shortly after admission. This, in combination with her radiographic features, influenced the decision to explore her surgical wound emergently. She made a full recovery and was discharged after 2 weeks in hospital. We hope to emphasise the need for a high index of suspicion for cerebrospinal fluid leaks and the low threshold to return to theatre to repair a potential dural defect, as well as illustrate that TP after spinal surgery can be treated successfully without burr holes.
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Affiliation(s)
- Y Lim
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - A Dahapute
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - A Clarke
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - M Hutton
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - W Selbi
- Royal Devon and Exeter NHS Foundation Trust, UK
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3
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Arnold R, Ahmed F, Clarke A, Quinn N, Beenstock J, Holland P. The relationship between parental adverse childhood experiences and the health, well-being and development outcomes of their children: a systematic review. Public Health 2023; 219:146-153. [PMID: 37186980 DOI: 10.1016/j.puhe.2023.03.025] [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: 10/07/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES A growing body of research is emerging regarding the relationship between parental adverse childhood experiences (ACEs) and negative health, well-being and developmental outcomes in their children. This systematic review seeks to understand the relationship between parental ACEs and the health, well-being and developmental outcomes of their children and whether the relationships differ according to the number and type of parental ACEs. STUDY DESIGN Systematic review. METHOD The review includes articles published between 2000 and 2021 from studies using quantitative longitudinal methods and multivariate analysis to investigate the relationship between parental ACEs and their offspring's outcomes. Relevant studies were identified through a systematic search of five databases and findings synthesised using a narrative synthesis. This review was registered on PROSPERO (CRD42021274068). RESULTS Nineteen studies met the inclusion criteria and were included in the review. This resulted in a combined population sample of 124,043 parents and 128,400 children. Diversity in measurement of parental ACE exposure and in the type of ACEs measured within the studies precluded a meta-analysis. Offspring of parents exposed to ACEs had a higher risk of a range of negative health, well-being and developmental outcomes. This relationship differs according to the number and type of parental ACEs, with a positive relationship observed between the number of parental ACEs and the risk of negative health, well-being and development outcomes in their children. CONCLUSIONS These findings indicate that screening for parental ACEs by health visitors, midwives and other health or social care staff may identify an at-risk population of infants, children and adolescents and improve child outcomes.
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Affiliation(s)
- R Arnold
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, England, UK.
| | - F Ahmed
- Division of Health Research, Lancaster University, UK
| | - A Clarke
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK; Save the Children UK, London, England, UK
| | - N Quinn
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK
| | - J Beenstock
- Lancashire & South Cumbria NHS Foundation Trust, Preston, England, UK
| | - P Holland
- Division of Health Research, Lancaster University, UK
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Sparks R, Power S, Kearns E, Clarke A, Mohan HM, Brannigan A, Mulsow J, Shields C, Cahill RA. Fallibility of tattooing colonic neoplasia ahead of laparoscopic resection: a retrospective cohort study. Ann R Coll Surg Engl 2023; 105:126-131. [PMID: 35175862 PMCID: PMC9889182 DOI: 10.1308/rcsann.2021.0319] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Precise geographical localisation of colonic neoplasia is a prerequisite for proper laparoscopic oncological resection. Preoperative endoscopic peri-tumoural tattoo practice is routinely recommended but seldom scrutinised. METHODS A retrospective review of recent consecutive patients with preoperative endoscopic lesional tattoo who underwent laparoscopic colonic resection as identified from our prospectively maintained cancer database with supplementary clinical chart and radiological, histological, endoscopic and theatre database/logbook interrogation. RESULTS Some 210 patients with 'tattooed' colonic neoplasia were identified, of whom 169 underwent laparoscopic surgery (mean age 68 years, median BMI 27.8kg/m2, male-to-female ratio 95:74). The majority of tumours were malignant (149; 88%), symptomatic (133; 79%) and proximal to the splenic flexure (92; 54%). Inaccurate colonoscopist localisation judgement occurred in 12% of cases, 60% of which were corrected by preoperative staging computed tomography scan. A useful lesional tattoo was absent in 11/169 cases (6.5%) being specifically stated as present in 104 operation notes (61%) and absent in 10 (5.9%). Tumours missing overt peritumoral tattoos intraoperatively were more likely to be smaller, earlier stage and injected longer preoperatively (p=0.006), although half had histological ink staining. Eight lesions missing tattoos were radiologically occult. Four (44%) of these patients had on-table colonoscopy, and five (55%) needed laparotomy (conversion rate 55% vs 23% overall, p<0.005) with one needing a second operation to resect the initially missed target lesion. Mean (range) operative duration and postoperative length of stay of those missing tattoos compared with those with tattoos was 200 (78-300) versus 188 (50-597) min and 15.5 (4-22) versus 12(4-70) days (p>0.05). CONCLUSIONS Tattoo in advance of attempting laparoscopic resection is vital for precision cancer surgery especially for radiologically unseen tumours to avoid adverse clinical consequence.
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Affiliation(s)
- R Sparks
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Power
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - A Clarke
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - A Brannigan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Mulsow
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Shields
- Mater Misericordiae University Hospital, Dublin, Ireland
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Gan C, Attwell-Heap A, Clarke A. Left distal ureter leiomyosarcoma: a case report. J Surg Case Rep 2022; 2022:rjac501. [PMID: 36381984 PMCID: PMC9649425 DOI: 10.1093/jscr/rjac501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Primary leiomyosarcoma of the ureter is an extremely rare, aggressive malignancy of the urinary tract. This report describes a case of primary leiomyosarcoma of the distal left ureter in a middle-aged male, with no tumor recurrence achieved following resection and end-to-end ureteroureterostomy.
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Affiliation(s)
- C Gan
- Correspondence address. Department of Urology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia.
| | - A Attwell-Heap
- Department of Urology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
| | - A Clarke
- Department of Urology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
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Patterson B, King M, Cowan S, Mosler A, Bruder A, Clarke A, Haberfield M, Girdwood M, Culvenor A, Donaldson A, McGhee D, Makdissi M, Barton C, Roughhead E, Lampard S, Chilman K, Crossley K. Self-reported injuries in 2440 women and girls playing community Australian football: a cross-sectional study. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.029] [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: 11/17/2022]
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7
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Jones E, Frith L, Chiumento A, Rodgers S, Clarke A, Markham S, Buchan I. Public involvement in big data projects: an ethnographically-informed study. Int J Popul Data Sci 2022. [PMCID: PMC9644929 DOI: 10.23889/ijpds.v7i3.1991] [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: 11/22/2022] Open
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Almaw G, Mihret A, Abebe T, Ameni G, Gumi B, Olani A, Tamiru M, Koran T, Aliy A, Sombo M, Ayalew S, Yesuf A, Taye H, Wood JLN, Berg S, Aseffa A, Tessema B, Belachew B, Fekadu E, Melese F, Gemechu G, Tschopp R, Haile S, Hailu T, Bekele A, Yirga C, Ambaw M, Mamo T, Solomon T, Teklewold T, Gebre S, Gari G, Sahle M, Sirak A, Mekonnen G, Guta S, Wood J, Conlan A, Clarke A, Moore HL, Hodge C, Hewinson RG, Vordermeier M, Nunez‐Garcia J, Bayissa B, Zewude A, Worku A, Terfassa L, Chanyalew M, Mohammed T, Zeleke Y. Spoligotype analysis of
Mycobacterium bovis
isolates from cattle and assessment of zoonotic
TB
transmission among individuals working in bovine
TB
‐infected dairy farms in Ethiopia. Zoonoses Public Health 2022. [PMCID: PMC9544066 DOI: 10.1111/zph.12955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/30/2022]
Abstract
Bovine tuberculosis (bTB) is a disease with impact on dairy productivity, as well as having the potential for zoonotic transmission. Understanding the genetic diversity of the disease agent Mycobacterium bovis is important for identifying its routes of transmission. Here we investigated the level of genetic diversity of M. bovis isolates and assessed the zoonotic potential in risk groups of people working in bTB‐infected dairy farms in central Ethiopia. M. bovis was isolated and spoligotyped from tissue lesions collected from slaughtered cattle as well as from raw milk collected from bTB positive cows in dairy farms from six urban areas of central Ethiopia. From consented dairy farm workers, knowledge and practices related to zoonotic TB transmission, together with demographic and clinical information, was collected through interviews. Sputum or Fine Needle Aspirate (FNA) samples were collected from suspected TB cases. Spoligotyping of 55 M. bovis isolates that originated either from cattle tissues with tuberculous lesion or from raw milk revealed seven spoligotype patterns where SB1176 was the most prevalent type (47.3%). Most isolates (89.1%) were of the M. bovis African 2 clonal complex. All sputum and FNA samples from 41 dairy farm workers with symptoms of TB were culture negative for any mycobacteria. Among the 41 TB suspected farm workers, 61% did not know about bTB in cattle and its zoonotic potential, and over two‐third of these workers practiced raw milk consumption. Our spoligotype analysis suggests a wider transmission of a single spoligotype in the study area. The results reported here may be useful in guiding future work to identify the source and direction of bTB transmission and hence design of a control strategy. Isolation of M. bovis from milk, knowledge gap on zoonotic TB and practice of consumption of raw milk in the study population showed potential risk for zoonotic transmission.
