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Green A, Quinn S, Kavnagh K, Bradley L, Kenny J, Lynch SA. Genetic knowledge, experience and educational needs of paediatric trainees in Ireland. Ir Med J 2023; 116:856. [PMID: 37874331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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McSweeney D, Gaffney J, Price JM, Lee LW, Thomson DD, McPartlin A, Green A, Bromiley P, van Herk M, McWilliam A. Are Different Modes of Weight Loss Associated with Survival in Oropharyngeal Cancer? Int J Radiat Oncol Biol Phys 2023; 117:e606. [PMID: 37785827 DOI: 10.1016/j.ijrobp.2023.06.1975] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients with oropharyngeal squamous cell carcinomas (OPSCC) often lose weight during radical radiotherapy (RT). Nutritional intervention is required in case of severe weight loss. However, weight loss does not provide full insight into body composition changes. Muscle mass is emerging as an important prognostic factor in cancer patients. We employed on-treatment cone-beam CT (CBCT) scans to monitor muscle mass and weight loss under the hypothesis that different modes of weight loss exist and may impact overall survival (OS). MATERIALS/METHODS A retrospective analysis of 197 OPSCC patients treated with definitive or adjuvant (chemo)RT. Weekly weight measurements & CBCTs were collected. Patients were included if at least two time-points were available and the interval between the first and last was between 15-50 days. CBCTs were normalized to account for calibration differences between treatment machines. An in-house deep-learning model automatically segmented the skeletal muscle compartment at C3 on all CBCTs. Segmentations were visually checked and failures removed. Skeletal muscle volume (SMV, in mm3) was extracted after thresholding for intra-muscular fat. Relative changes in weight & SMV were then calculated. Linear models were fitted to each trajectory for every patient and slopes were estimated. The following weight & SMV categories were defined to generate equal groups: lost (more than 0.4 standard deviations (SDs) below the mean (M)), maintained (within +/- 0.4 SDs of M) or gained (more than 0.4 SDs above the M). Table 1 highlights the nine modes of body composition change. The prognostic value of these was investigated in multivariable Cox models accounting for age, sex, disease stage, oropharynx subsite, smoking status, performance status (PS), tumor p16 status, baseline weight & SMV, and treatment prescribed. The primary endpoint was OS. RESULTS Mean weight & SMV changes during treatment were -0.047±0.001% & -0.044±0.019% per day. In multivariable analysis, gaining weight & losing SMV was identified as a significant risk factor for OS (p = 0.01, hazard ratio [95% CI]: 4.59 [1.40-15.10]). In this sub-group, mean weight & SMV change were +0.054±0.008% & -0.396±0.030% per day. PS>2 (p<0.001) & lower baseline weight (p = 0.02) were also significantly associated with OS. CONCLUSION Patients losing substantial SMV but mildly gaining weight have significantly worse OS than others. This suggests there exists a group of patients where nutritional support is needed, but not offered because they maintain weight during treatment. Although our results need validation, continual monitoring of muscle condition during RT would allow these patients to be identified and promptly targeted for nutritional support.
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Affiliation(s)
- D McSweeney
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Gaffney
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J M Price
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - L W Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - D D Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McPartlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Green
- EMBL European Bioinformatics Institute, Cambridge, United Kingdom
| | - P Bromiley
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - M van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Green A, Lyus R, Ocan M, Pollock AM, Brhlikova P. Registration of essential medicines in Kenya, Tanzania and Uganda: a retrospective analysis. J R Soc Med 2023; 116:331-342. [PMID: 37343667 PMCID: PMC10695152 DOI: 10.1177/01410768231181263] [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] [Received: 09/27/2022] [Accepted: 04/25/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES To audit national drug registers (NDRs) in Kenya, United Republic of Tanzania and Uganda with respect to national Essential Medicine Lists (EMLs) and to conduct an analysis of highly registered products including a sub-analysis of highly registered antimicrobial products. DESIGN Retrospective analysis of registration of essential medicines and medicinal products on NDRs as of February 2018. SETTING Not applicable. PARTICIPANTS None. MAIN OUTCOME MEASURES Registration status of essential medicines by country, essential medicine status of registered products by country and medicines with more than 50 registrations across all three countries. RESULTS A high proportion of essential medicines are not registered: Kenya 28% (175/632), United Republic of Tanzania 50% (400/797) and Uganda 40% (266/663). Of registered products on the NDRs, more than half are not essential: Kenya 71% (4350/6151), United Republic of Tanzania 64% (2278/3590) and Uganda 58% (2268/3896). When the three NDRs were combined, there were 42 medicines with over 50 registered products, accounting for 30% (4153/13637) of products, many of which were non-essential. CONCLUSIONS Non-registration of essential medicines is a barrier to availability. Over-registration of medicines, particularly non-essential medicines, diverts regulatory resources towards registering non-priority and, sometimes, clinically sub-optimal medicines. The East African Community Medicines Registration Harmonization Project has the potential to improve access to key medicines if registration of essential medicines is prioritised and registration of non-essential medicines is restricted.
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Affiliation(s)
- A Green
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - R Lyus
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - M Ocan
- Department of Pharmacology and Therapeutics, Makerere University, Republic of Uganda, Kampala, PO Box 7062
| | - AM Pollock
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - P Brhlikova
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
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Peyper KR, Olivier B, Green A. The cycle ergometer test is not a reliable alternative to the countermovement jump in the assessment of power output. S Afr J Sports Med 2023; 34:v34i1a12869. [PMID: 36815915 PMCID: PMC9927866 DOI: 10.17159/2078-516x/2022/v34i1a12869] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Rugby union is a physically demanding collision sport that requires optimal neuromuscular function for maximal power output, with mechanical power an integral component of performance. Peak power (Pp) and relative Pp are parameters of neuromuscular function commonly assessed through the countermovement jump (CMJ) as a measure of fatigue. The Wattbike cycle ergometer test (CET) is a non-load bearing method of evaluating lower limb power. The cost-effective CET could therefore offer a viable alternative to the CMJ. Objectives This study aimed to determine the concurrent validity of the CMJ and CET. Methods Thirty-eight professional rugby union players performed twelve CMJs on a force platform with four loads (bodyweight: BW-CMJ; 20kg: 20-CMJ; 40kg: 40-CMJ and 60kg: 60-CMJ) and a six second peak power (6PPO) CET assessment on a Wattbike ergometer. Results CMJ power outputs were [BW-CMJ: Pp - 3101±648 W; 20-CMJ: Pp - 2724±513 W; 40-CMJ: Pp - 2490±496 W; 60-CMJ: Pp - 2238±366 W] and CET [Pp - 1310±161 W]. None of the CMJ-Pp values showed relationships with any CET power variables. Large (r = 0.51-0.63; p = 0.000 - 0.001) relationships were found to be between relative CMJ and relative CET power outputs. Bland-Altman plots, which were used to determine the level of agreement between the two assessments, showed the agreement between the tests was poor. Conclusion Though positive relationships existed between relative CMJ and relative CET power variables, analyses of the level of agreement in the Bland-Altman plots suggest that the two power assessment methods are not interchangeable measures of power.
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Affiliation(s)
- KR Peyper
- Department of Sport and Movement Studies, Faculty of Health Sciences, University of Johannesburg,
South Africa
| | - B Olivier
- Wits Cricket Research Hub for Science, Medicine and Rehabilitation, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - A Green
- Department of Sport and Movement Studies, Faculty of Health Sciences, University