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Affiliation(s)
- Gizat Almaw
- National Animal Health Diagnostic and Investigation Center Sebeta Ethiopia
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
- Armauer Hansen Research Institute Addis Ababa Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology Addis Ababa University Addis Ababa Ethiopia
- Department of Veterinary Medicine, College of Food and Agriculture United Arab Emirates University Al Ain United Arab Emirates
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology Addis Ababa University Addis Ababa Ethiopia
| | - Abebe Olani
- National Animal Health Diagnostic and Investigation Center Sebeta Ethiopia
| | - Mekdes Tamiru
- National Animal Health Diagnostic and Investigation Center Sebeta Ethiopia
| | - Tafesse Koran
- National Animal Health Diagnostic and Investigation Center Sebeta Ethiopia
| | - Abde Aliy
- National Animal Health Diagnostic and Investigation Center Sebeta Ethiopia
| | - Melaku Sombo
- National Animal Health Diagnostic and Investigation Center Sebeta Ethiopia
| | - Sosina Ayalew
- Armauer Hansen Research Institute Addis Ababa Ethiopia
| | - Adem Yesuf
- Armauer Hansen Research Institute Addis Ababa Ethiopia
| | - Hawult Taye
- Armauer Hansen Research Institute Addis Ababa Ethiopia
| | - James L. N. Wood
- Disease Dynamics Unit, Department of Veterinary Medicine University of Cambridge Cambridge UK
| | - Stefan Berg
- Bacteriology Department Animal and Plant Health Agency Weybridge UK
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9
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Zhang Y, Clarke A, Regan KH, Campbell K, Donaldson S, Crowe J, Rossi AG, Hill AT. Isolated IgG2 deficiency is an independent risk factor for exacerbations in bronchiectasis. QJM 2022; 115:292-297. [PMID: 33970283 PMCID: PMC9086763 DOI: 10.1093/qjmed/hcab129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Immunoglobulin G (IgG) subclass 2 deficiency is the most frequent IgG subclass deficiency identified in patients with bronchiectasis, but its clinical significance is not known. AIM To analyse if bronchiectasis patients with isolated IgG2 deficiency at risk of recurrent exacerbations and/or hospitalization? Do patients with IgG2 deficiency have worse disease progression? DESIGN AND METHODS This is a retrospective study (2015-20) exploring independent risk factors for recurrent exacerbations (3 or more per year) and/or hospitalization with bronchiectasis exacerbations using multivariable models using binary logistic regression. There was no patient with IgG deficiency, IgG 1, 3 or 4 deficiency, or IgA or IgM deficiency included. In this model, the authors included: serum IgG2 level; lung function; body mass index; MRC breathlessness scale; age; sex; number of bronchiectatic lobes; bacterial colonization; comorbidities; and the use of long-term immunosuppressant drugs or antibiotics for more than 28 days. Analysing 2-year longitudinal data, one-way ANOVA and Mann-Whitney U-test were used to compare bronchiectasis severity between patients with different IgG2 levels. RESULTS Serum IgG2 levels (<2.68 g/l, 2.68-3.53 g/l and 3.54-4.45 g/l); hospital admission in the preceding 2 years; bacterial colonization with potentially pathogenic organisms and asthma were independent predictors for three or more bronchiectasis exacerbations. Those with low IgG2 levels (<2.68 g/l and 2.68-3.53 g/l), had worsening progression of their bronchiectasis, using the Bronchiectasis Severity Index, over 1 year compared with those who were IgG2 replete (>4.45 g/l) (P = 0.003, 0.013). CONCLUSION Reduced IgG2 levels were an independent predictor for bronchiectasis exacerbations and have increased disease progression.
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Affiliation(s)
- Y Zhang
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - A Clarke
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - K H Regan
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - K Campbell
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - S Donaldson
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - J Crowe
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - A G Rossi
- The Centre for Inflammation Research at the University of Edinburgh, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - A T Hill
- Address correspondence to Prof A.T. Hill, Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
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10
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Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell AM, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Brown S, Kawka M, Mclean K, Savva N, Wilkinson P, Sam AH, Singal A, Chia C, Chia W, Ganesananthan S, Ooi SZY, Pengelly S, Wellington J, Mak S, Subbiah Ponniah H, Heyes A, Aberman I, Ahmed T, Al-Shamaa S, Appleton L, Arshad A, Awan H, Baig Q, Benedict K, Berkes S, Citeroni NL, Damani A, de Sancha A, Fisayo T, Gupta S, Haq M, Heer B, Jones A, Khan H, Kim H, Meiyalagan N, Miller G, Minta N, Mirza L, Mohamed F, Ramjan F, Read P, Soni L, Tailor V, Tas RN, Vorona M, Walker M, Winkler T, Bardon A, Acquaah J, Ball T, Bani W, Elmasry A, Hussein F, Kolluri M, Lusta H, Newman J, Nott M, Perwaiz MI, Rayner R, Shah A, Shaw I, Yu K, Cairns M, Clough R, Gaier S, Hirani D, Jeyapalan T, Li Y, Patel CR, Shabir H, Wang YA, Weatherhead A, Dhiran A, Renney O, Wells P, Ferguson S, Joyce A, Mergo A, Adebayo O, Ahmad J, Akande O, Ang G, Aniereobi E, Awasthi S, Banjoko A, Bates J, Chibada C, Clarke N, Craner I, Desai DD, Dixon K, Duffaydar HI, Kuti M, Mughal AZ, Nair D, Pham MC, Preest GG, Reid R, Sachdeva GS, Selvaratnam K, Sheikh J, Soran V, Stoney N, Wheatle M, Howarth K, Knapp-Wilson A, Lee KS, Mampitiya N, Masson C, McAlinden JJ, McGowan N, Parmar SC, Robinson B, Wahid S, Willis L, Risquet R, Adebayo A, Dhingra L, Kathiravelupillai S, Narayanan R, Soni J, Ghafourian P, Hounat A, Lennon KA, Abdi Mohamud M, Chou W, Chong L, Graham CJ, Piya S, Riad AM, Vennard S, Wang J, Kawar L, Maseland C, Myatt R, Tengku Saifudin TNS, Yong SQ, Douglas F, Ogbechie C, Sharma K, Zafar L, Bajomo MO, Byrne MHV, Obi C, Oluyomi DI, Patsalides MA, Rajananthanan A, Richardson G, Clarke A, Roxas A, Adeboye W, Argus L, McSweeney J, Rahman-Chowdhury M, Hettiarachchi DS, Masood MT, Antypas A, Thomas M, de Andres Crespo M, Zimmerman M, Dhillon A, Abraha S, Burton O, Jalal AHB, Bailey B, Casey A, Kathiravelupillai A, Missir E, Boult H, Campen D, Collins JM, Dulai S, Elhassan M, Foster Z, Horton E, Jones E, Mahapatra S, Nancarrow T, Nyamapfene T, Rimmer A, Robberstad M, Robson-Brown S, Saeed A, Sarwar Y, Taylor C, Vetere G, Whelan MK, Williams J, Zahid D, Chand C, Matthews M. The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey. Med Teach 2022; 44:574-575. [PMID: 34428109 DOI: 10.1080/0142159x.2021.1962835] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Damir Rafi
- School of Medicine, Imperial College London, London, UK
| | - Sam Brown
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Alona Courtney
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michal Kawka
- School of Medicine, Imperial College London, London, UK
| | - Ann-Marie Howell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kenneth McLean
- Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Matthew Gardiner
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amir H Sam
- School of Medicine, Imperial College London, London, UK
| | - Nicos Savva
- Division of Management Science and Operations, London Business School, London, UK
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- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - T Ball
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - W Bani
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Elmasry
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - F Hussein
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Kolluri
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - H Lusta
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - J Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Nott
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M I Perwaiz
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - R Rayner
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Shah
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - I Shaw
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - K Yu
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | | | | | - S Gaier
- Queen Mary University of London
| | | | | | - Y Li
- Queen Mary University of London
| | | | | | | | | | - A Dhiran
- St George's Hospital Medical School
| | - O Renney
- St George's Hospital Medical School
| | - P Wells
- St George's Hospital Medical School
| | | | - A Joyce
- The Queen's University of Belfast
| | | | | | - J Ahmad
- The University of Birmingham
| | | | - G Ang
- The University of Birmingham
| | | | | | | | - J Bates
- The University of Birmingham
| | | | | | | | | | - K Dixon
- The University of Birmingham
| | | | - M Kuti
- The University of Birmingham
| | | | - D Nair
- The University of Birmingham
| | | | | | - R Reid
- The University of Birmingham
| | | | | | | | - V Soran
- The University of Birmingham
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Soni
- The University of Cambridge
| | | | | | | | | | - W Chou
- The University of East Anglia
| | | | | | - S Piya
- The University of Edinburgh
| | | | | | - J Wang
- The University of Edinburgh
| | | | | | | | | | | | | | | | | | | | | | | | - C Obi
- The University of Leicester
| | | | | | | | | | | | | | | | - L Argus
- The University of Manchester
| | | | | | | | | | | | | | | | | | | | | | | | | | - B Bailey
- University of Brighton and Sussex
| | - A Casey
- University of Brighton and Sussex
| | | | - E Missir
- University of Brighton and Sussex
| | - H Boult
- University of Exeter Medical School
| | - D Campen
- University of Exeter Medical School
| | | | - S Dulai
- University of Exeter Medical School
| | | | - Z Foster
- University of Exeter Medical School
| | - E Horton
- University of Exeter Medical School
| | - E Jones
- University of Exeter Medical School
| | | | | | | | - A Rimmer
- University of Exeter Medical School
| | | | | | - A Saeed
- University of Exeter Medical School
| | - Y Sarwar
- University of Exeter Medical School
| | - C Taylor
- University of Exeter Medical School
| | - G Vetere
- University of Exeter Medical School
| | | | | | - D Zahid
- University of Exeter Medical School
| | - C Chand
- University of Hull and the University of York
| | - M Matthews
- University of Hull and the University of York
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11
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Galante J, Adeleke S, Wong M, Choy A, Lees K, Edwards A, Raman R, Thomas C, Taylor H, Pang J, Ramadan A, Bianchini D, Clarke A, Naji M, Ellul G, Brulinski P. Use of Novel Imaging for Patient Selection for Stereotactic Ablative Radiotherapy (SABR) in Oligometastatic Prostate Cancer (PCa): Does the PET Tracer Make a Difference? Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2021.11.032] [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: 11/15/2022]
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12
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Marcon P, Clarke A, Pace K, McDonald C, Saibil F, Lochnan HA, Punthakee Z, Mahmud F. A191 PERSISTENT BENEFIT OF DIETITIAN-LED GLUTEN-FREE DIET EDUCATION AT CD DIAGNOSIS ON DIETARY ADHERENCE IN CHILDREN AND ADULTS WITH TYPE 1 DIABETES AND CELIAC DISEASE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859248 DOI: 10.1093/jcag/gwab049.190] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Celiac disease (CD) is a common autoimmune comorbidity of type 1 diabetes (T1D) with a gluten-free diet (GFD) being the current gold standard treatment for this condition. Adherence to a GFD can be impacted by several factors including dietetic counselling, yet little is known about the impact of clinic-based interventions on long-term GFD adherence in this population.
Aims
To prospectively evaluate the impact of a dietitian-led GFD education intervention on adherence to a GFD in children and adults with T1D and CD over a 3-year period.
Methods
A cohort of N=62 pediatric and adult subjects who screened seropositive for CD as part of the CD-DIET clinical trial were followed over a 3-year period post-CD diagnosis and assessed on the basis of the GFD education regimen they received at initial CD diagnosis. This included 3 groups: 1) intensive dietitian training (IDT = 5 dietitian visits over 1 year while following GFD), 2) single dietitian training (SDT = 1 GFD training session after 1 year of following GCD) and 3) no dietitian training (NDT) at CD diagnosis. Annual visits included serologic testing of TTG-IgA titres, anthropometric assessments and the completion of questionnaires evaluating diet and adherence to a GFD. Data was analysed longitudinally using linear mixed effects and generalized estimating equations (GEE) regression modeling adjusting for the fixed effects of age, sex, duration of diabetes and time.
Results
At baseline, participants who received IDT (n=15), SDT (n=16) and NDT (n=31) represented 24.2%, 25.8%, and 50.0% of the cohort, respectively. Over the 3-year study period, participants in the IDT group had the greatest odds of self-reporting being a GFD, with odds 4.3 (95%CI: 1.1 to 16.4; P=0.033) and 9.5 (95%CI: 2.7 to 33.7; P<0.001) greater than the SDT and NDT groups, respectively. The assessment of daily gluten intakes less than 10mg, as recommended for a GFD, revealed a lack of differences between the IDT and SDT groups. In contrast, the NDT group had significantly lower odds of meeting this threshold relative to those who received IDT (OR=0.2; 95%CI: 0.04 to 0.56; P=0.004). No longitudinal differences in TTG-IgA levels were seen between groups over the 3-year period.
Conclusions
In diabetes patients greater contact with a dietitian at CD diagnosis was associated with higher levels of GFD adherence over time, which was not reflected in follow-up Serologic evaluation. These findings highlight the importance of nutritional support in patients with both diabetes and celiac disease at the time of CD diagnosis. In addition, following TTG-IgA alone does not fully inform dietary compliance to a GFD.
Diet teaching stratification
Diet assignment
Funding Agencies
Juvenile Diabetes Research Foundation / PSI
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Affiliation(s)
- P Marcon
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - A Clarke
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Pace
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - C McDonald
- Western University Faculty of Science, London, ON, Canada
| | - F Saibil
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Z Punthakee
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - F Mahmud
- Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
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13
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Paraskeva N, Tollow P, Clarke A, White P, Powell JE, Cox DM, Harcourt DM. A multi-centred sequential trial comparing PEGASUS, an intervention to promote shared decision making about breast reconstruction with usual care. J Plast Reconstr Aesthet Surg 2021; 75:1342-1351. [PMID: 34924325 DOI: 10.1016/j.bjps.2021.11.033] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/01/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
Decision making about breast reconstruction (BR) is complex. The Patients' Expectations and Goals: Assisting Shared Understanding of Surgery (PEGASUS) intervention aims to support shared decision making by helping women and clinicians clarify and discuss their expectations around reconstructive surgery. We conducted a multi-centred sequential trial comparing PEGASUS (n = 52) with usual care (UC) (n = 86) in women considering reconstruction, who completed outcome measures at baseline, and 3, 6 and 12 months post-surgery. The primary outcome was BR-specific quality of life (Breast-Q) 6 months post-intervention. Secondary outcomes were health-related quality of life (EQ-5D-5L), capabilities (ICECAP-A) and decisional regret, compared using t-tests and Cohen's d. Comparative analyses revealed no significant differences between groups in Breast-Q scores at any time point, except for a favourable effect for UC on psychological well-being at 3 months (t = -2.41, p = .019, d= -0.59). Intervention participants reported significantly higher, therefore improved, ICECAP-A (t = -2.13, p = .037, d = -0.45) and EQ VAS (t = -2.28, p = .026, d = -0.49) scores at 12 months compared to UC. Decisional regret was significantly lower in the PEGASUS group compared to the UC group at 6 months (t =2.06, p = .044, d= -0.51), but this was not sustained at 12 months. In conclusion, the PEGASUS intervention offers some benefits to women considering BR. At times, women experienced less decisional regret, improved health-related quality of life and capability well-being. Findings are discussed in the light of fidelity testing and embedding PEGASUS into practice.
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Affiliation(s)
- N Paraskeva
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
| | - P Tollow
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
| | - A Clarke
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
| | - P White
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
| | - J E Powell
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
| | - D M Cox
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
| | - D M Harcourt
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK.
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14
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Paluch A, Clarke A, Smith S, Adams S. 505 Failed Femoral Nail with Significant Operative Technical Difficulty: A Practical Solution to Achieve Metalwork Extraction Using Conical Screw Remover. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.294] [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: 11/14/2022]
Abstract
Abstract
Introduction
There is a greater risk of delayed healing and revision surgery in atypical femoral fractures (AFFs). Although non-union in reamed intra-medullary (IM) nailing is relatively uncommon, it can lead to fracture of the nail and present a considerable challenge to the treating surgeon.
Case Report
We present a case of AFF treated with IM nail fixation. Metalwork failure of the nail prompted removal of distal locking screws and plating of the fracture site at 8 months. Failure of the plate-bone interface 3 months later led to further revision surgery to remove the broken metalwork. We focus on the significant operative difficulty encountered during removal of the failed IM metalwork and provide a novel practical solution to overcome this particular challenge - insertion of a conical cannulated screw remover under fluoroscopy guidance to create an interference fit with the distal segment of the broken nail.
Discussion
This case is an example of significant and unexpected intra-operative technical difficulty, requiring improvisation and teamwork to manage. We introduce an accessible and uncomplicated alternative to the existing techniques for removal of a broken femoral nail and in doing so hope to benefit peers and colleagues should they encounter similar difficulties in the future.
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Affiliation(s)
- A Paluch
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - A Clarke
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - S Smith
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - S Adams
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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15
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Clarke A, Paraskeva N, White P, Tollow P, Hansen E, Harcourt D. PEGASUS: the Design of an Intervention to Facilitate Shared Decision-making in Breast Reconstruction. J Cancer Educ 2021; 36:508-518. [PMID: 31994007 PMCID: PMC8099795 DOI: 10.1007/s13187-019-01656-6] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Studies have found varying levels of satisfaction after breast reconstruction surgery with a substantial group of patients reporting some level of regret about their decision. The variable outcomes reported by women undergoing breast reconstruction surgery suggest a role for improved pre-operative communication and shared decision-making (SDM) between patient and health professional. Pragmatic approaches such as decision aids have been evaluated, but the aim of the Patient Expectations and Goals Assisting Shared Understanding of Surgery (PEGASUS) intervention is to facilitate closer interaction between the patient and clinical team. PEGASUS is a standardised two-stage process, in which patients' goals are first elicited, ranked in importance and recorded before being used to frame discussion and decision-making with the surgeon managing care. Following the Medical Research Council (MRC) model, feasibility and acceptability studies have already been reported and a 4-year multicentre randomised controlled trial of 180 participants is underway, (completion 2020). This paper therefore focuses on the design of the intervention itself, in line with recent advice that interventions, in comparison with evaluations, commonly lack a theoretical base and are often under reported. We report a retrospective application of the Capability, Opportunity, Motivation-Behaviour (COM-B) model to provide explicit detail of each step in the intervention design. This is intended to facilitate replication by other clinicians and to provide systematic guidance for others wishing to develop PEGASUS as a strategy for implementing SDM in other clinical populations. Trial Registration: ISRCTN 18000391 (DOI 10.1186/ISRCTN18000391) 27/01/2016.
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Affiliation(s)
- A. Clarke
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - N. Paraskeva
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - P. White
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - P. Tollow
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
| | - E. Hansen
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG UK
| | - D. Harcourt
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY UK
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16
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Burns JE, Stöhr W, Kinloch-De Loes S, Fox J, Clarke A, Nelson M, Thornhill J, Babiker A, Frater J, Pett SL, Fidler S. Tolerability of four-drug antiretroviral combination therapy in primary HIV-1 infection. HIV Med 2021; 22:770-774. [PMID: 33964099 PMCID: PMC8612356 DOI: 10.1111/hiv.13118] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Objectives Rapid initiation of antiretroviral therapy (ART) is important for individuals with high baseline viral loads, such as in primary HIV‐1 infection (PHI). Four‐drug regimens are sometimes considered; however, data are lacking on tolerability. We aimed to evaluate the tolerability of four‐drug regimens used in the Research in Viral Eradication of HIV‐1 Reservoirs (RIVER) study. Methods At enrolment, ART‐naïve adult participants or those newly commenced on ART were initiated or intensified to four‐drug regimens within 4 weeks of PHI. Rapid start was defined as pre‐confirmation or ≤ 7 days of confirmed diagnosis. Primary and secondary outcomes were patient‐reported adherence measured by 7‐day recall and regimen switches between enrolment and randomization, respectively. Results Overall, 54 men were included: 72.2% were of white ethnicity, with a median age of 32 years old, 42.6% had a viral load of ≥ 100 000 HIV‐1 RNA copies/mL, and in 92.6% sex with men was the mode of acquisition of HIV‐1. Twenty (37%) started a four‐drug regimen and 34 (63%) were intensified. Rapid ART initiation occurred in 28%, 100% started in ≤ 4 weeks. By weeks 4, 12, and 24, 37.0%, 69.0%, and 94.0% were undetectable (viral load < 50 copies/mL), respectively. Adherence rates of 100% at weeks 4, 12, 22 and 24 were reported in 88.9%, 87.0%, 82.4% and 94.1% of participants, respectively. Five individuals switched to three drugs, four changed their regimen constituents, and two switched post‐randomization. Conclusions Overall, four‐drug regimens were well tolerated and had high levels of adherence. Whilst their benefit over three‐drug regimens is lacking, our findings should provide reassurance if a temporarily intensified regimen is clinically indicated to help facilitate treatment.
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Affiliation(s)
- J E Burns
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - W Stöhr
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Kinloch-De Loes
- Department of Infection and Immunity, Royal Free Hospital, London, UK.,Institute of Immunity & Transplantation, University College London, London, UK
| | - J Fox
- Department of Genitourinary Medicine and Infectious Diseases, Guys and St, Thomas' NHS Trust, London, UK.,Department of Genitourinary Medicine and Infectious Diseases, NIHR Biomedical Research Centre, King's College London, London, UK
| | - A Clarke
- Elton John Centre, Brighton, UK.,Department of HIV and Sexual Health, Sussex University Hospital, Brighton, UK.,Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - M Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - J Thornhill
- Department of Infectious Disease, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - A Babiker
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - J Frater
- Nuffield Department of Medicine, Oxford University, Oxford, UK.,Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - S L Pett
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Fidler
- Department of Infectious Disease, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
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17
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Guest E, Paraskeva N, Griffiths C, Hansen E, Clarke A, Baker E, Harcourt D. The nature and importance of women's goals for immediate and delayed breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 74:2169-2175. [PMID: 33495140 DOI: 10.1016/j.bjps.2020.12.085] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/11/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Increasingly, women undergo breast reconstruction (BR) surgery to restore health-related and psychosocial quality of life after mastectomy. Most research focuses on BR outcomes rather than women's pre-surgical expectations of, and goals for, immediate (IBR) or delayed (DBR) procedures, yet such information could support women's decision-making. This study aimed to investigate women's BR goals, whether they differed according surgery timing (IBR or DBR), and the importance women placed on them. METHODS Seventy-six women considering DBR (n = 50) or IBR (n = 26) at a UK hospital were encouraged to clarify their BR goals and rate the importance of achieving each one. Content analysis categorised and counted the frequency of the goals they reported. RESULTS Fifteen goal categories (7 surgical, e.g. scarring; 8 psychosocial/lifestyle, e.g. feeling feminine) were identified. Many (e.g. scarring, intimacy) were reported by a similar percentage of women in each surgical group, however, differences were identified (e.g. breast sensation was not mentioned by women considering IBR). Women reported more psychosocial (n = 206) than surgical goals (n = 160). Further, an independent t-tests revealed that women in both groups placed significantly more importance on the psychosocial (M = 9.4) than surgical goals (M = 8.5). CONCLUSIONS This study highlights the variety of goals women have for BR, the importance they attach to them, and differences and similarities between those seeking IBR and DBR. Future research should consider whether BR goals are met, how goal achievement influences satisfaction with outcome over time and how best to incorporate goals into pre-surgical treatment decision-making.
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Affiliation(s)
- E Guest
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom.
| | - N Paraskeva
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
| | - C Griffiths
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
| | - E Hansen
- Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, United Kingdom
| | - A Clarke
- Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, United Kingdom
| | - E Baker
- Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London NW3 2QG, United Kingdom
| | - D Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
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18
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Kazmerski T, Clarke A, Stransky O, Bernard M, Hughan K, Ladores S, Sawicki G, Stalvey M. P249 Men's health in cystic fibrosis in the modern era: a qualitative study. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01274-1] [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: 10/21/2022]
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19
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Renzi E, Clarke A. Life of a droplet: Buoyant vortex dynamics drives the fate of micro-particle expiratory ejecta. Phys Fluids (1994) 2020; 32:123301. [PMID: 33362400 PMCID: PMC7757612 DOI: 10.1063/5.0032591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/01/2020] [Indexed: 05/04/2023]
Abstract
We show that the dynamics of the expiratory cloud ejected during human respiratory events can be modeled by extending the theory of buoyant vortex rings with an initial momentum. We embed the integral conservation laws that govern the cloud's motion into the model of an expanding vortex to determine the velocity field inside and outside the cloud. We then apply a Lagrangian particle-tracking model to calculate the trajectories of the mucosalivary droplets suspended within the cloud. Our results show very good agreement with the available experimental data. The vortex is shown to have a significant effect on suspending the droplets present in the cloud, increasing the time they remain airborne and extending their range further than predicted by the existing models. We also study the role that initial conditions have on the maximum streamwise range of the droplets, finding that decreasing the angle of projection can reduce the spread of the droplets by an order of meters. Finally, we discuss the importance of these findings in the context of informing public health policies and global information campaigns to slow down the spread of respiratory viruses.
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Affiliation(s)
- E. Renzi
- Department of Mathematical Sciences, Loughborough
University, Loughborough LE11 3TU, United Kingdom
| | - A. Clarke
- Department of Mathematical Sciences, Loughborough
University, Loughborough LE11 3TU, United Kingdom
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20
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Booth R, Aliozo C, Mureb A, Ahmad M, Clarke A, Nash G, Qureshi T, Siddiqi N, Parvaiz A. Minimally invasive surgery in the COVID-19 pandemic: An early single centre experience. Br J Surg 2020; 107:e516-e517. [PMID: 32822507 PMCID: PMC7461392 DOI: 10.1002/bjs.11986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
Affiliation(s)
- R Booth
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - C Aliozo
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - A Mureb
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - M Ahmad
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - A Clarke
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - G Nash
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - T Qureshi
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - N Siddiqi
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
| | - A Parvaiz
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
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21
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Clarke A, Beenstock J, Lukacs JN, Turner L, Limmer M. Major risk factors for sexual minority young people's mental and physical health: findings from a county-wide school-based health needs assessment. J Public Health (Oxf) 2020; 41:e274-e282. [PMID: 30252096 DOI: 10.1093/pubmed/fdy167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/31/2018] [Revised: 07/26/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood health is an important adult health predictor. Sexual orientation is increasingly recognized as influential on children and young people's (CYP) mental and physical health. METHODS Data came from a cross-sectional survey of year 9 children attending schools in two local authorities in the north-west of England, including mental and physical health indicators, and demographic characteristics including sexual orientation. The sample of 8058 represented 67.8% of the eligible population. Data were analysed by sexual orientation, sexual majority or sexual minority. RESULTS Children reporting their sexual orientation as sexual minority reported worse mental and physical health outcomes and behaviours than sexual majority peers; had higher odds of being lonely (odds ratios (OR) = 8.24, 95% C.I.: 6.56-10.37), having self-harmed (OR = 7.28, 95% C.I.: 5.78-9.15), being bullied (OR = 4.76, 95% C.I.: 3.74-6.05) or perceiving themselves as overweight (OR = 2.40, 95% C.I.: 1.89-3.06). CONCLUSIONS It is important to identify and support children in a sexual minority. Research is required to understand differences between children within sexual minorities and the impact on outcomes and rights. Health and social policy and services, should respond to the vulnerabilities of sexual minority CYP.
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Affiliation(s)
- A Clarke
- Children and Family Health Service, Lancashire Care NHS Foundation Trust, Preston , UK
| | - J Beenstock
- Lancashire Care NHS Foundation Trust, Preston, UK.,Faculty of Health & Medicine, Lancaster University, UK
| | - J N Lukacs
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - L Turner
- Lancashire LGBT, Preston PR2 8PS, UK
| | - M Limmer
- Division of Health Research, Lancaster University, Lancaster, UK
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22
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Cahn P, Madero JS, Arribas J, Antinori A, Ortiz R, Clarke A, Hung C, Rockstroh J, Girard P, Sievers J, Man C, Urbaityte R, Underwood M, Tenorio A, Pappa K, Wynne B, Gartland M, Aboud M, van Wyk J, Smith K, El-Bahy Y. Durable Efficacy of Dolutegravir (DTG) Plus Lamivudine (3TC) in Antiretroviral Treatment-Naive Adults With HIV-1 Infection: 96-Week Results From the GEMINI Studies. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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Mandala A, Murdoch D, Poon K, Aroney N, Gopal K, Walters D, Clarke A, Scalia G, Raffel O. 905 Transcatheter Mitral Valve in Valve: An Early Institutional Experience. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.912] [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: 11/27/2022]
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Abstract
Aim: Little is known about paramedics who have left the ambulance service to work in emergency departments (EDs). This study sought to explore the lived experiences of paramedics working in specialist/advanced ED roles, focusing on role transition, influences on effective clinical practice and perceptions of role optimisation. A secondary aim of the study was to make recommendations on the future development of specialist/advanced ED roles for paramedics. Methods: This was a qualitative study utilising descriptive phenomenology to collect and describe the lived experiences of participants via semi-structured interviews. The final sample comprised three emergency care practitioners (ECPs), three student ECPs and two advanced clinical practitioners (ACPs), all Health and Care Professions Council registered paramedics. Interview data were transcribed verbatim and analysed using inductive thematic analysis. Results: Conclusions: While role transition to the ED represents a turbulent period for paramedics, elements of pre-hospital paramedic practice transfer directly into ED roles and contribute to effective practice. Participants found that they were accepted and supported to work in the ED setting and spoke positively of future role expansion. A lack of access to medicines presents a significant barrier to current clinical practice and a disparity in practice between paramedics and their nursing counterparts. The change in legislation to allow independent prescribing for advanced paramedics will address some of these issues, but interim improvements are required to extend existing arrangements to paramedics, improving the quality and safety of care they provide and ultimately the patient experience.
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Auguste P, Madan J, Tsertsvadze A, Court R, McCarthy N, Sutcliffe P, Taylor-Phillips S, Pink J, Clarke A. Identifying latent tuberculosis in high-risk populations: systematic review and meta-analysis of test accuracy. Int J Tuberc Lung Dis 2019; 23:1178-1190. [DOI: 10.5588/ijtld.18.0743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The relative accuracy of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) in identifying latent tuberculosis infection (LTBI) is uncertain.OBJECTIVE: To perform a systematic review and meta-analysis to compare the sensitivity and
specificity of IGRAs and TST for the prediction of progression to clinical tuberculosis (TB).METHODS: We searched electronic databases (e.g., MEDLINE and EMBASE) from December 2009 to September 2018 for prospective studies that followed up individuals who had undergone testing with
commercial IGRAs and/or TST but had not received treatment based on the test result. The sensitivity and specificity estimates were pooled using a Bayesian bivariate random-effects model.RESULTS: Twenty-five studies, mostly with moderate to high risk of bias and a mean follow-up
time ranging from 1 to 5 years were included. TST (10–15 mm) tended to have lower sensitivity and higher specificity than QuantiFERON® Gold In-Tube, T-SPOT®.TB and TST (5 mm). The evidence did not indicate that any test outperformed the others due
to wide and overlapping 95% credible intervals.CONCLUSION: The evidence following individuals who had undergone testing for LTBI and had progressed to clinical TB is sparse. We did not find that IGRAs were superior to TST or vice versa; however, as our findings are based on a small
number of studies with methodological limitations and great uncertainty around the pooled estimates, the results should be interpreted with caution.
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Affiliation(s)
- P. Auguste
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - J. Madan
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry
| | - A. Tsertsvadze
- Evidence in Communicable Disease Epidemiology and Control, Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - R. Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - N. McCarthy
- Evidence in Communicable Disease Epidemiology and Control, Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - P. Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - S. Taylor-Phillips
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - J. Pink
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - A. Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
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Gartrell BD, Ahn JY, Khude R, Dougherty N, Johnson K, McCutchan J, Clarke A, Hunter S. Thermal burns of the spectacle associated with supplementary heating in native New Zealand geckos. N Z Vet J 2019; 68:126-133. [PMID: 31608795 DOI: 10.1080/00480169.2019.1674747] [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: 10/25/2022]
Abstract
Case history: Gradual onset of ocular opacity was observed in three gold-striped geckos (Woodworthia chrysosiretica), and five Pacific geckos (Dactylocnemis pacificus) held in two adjacent terrariums in a zoological institution located in the North Island of New Zealand. Ultraviolet light and heat had been provided for the previous 3-4 years by a fluorescent bulb, but in the last 4 weeks of winter a ceramic heat bulb had been added, situated 10 cm above the upper mesh of the cageClinical findings: All eight geckos presented with mostly bilateral lesions of varying severity confined to the central or upper quadrant of the spectacles. These lesions ranged from variable areas of opacity within the stroma of the spectacle to similarly distributed ulcers of the surface epithelium of both spectacles. The spectacle lesions in the Pacific geckos responded well to treatment with topical combined antimicrobial therapy, within 18-29 days. The gold-striped geckos suffered complications including dysecdysis, severe spectacle ulceration and perforation, mycotic spectaculitis, and widespread mycotic dermatitis resulting in death or leading to euthanasia.Pathological findings: In the three gold-striped geckos, there were extensive areas of deep ulceration and replacement of the spectacle with a thick serocellular crust containing large numbers of fungal elements. The affected areas of the stroma were expanded by large deposits of proteinaceous and mucinous material, pyknotic cellular debris and moderate numbers of heterophils and macrophages as well as infiltrating fungal hyphae.Diagnosis: Mycotic spectaculitis with ulceration and perforation, and disseminated mycotic dermatitis likely secondary to thermal burns.Clinical relevance: This is the first report of thermal burns of the spectacle in any reptile. There was species variation in the burn severity with gold-striped geckos showing more severe lesions, possibly due to a mix of behavioural and anatomical factors. The thermal burns to the spectacles in three cases were complicated by delayed healing, perforation, dysecdysis and severe mycotic infection.
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Affiliation(s)
- B D Gartrell
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - J Y Ahn
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - R Khude
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - N Dougherty
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - K Johnson
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - J McCutchan
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - A Clarke
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - S Hunter
- Wildbase, School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Fox P, Neill OO, Slevin T, Carberry S, Furlong E, Coughlan B, Clarke A, Corboy H. The perceptions of parents/guardians regarding their child/adolescent’s experience of reflexology or non specific foot massage. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz275.005] [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: 11/13/2022] Open
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Eron JJ, Orkin C, Cunningham D, Pulido F, Post FA, De Wit S, Lathouwers E, Hufkens V, Jezorwski J, Petrovic R, Brown K, Van Landuyt E, Opsomer M, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girardy PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas J, Perez-Valero I, Berenguer J, Casado J, Gatell J, Gutierrez F, Galindo M, Gutierrez M, Iribarren J, Knobel H, Negredo E, Pineda J, Podzamczer D, Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard B, Johnson M, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek U, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry W, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1. Antiviral Res 2019; 170:104543. [DOI: 10.1016/j.antiviral.2019.104543] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/27/2022]
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Hutt S, Clarke A, Pullin R, Evans HP. The acoustic emission from asperity interactions in mixed lubrication. Proc Math Phys Eng Sci 2019; 475:20180900. [PMID: 31423088 DOI: 10.1098/rspa.2018.0900] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/03/2019] [Indexed: 11/12/2022] Open
Abstract
Gears typically operate in mixed lubrication conditions, where the lubricant film is too thin to prevent opposing surface asperities from interacting with each other. The likelihood/intensity of interactions is indicated by the Λ ratio: the ratio of smooth surface film thickness to surface roughness. Researchers have asserted that asperity interactions are the predominant cause of acoustic emission (AE) in healthy gear contacts. However, direct experiments on gears have yet to yield a clear relationship between the Asperity AE (AAE) and Λ ratio, this is in part due to the complexity of gear tooth contacts. In this paper, a disc rig was used to simulate a simplified gear contact so that the fundamental relationship between AAE and Λ could be investigated more effectively. By varying oil temperature and entrainment speed, a wide spectrum of lubrication conditions was generated. In contrast to other published studies, an independent measurement technique, the contact voltage (CV), was used to verify the amount of interactions, and repeated roughness measurements were used to confirm minimal surface wear. A simple, consistent and precise relationship between AAE amplitude and Λ was identified and defined for changes from full-film to mixed lubrication. Within the mixed lubrication regime, the AAE amplitude increased exponentially as Λ decreased at all speeds tested. It was also observed that an increase in speed always resulted in an increase in AAE amplitude, independently of any changes in Λ. This direct effect of speed was modelled so that the AAE could be predicted for any combination of speed and Λ within the tested envelope. This paper links gear contact tribology and AE with new precision and clearly demonstrates the potential of using AAE as a sensitive monitoring technique for the lubrication condition of gears.
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Affiliation(s)
- S Hutt
- School of Engineering, Cardiff University, Cardiff, UK
| | - A Clarke
- School of Engineering, Cardiff University, Cardiff, UK
| | - R Pullin
- School of Engineering, Cardiff University, Cardiff, UK
| | - H P Evans
- School of Engineering, Cardiff University, Cardiff, UK
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Shum G, Cinnamond S, Hutton M, Chan D, Chauhan R, Bloxham S, Choy S, Cheung R, Eldabe S, Clarke A. Decreased tibial nerve movement in patients with failed back surgery syndrome and persistent leg pain. Eur Spine J 2019; 28:2122-2128. [DOI: 10.1007/s00586-019-06056-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 02/28/2024]
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Clarke A. What influences the effective practice and role optimisation of specialist/advanced paramedics working in emergency departments? A qualitative study. Br Paramed J 2019; 4:40-41. [PMID: 33328827 PMCID: PMC7706771 DOI: 10.29045/14784726.2019.06.4.1.40] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims: Little is known about the experiences of paramedics who have left the ambulance service to work in emergency departments (ED). This study sought to explore the lived experiences of paramedics working in specialist/advanced ED roles, focusing on role transition, influences on effective clinical practice and perceptions of role optimisation. A secondary aim of the study was to make recommendations on the future development of specialist/advanced ED roles for paramedics. Methods: This was a qualitative study utilising descriptive phenomenology to collect and describe the lived experiences of participants via semi-structured interviews. Purposive and convenience sampling identified three emergency care practitioners (ECP), three student ECPs and two advanced clinical practitioners working across five EDs to participate in the study; all were Health and Care Professions Council (HCPC) registered paramedics. Interview data were transcribed verbatim and analysed using inductive thematic analysis. Results: This research produced a number of key findings:
Transition to the ED involves significant adjustment to a new clinical environment, and new responsibilities and decision making, which can lead to a perception of regression to a novice practitioner. Pre-hospital assessment and history taking skills, and experience of autonomous working are pertinent enablers to effective practice within the ED. Support and mentorship from ED colleagues is available to enhance practice development. A limited access to medicines emerged as a significant barrier to daily practice, which could affect the patient experience. This also contributed to perceptions of sub-optimal working for many participants. Misconceptions over paramedic competencies could lead to role confusion and make inter-professional working difficult. Opportunities exist for future role expansion into areas such as resuscitation, majors and paediatrics within the ED environment.
Conclusion: While role transition to the ED represents a turbulent period for paramedics, elements of pre-hospital paramedic practice transfer directly into new roles and contribute to effective practice. The paramedics in this study found that they were accepted and supported to work in the ED setting and spoke positively of expanding their roles into other areas of the ED in the future. A significant barrier to current clinical practice emerges from a lack of access to medicines, which impacts directly on the patient experience. The change in legislation to allow independent prescribing for advanced paramedics will address some of these issues, but interim improvements are required to extend existing arrangements to include paramedics; ultimately this will improve the quality and safety of care they are able to provide and the patient experience.
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Austin DE, Burns B, Lowe D, Cartwright B, Clarke A, Dennis M, D'Souza M, Nathan R, Bannon PG, Gattas D, Connellan M, Forrest P. Retrieval of critically ill adults using extracorporeal membrane oxygenation: the nine-year experience in New South Wales. Anaesth Intensive Care 2019; 46:579-588. [PMID: 30447667 DOI: 10.1177/0310057x1804600608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In New South Wales, a coordinated extracorporeal membrane oxygenation (ECMO) retrieval program has been in operation since 2007. This study describes the characteristics and outcomes of patients transported by this service. We performed a retrospective observational study and included patients who were transported on ECMO to either of two adult tertiary referral hospitals in Sydney, New South Wales, between February 28, 2007 and February 29, 2016. One hundred and sixty-four ECMO-facilitated transports occurred, involving 160 patients. Of these, 118 patients (74%) were treated with veno-venous (VV) ECMO and 42 patients (26%) were treated with veno-arterial ECMO. The mean (standard deviation, SD) age was 40.4 (15.0) years. Seventy-seven transports (47%) occurred within metropolitan Sydney, 52 (32%) were from rural or regional areas within NSW, 17 (10%) were interstate transfers and 18 (11%) were international transfers. Transfers were by road (58%), fixed wing aircraft (27%) or helicopter (15%). No deaths occurred during transport. The median (interquartile range) duration of ECMO treatment was 8.9 (5.2-15.3) days. One hundred and nineteen patients (74%) were successfully weaned from ECMO and 109 (68%) survived to hospital discharge or transfer. In patients treated with VV ECMO, age, sequential organ failure assessment score, pre-existing immunosuppressive disease, pre-existing diabetes, renal failure requiring dialysis and failed prone positioning prior to ECMO were independently associated with increased mortality. ECMO-facilitated patient transport is feasible, safe, and results in acceptable short-term outcomes. The NSW ECMO Retrieval Service provides specialised support to patients with severe respiratory and cardiovascular illness, who may otherwise be too unstable to undergo inter-hospital transfer to access advanced cardiovascular and critical care services.
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AL-Mayali MF, Hutt S, Sharif KJ, Clarke A, Evans HP. Experimental and Numerical Study of Micropitting Initiation in Real Rough Surfaces in a Micro-elastohydrodynamic Lubrication Regime. Tribol Lett 2018; 66:150. [PMID: 30930593 PMCID: PMC6404807 DOI: 10.1007/s11249-018-1110-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 06/21/2018] [Accepted: 10/26/2018] [Indexed: 06/09/2023]
Abstract
Micropitting is a form of surface fatigue damage that happens at the surface roughness scale in lubricated contacts in commonly used machine elements, such as gears and bearings. It occurs where the specific film thickness (ratio of smooth surface film thickness to composite surface roughness) is sufficiently low for the contacts to operate in the mixed lubrication regime, where the load is in part carried by direct asperity contacts. Micropitting is currently seen as a greater issue for gear designers than is regular pitting fatigue failure as the latter can be avoided by control of steel cleanliness. This paper describes the results of both theoretical and experimental studies of the onset of micropitting in test disks operated in the mixed lubrication regime. A series of twin disk mixed-lubrication experiments were performed in order to examine the evolution of micropitting damage during repeated cyclic loading of surface roughness asperities as they pass through the contact. Representative measurements of the surfaces used in the experimental work were then evaluated using a numerical model which combines a transient line contact micro-elastohydrodynamic lubrication (micro-EHL) simulation with a calculation of elastic sub-surface stresses. This model generated time-history of stresses within a block of material as it passes through the contact, based on the instantaneous surface contact pressure and traction at each point in the computing mesh at each timestep. This stress time-history was then used within a shear-strain-based fatigue model to calculate the cumulative damage experienced by the surface due to the loading sequence experienced during the experiments. The proposed micro-EHL model results and the experimental study were shown to agree well in terms of predicting the number of loading cycles that are required for the initial micropitting to occur.
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Affiliation(s)
- M. F. AL-Mayali
- College of Engineering, University of Al-Qadisiyah, Al Diwaniyah, Iraq
| | - S. Hutt
- School of Engineering, Cardiff University, Cardiff, UK
| | - K. J. Sharif
- School of Engineering, Cardiff University, Cardiff, UK
| | - A. Clarke
- School of Engineering, Cardiff University, Cardiff, UK
| | - H. P. Evans
- School of Engineering, Cardiff University, Cardiff, UK
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Li W, Churchill L, Cheng J, Kane K, Procter-Gray E, Clarke A, Crouter S. OBJECTIVELY MEASURED SPACE AND TIME USE AMONG OLDER MEN AND WOMEN. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2516] [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: 11/14/2022] Open
Affiliation(s)
- W Li
- University of Massachusetts Medical School
| | | | - J Cheng
- University of Massachusetts Medical School
| | - K Kane
- University of Massachusetts Medical School
| | | | - A Clarke
- University of Massachusetts Medical School
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Papandreou A, Rahman S, Fratter C, Ng J, Meyer E, Carr LJ, Champion M, Clarke A, Gissen P, Hemingway C, Hussain N, Jayawant S, King MD, Lynch BJ, Mewasingh L, Patel J, Prabhakar P, Neergheen V, Pope S, Heales SJR, Poulton J, Kurian MA. Correction to: Spectrum of movement disorders and neurotransmitter abnormalities in paediatric POLG disease. J Inherit Metab Dis 2018; 41:1299-1301. [PMID: 30456588 PMCID: PMC6828478 DOI: 10.1007/s10545-018-0247-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to a typesetting error the wrong Table 2 was used. The correct Table 2 is shown here.
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Affiliation(s)
- A Papandreou
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
- Genetics and Genomics Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - S Rahman
- Mitochondrial Research Group, Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Metabolic Department, Great Ormond Street Hospital for Children, London, UK
| | - C Fratter
- Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Ng
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
| | - E Meyer
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
| | - L J Carr
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - M Champion
- Department of Inherited Metabolic Disease, Evelina London Children's Hospital, London, UK
| | - A Clarke
- Paediatric Neurology Department, St George's University Hospital, London, UK
| | - P Gissen
- Genetics and Genomics Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Metabolic Department, Great Ormond Street Hospital for Children, London, UK
- UCL-MRC Laboratory of Molecular Cell Biology, London, UK
| | - C Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - N Hussain
- Department of Paediatric Neurology, University Hospital of Leicester, Leicester, UK
| | - S Jayawant
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - M D King
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's University Hospital, Temple Street, Dublin, Ireland
| | - B J Lynch
- Department of Neurology and Clinical Neurophysiology, Children's University Hospital, Temple Street, Dublin, Ireland
| | - L Mewasingh
- Department of Paediatric Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - J Patel
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK
| | - P Prabhakar
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - V Neergheen
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Pope
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - S J R Heales
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Paediatric Laboratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - J Poulton
- Nuffield Department of Women's and Reproductive Health, University of Oxford, The Women's Centre, Oxford, UK
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK.
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Adlington K, Brown J, Ralph L, Clarke A, Bhoyroo T, Henderson M, Boora F, Aurelio M, Fawzi W. Better care: reducing length of stay and bed occupancy on an older adult psychiatric ward. BMJ Open Qual 2018; 7:e000149. [PMID: 30515462 PMCID: PMC6231107 DOI: 10.1136/bmjoq-2017-000149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/19/2018] [Accepted: 10/07/2018] [Indexed: 11/29/2022] Open
Abstract
Background Length of stay and bed occupancy are important indicators of quality of care. Admissions are longer on older adult psychiatric wards as a result of physical comorbidity and complex care needs. The recommended bed occupancy is 85%; levels of 95% or higher are associated with violent incidents on inpatient wards. Methods We aimed to reduce length of stay and bed occupancy on Leadenhall ward, a functional older adult psychiatric ward serving a population of just under 40 000 older adults in two of the most deprived areas of the UK. At baseline in October 2015, the average length of stay was 47 days, and bed occupancy was at 77%. We approached the problem using quality improvement methods, established a project team and proceeded to test a number of changes over time in line with the driver diagram we produced. Results In 12 months, length of stay was reduced from an average 47 to an average 30 days and bed occupancy from 77% to 54%. At the end of 2016, the closure of some beds effected this calculation and we added an additional outcome measure of occupied bed days (OBD) better to assess the impact of the work. OBD data show a decrease over the course of the project from 251 to 194 bed days (a reduction of 23%). Conclusion The most effective interventions to address length of stay and bed occupancy on an older adult functional mental health ward were the daily management round and the high-level management focus on longer-stay patients. The work depended on an effective community team and on the support of the quality improvement programme in the trust, which have led to sustained improvements.
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Affiliation(s)
- Katherine Adlington
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Juliette Brown
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Laura Ralph
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Alan Clarke
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Tim Bhoyroo
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Michael Henderson
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Farai Boora
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Marco Aurelio
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
| | - Waleed Fawzi
- Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK
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Papandreou A, Rahman S, Fratter C, Ng J, Meyer E, Carr LJ, Champion M, Clarke A, Gissen P, Hemingway C, Hussain N, Jayawant S, King MD, Lynch BJ, Mewasingh L, Patel J, Prabhakar P, Neergheen V, Pope S, Heales SJR, Poulton J, Kurian MA. Spectrum of movement disorders and neurotransmitter abnormalities in paediatric POLG disease. J Inherit Metab Dis 2018; 41:1275-1283. [PMID: 30167885 PMCID: PMC6326959 DOI: 10.1007/s10545-018-0227-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/15/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the spectrum of movement disorders and cerebrospinal fluid (CSF) neurotransmitter profiles in paediatric patients with POLG disease. METHODS We identified children with genetically confirmed POLG disease, in whom CSF neurotransmitter analysis had been undertaken. Clinical data were collected retrospectively. CSF neurotransmitter levels were compared to both standardised age-related reference ranges and to non-POLG patients presenting with status epilepticus. RESULTS Forty-one patients with POLG disease were identified. Almost 50% of the patients had documented evidence of a movement disorder, including non-epileptic myoclonus, choreoathetosis and ataxia. CSF neurotransmitter analysis was undertaken in 15 cases and abnormalities were seen in the majority (87%) of cases tested. In many patients, distinctive patterns were evident, including raised neopterin, homovanillic acid and 5-hydroxyindoleacetic acid levels. CONCLUSIONS Children with POLG mutations can manifest with a wide spectrum of abnormal movements, which are often prominent features of the clinical syndrome. Underlying pathophysiology is probably multifactorial, and aberrant monoamine metabolism is likely to play a role.
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Affiliation(s)
- A Papandreou
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
- Genetics and Genomics Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - S Rahman
- Mitochondrial Research Group, Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Metabolic Department, Great Ormond Street Hospital for Children, London, UK
| | - C Fratter
- Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Ng
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
| | - E Meyer
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
| | - L J Carr
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - M Champion
- Department of Inherited Metabolic Disease, Evelina London Children's Hospital, London, UK
| | - A Clarke
- Paediatric Neurology Department, St George's University Hospital, London, UK
| | - P Gissen
- Genetics and Genomics Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Metabolic Department, Great Ormond Street Hospital for Children, London, UK
- UCL-MRC Laboratory of Molecular Cell Biology, London, UK
| | - C Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - N Hussain
- Department of Paediatric Neurology, University Hospital of Leicester, Leicester, UK
| | - S Jayawant
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - M D King
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's University Hospital, Temple Street, Dublin, Ireland
| | - B J Lynch
- Department of Neurology and Clinical Neurophysiology, Children's University Hospital, Temple Street, Dublin, Ireland
| | - L Mewasingh
- Department of Paediatric Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - J Patel
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK
| | - P Prabhakar
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - V Neergheen
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Pope
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - S J R Heales
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Paediatric Laboratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - J Poulton
- Nuffield Department of Women's and Reproductive Health, University of Oxford, The Women's Centre, Oxford, UK
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK.
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Li R, Sridharan M, Clarke A, Beesley S, Taylor H, Lees K. Comparison of Toxicity and Efficacy Outcomes of Capecitabine/MMC and 5FU/MMC in Patients with Bladder Cancer Treated with Radical Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2017.12.016] [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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Xu H, Clarke A, Rothstein J, Poole R. Viscoelastic drops moving on hydrophilic and superhydrophobic surfaces. J Colloid Interface Sci 2018; 513:53-61. [DOI: 10.1016/j.jcis.2017.10.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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Armoiry X, Kan A, Melendez-Torres GJ, Court R, Sutcliffe P, Auguste P, Madan J, Counsell C, Clarke A. Short- and long-term clinical outcomes of use of beta-interferon or glatiramer acetate for people with clinically isolated syndrome: a systematic review of randomised controlled trials and network meta-analysis. J Neurol 2018; 265:999-1009. [PMID: 29356977 PMCID: PMC5937891 DOI: 10.1007/s00415-018-8752-8] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 12/20/2022]
Abstract
Background Beta-interferon (IFN-β) and glatiramer acetate (GA) have been evaluated in people with clinically isolated syndrome (CIS) with the aim to delay a second clinical attack and a diagnosis of clinically definite multiple sclerosis (CDMS). We systematically reviewed trials evaluating the short- and long-term clinical effectiveness of these drugs in CIS. Methods We searched multiple electronic databases. We selected randomised controlled studies (RCTs) conducted in CIS patients and where the interventions were IFN-β and GA. Main outcomes were time to CDMS, and discontinuation due to adverse events (AE). We compared interventions using random-effect network meta-analyses (NMA). We also reported outcomes from long-term open-label extension (OLE) studies. Results We identified five primary studies. Four had open-label extensions following double-blind periods comparing outcomes between early vs delayed DMT. Short-term clinical results (double-blind period) showed that all drugs delayed CDMS compared to placebo. Indirect comparisons did not suggest superiority of any one active drug over another. We could not undertake a NMA for discontinuation due to AE. Long-term clinical results (OLE studies) showed that the risk of developing CDMS was consistently reduced across studies after early DMT treatment compared to delayed DMT (HR = 0.64, 95% CI 0.55, 0.74). No data supported the benefit of DMTs in reducing the time to, and magnitude of, disability progression. Conclusions Meta-analyses confirmed that IFN-β and GA delay time to CDMS compared to placebo. In the absence of evidence that early DMTs can reduce disability progression, future research is needed to better identify patients most likely to benefit from long-term DMTs. Electronic supplementary material The online version of this article (10.1007/s00415-018-8752-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- X Armoiry
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK.
| | - A Kan
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK
| | - G J Melendez-Torres
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK
| | - R Court
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK
| | - P Sutcliffe
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK
| | - P Auguste
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK
| | - J Madan
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK
| | - C Counsell
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - A Clarke
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, England, UK
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Walters D, Savage M, Anthony P, Crowhurst J, Poon K, Bett J, Scalia G, Raffel C, Clarke A. Outcomes of Transcatheter Aortic Valve Implantation in High Surgical Risk and Inoperable Patients With Aortic Stenosis: A Single Australian Centre Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.955] [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: 11/15/2022]
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Roen A, Laut K, Pelchen-Matthews A, Borodulina E, Caldeira L, Clarke A, Clotet B, d'Arminio Monforte A, Fätkenheuer G, Gatell Artigas JM, Karpov I, Kuznetsova A, Kyselyova G, Mozer-Lisewska I, Mulcahy F, Ragone L, Scherrer A, Uzdaviniene V, Vandekerckhove L, Vannappagari V, Ostergaard L, Mocroft A. Abacavir usage patterns and hypersensitivity reactions in the EuroSIDA cohort. HIV Med 2017; 19:252-260. [PMID: 29271606 DOI: 10.1111/hiv.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/16/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Five to eight per cent of HIV-positive individuals initiating abacavir (ABC) experience potentially fatal hypersensitivity reactions (HSRs). We sought to describe the proportion of individuals initiating ABC and to describe the incidence and factors associated with HSR among those prescribed ABC. METHODS We calculated the proportion of EuroSIDA individuals receiving ABC-based combination antiretroviral therapy (cART) among those receiving cART after 1 January 2009. Poisson regression was used to identify demographic, and current clinical and laboratory factors associated with ABC utilization and discontinuation. RESULTS Between 2009 and 2016, of 10 076 individuals receiving cART, 3472 (34%) had ever received ABC-based cART. Temporal trends of ABC utilization were also heterogeneous, with 28% using ABC in 2009, dropping to 26% in 2010 and increasing to 31% in 2016, and varied across regions and over time. Poisson models showed lower ABC utilization in older individuals, and in those with higher CD4 cell counts, higher cART lines, and prior AIDS. Higher ABC utilization was associated with higher HIV RNA and poor renal function, and was more common in Central-East and Eastern Europe and lowest during 2014. During 779 person-years of follow-up (PYFU) in 2139 individuals starting ABC after 1 January 2009, 113 discontinued ABC within 6 weeks of initiation for any reason [incidence rate (IR) 14.5 (95% confidence interval (CI) 12.1, 17.5) per 100 PYFU], 13 because of reported HSR [IR 0.3 (95% CI 0.1, 1.0) per 100 PYFU] and 35 because of reported HSR/any toxicity [IR 4.5 (95% CI 3.2, 6.3) per 100 PYFU]. There were no factors significantly associated with ABC discontinuation because of reported HSR/any toxicity. CONCLUSIONS ABC remains commonly used across Europe and the incidence of discontinuation because of reported HSR was low in our study population.
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Affiliation(s)
- A Roen
- University College London, London, UK
| | - K Laut
- University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - A Clarke
- Royal Sussex County Hospital, Brighton, UK
| | - B Clotet
- Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | - I Karpov
- Belarus State Medical University, Minsk, Belarus
| | - A Kuznetsova
- Kharkov State Medical University, Khrakov, Ukraine
| | - G Kyselyova
- Crimean Republican AIDS Centre, Simferopol, Ukraine
| | | | | | - L Ragone
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - A Scherrer
- University Hospital Zürich, Zürich, Switzerland
| | - V Uzdaviniene
- Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | | | | | | | - A Mocroft
- University College London, London, UK
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Isenberg D, Sturgess J, Allen E, Aranow C, Askanase A, Sang-Cheol B, Bernatsky S, Bruce I, Buyon J, Cervera R, Clarke A, Dooley MA, Fortin P, Ginzler E, Gladman D, Hanly J, Inanc M, Jacobsen S, Kamen D, Khamashta M, Lim S, Manzi S, Nived O, Peschken C, Petri M, Kalunian K, Rahman A, Ramsey-Goldman R, Romero-Diaz J, Ruiz-Irastorza G, Sanchez-Guerrero J, Steinsson K, Sturfelt G, Urowitz M, van Vollenhoven R, Wallace DJ, Zoma A, Merrill J, Gordon C. Study of Flare Assessment in Systemic Lupus Erythematosus Based on Paper Patients. Arthritis Care Res (Hoboken) 2017; 70:98-103. [PMID: 28388813 PMCID: PMC5767751 DOI: 10.1002/acr.23252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 04/04/2017] [Indexed: 12/22/2022]
Abstract
Objective To determine the level of agreement of disease flare severity (distinguishing severe, moderate, and mild flare and persistent disease activity) in a large paper‐patient exercise involving 988 individual cases of systemic lupus erythematosus. Methods A total of 988 individual lupus case histories were assessed by 3 individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%), and these provided the reference standard for the second part of the study. This component used 3 flare activity instruments (the British Isles Lupus Assessment Group [BILAG] 2004, Safety of Estrogens in Lupus Erythematosus National Assessment [SELENA] flare index [SFI] and the revised SELENA flare index [rSFI]). The 451 patient case histories were distributed to 18 pairs of physicians, carefully randomized in a manner designed to ensure a fair case mix and equal distribution of flare according to severity. Results The 3‐physician assessment of flare matched the level of flare using the 3 indices, with 67% for BILAG 2004, 72% for SFI, and 70% for rSFI. The corresponding weighted kappa coefficients for each instrument were 0.82, 0.59, and 0.74, respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged, including a tendency to score moderate flares as severe and persistent activity as flare, especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare, even if there were no new or worsening clinical features. Conclusion Given the complexity of assessing lupus flare, we were encouraged by the overall results reported. However, the problem of capturing lupus flare accurately is not completely solved.
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Affiliation(s)
| | - J Sturgess
- The Hospital For Tropical Diseases, London, UK
| | - E Allen
- The Hospital For Tropical Diseases, London, UK
| | - C Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - B Sang-Cheol
- Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | | | - I Bruce
- The University of Manchester, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - J Buyon
- New York School of Medicine, New York
| | - R Cervera
- Universitat de Barcelona, Barcelona, Spain
| | - A Clarke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - P Fortin
- Université Laval, Quebec City, Québec, Canada
| | - E Ginzler
- Downstate Medical Center Rheumatology, Brooklyn, New York
| | - D Gladman
- Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Hanly
- Nova Scotia Rehabiliation Center, Halifax, Nova Scotia, Canada
| | - M Inanc
- Istanbul University, Istanbul, Turkey
| | | | - D Kamen
- Medical University of South Carolina, Charleston, UK
| | | | - S Lim
- Emory University, Atlanta, Georgia
| | - S Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - O Nived
- Lund University, Lund, Sweden
| | - C Peschken
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - M Petri
- Johns Hopkins University, Baltimore, Maryland
| | - K Kalunian
- University of California at San Diego, Chicago, Illinois
| | - A Rahman
- University College London, London, UK
| | - R Ramsey-Goldman
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - J Romero-Diaz
- Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
| | - G Ruiz-Irastorza
- Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain
| | - J Sanchez-Guerrero
- Mount Sinai Hospital and University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - K Steinsson
- Landspitali University Hospital, Reykjavik, Iceland
| | | | - M Urowitz
- Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - D J Wallace
- University of California at Los Angeles, Scotland, UK
| | - A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | - J Merrill
- Oklahoma Medical Research Foundation, Oklahoma City, UK
| | - C Gordon
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Berenjeno IM, Piñeiro R, Castillo SD, Pearce W, McGranahan N, Dewhurst SM, Meniel V, Birkbak NJ, Lau E, Sansregret L, Morelli D, Kanu N, Srinivas S, Graupera M, Parker VER, Montgomery KG, Moniz LS, Scudamore CL, Phillips WA, Semple RK, Clarke A, Swanton C, Vanhaesebroeck B. Oncogenic PIK3CA induces centrosome amplification and tolerance to genome doubling. Nat Commun 2017; 8:1773. [PMID: 29170395 PMCID: PMC5701070 DOI: 10.1038/s41467-017-02002-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/01/2017] [Indexed: 01/01/2023] Open
Abstract
Mutations in PIK3CA are very frequent in cancer and lead to sustained PI3K pathway activation. The impact of acute expression of mutant PIK3CA during early stages of malignancy is unknown. Using a mouse model to activate the Pik3ca H1047R hotspot mutation in the heterozygous state from its endogenous locus, we here report that mutant Pik3ca induces centrosome amplification in cultured cells (through a pathway involving AKT, ROCK and CDK2/Cyclin E-nucleophosmin) and in mouse tissues, and increased in vitro cellular tolerance to spontaneous genome doubling. We also present evidence that the majority of PIK3CA H1047R mutations in the TCGA breast cancer cohort precede genome doubling. These previously unappreciated roles of PIK3CA mutation show that PI3K signalling can contribute to the generation of irreversible genomic changes in cancer. While this can limit the impact of PI3K-targeted therapies, these findings also open the opportunity for therapeutic approaches aimed at limiting tumour heterogeneity and evolution.
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Affiliation(s)
- Inma M Berenjeno
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK.
| | - Roberto Piñeiro
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK
- Roche-Chus Joint Unit, Complexo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Sandra D Castillo
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK
| | - Wayne Pearce
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK
| | - Nicholas McGranahan
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UCL Cancer Institute and Hospitals, 72 Huntley Street, London, WC1E 6DD, UK
| | - Sally M Dewhurst
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UCL Cancer Institute and Hospitals, 72 Huntley Street, London, WC1E 6DD, UK
| | - Valerie Meniel
- European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Nicolai J Birkbak
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UCL Cancer Institute and Hospitals, 72 Huntley Street, London, WC1E 6DD, UK
| | - Evelyn Lau
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK
| | - Laurent Sansregret
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UCL Cancer Institute and Hospitals, 72 Huntley Street, London, WC1E 6DD, UK
| | - Daniele Morelli
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK
| | - Nnennaya Kanu
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UCL Cancer Institute and Hospitals, 72 Huntley Street, London, WC1E 6DD, UK
| | - Shankar Srinivas
- Department of Physiology Anatomy and Genetics, University of Oxford, Oxford, OX1 2JD, UK
| | - Mariona Graupera
- Vascular Signalling Laboratory, Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, 08908, Spain
| | - Victoria E R Parker
- Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Karen G Montgomery
- Cancer Biology and Surgical Oncology Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, 3000, VIC, Australia
| | - Larissa S Moniz
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK
| | | | - Wayne A Phillips
- Cancer Biology and Surgical Oncology Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, 3000, VIC, Australia
| | - Robert K Semple
- Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Alan Clarke
- European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Charles Swanton
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK.
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UCL Cancer Institute and Hospitals, 72 Huntley Street, London, WC1E 6DD, UK.
| | - Bart Vanhaesebroeck
- UCL Cancer Institute, Paul O'Gorman Building, University College London, 72 Huntley Street London, London, WC1E 6DD, UK.
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46
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. The Lancet HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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47
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Sewell MD, Rothera L, Stokes O, Clarke A, Hutton M. Assessing the amount of distraction needed for expandable anterior column cages in the cervical spine. Ann R Coll Surg Engl 2017; 99:659-660. [PMID: 29022803 DOI: 10.1308/rcsann.2017.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M D Sewell
- Spinal Unit, Royal Devon and Exeter Hospital , Exeter , UK
| | - L Rothera
- Spinal Unit, Royal Devon and Exeter Hospital , Exeter , UK
| | - O Stokes
- Spinal Unit, Royal Devon and Exeter Hospital , Exeter , UK
| | - A Clarke
- Spinal Unit, Royal Devon and Exeter Hospital , Exeter , UK
| | - M Hutton
- Spinal Unit, Royal Devon and Exeter Hospital , Exeter , UK
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48
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Migone C, Barrett T, Cotter S, Clarke A, Corcoran B. The Uptake of Human Papillomavirus Vaccine In Irish Schools: The Impact Of Disadvantage. Ir Med J 2017; 110:603. [PMID: 29341515] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
HPV vaccine Gardasil© is offered to girls in first year of secondary school in Ireland. We aimed to determine the association between HPV vaccine uptake among girls for academic year 2013/2014, by school and school characteristics: socioeconomic disadvantage and religious ethos. The National Schools Immunisation System (SIS) was searched to determine HPV vaccine uptake in schools for 2013/2014 (prior to recent anti-HPV vaccine publicity). The disadvantaged status and ethos of each school was added to the report. In total 577 schools were identified. Mean vaccine uptake was 83.7%. Disadvantaged schools had a lower mean uptake (%) than other schools (79.4% vs 85.0%, difference 5.58%, 95%CI 2.69-8.21) and were twice as likely to have an uptake of ?50% (OR 2.07, 95% CI 2.76 - 5.18). No difference was found between schools of different ethoses. HPV vaccine uptake is lower in disadvantaged Irish schools. Policies should be developed to ensure a more equitable uptake of HPV vaccine.
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Affiliation(s)
- C Migone
- Department of Public Health, Health Service Executive-East, Dr Steevens' Hospital, Dublin 8, Ireland
| | - T Barrett
- National Immunisation Office, Units 8-9 Manor Street Business Park, Manor Street, Dublin 7, Ireland
| | - S Cotter
- Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1, Ireland
| | - A Clarke
- National Immunisation Office, Units 8-9 Manor Street Business Park, Manor Street, Dublin 7, Ireland
| | - B Corcoran
- National Immunisation Office, Units 8-9 Manor Street Business Park, Manor Street, Dublin 7, Ireland
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49
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Pett SL, Amin J, Horban A, Andrade-Villanueva J, Losso M, Porteiro N, Madero JS, Belloso W, Tu E, Silk D, Kelleher A, Harrigan R, Clark A, Sugiura W, Wolff M, Gill J, Gatell J, Clarke A, Ruxrungtham K, Prazuck T, Kaiser R, Woolley I, Alberto Arnaiz J, Cooper D, Rockstroh JK, Mallon P, Emery S. Week 96 results of the randomized, multicentre Maraviroc Switch (MARCH) study. HIV Med 2017; 19:65-71. [DOI: 10.1111/hiv.12532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- SL Pett
- The Kirby Institute; UNSW Australia; Sydney NSW Australia
- Institutes of Clinical Trials and Methodology; University College London; London UK
- Clinical Research Group; Infection and Population Health; Institute for Global Health; University College London; London UK
| | - J Amin
- The Kirby Institute; UNSW Australia; Sydney NSW Australia
| | - A Horban
- Wojewodzki Szpital Zakazny Centre for AIDS therapy and Diagnosis; Warsaw Poland
| | | | - M Losso
- Hospital General de Agudos J M Ramos Mejia; Buenos Aires Argentina
- Fundación IBIS CICAL; Buenos Aires Argentina
| | | | - JS Madero
- Instituto Nacional de Ciencias Medicas y Nutriciòn Salvador Zubiran; Tlalpan Mexico
| | - W Belloso
- Fundación IBIS CICAL; Buenos Aires Argentina
- Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - E Tu
- The Kirby Institute; UNSW Australia; Sydney NSW Australia
| | - D Silk
- The Kirby Institute; UNSW Australia; Sydney NSW Australia
| | - A Kelleher
- The Kirby Institute; UNSW Australia; Sydney NSW Australia
- St Vincent's Hospital; Sydney NSW Australia
| | - R Harrigan
- BC Centre for Excellence in HIV/AIDS; Vancouver BC Canada
| | - A Clark
- ViiV Healthcare Ltd; London UK
| | | | - M Wolff
- Fundacion Arriaran; Santiago Chile
| | - J Gill
- Southern Alberta Clinic; Calgary AB Canada
| | - J Gatell
- Hospital Clinic de Barcelona; Barcelona Spain
| | - A Clarke
- Brighton & Sussex University Hospitals NHS Trust; Brighton UK
| | - K Ruxrungtham
- HIV-NAT; Thai Red Cross AIDS Research Center
- Chulalongkorn University; Bangkok Thailand
| | - T Prazuck
- Orleans Hospital (CHR Orleans La Source); Orleans France
| | - R Kaiser
- Institut für Virologie; Cologne Germany
| | - I Woolley
- Monash Medical Centre and Monash University; Melbourne Vic Australia
| | | | - D Cooper
- The Kirby Institute; UNSW Australia; Sydney NSW Australia
- St Vincent's Hospital; Sydney NSW Australia
| | - JK Rockstroh
- Department of Medicine I; University Hospital Bonn; Bonn Germany
| | - P Mallon
- School of Medicine; University College Dublin; Dublin Ireland
| | - S Emery
- The Kirby Institute; UNSW Australia; Sydney NSW Australia
- Faculty of Medicine; The University of Queensland; Brisbane Qld Australia
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50
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Li W, Churchill L, Procter-Gray E, Kane K, Cheng J, Clarke A, Ockene J. SEX DIFFERENCES IN PHYSICAL ACTIVITY AMONG OLDER ADULTS LIVING IN URBAN AND RURAL NEIGHBORHOODS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4005] [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: 11/13/2022] Open
Affiliation(s)
- W. Li
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - L. Churchill
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - E. Procter-Gray
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - K. Kane
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - J. Cheng
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A. Clarke
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - J. Ockene
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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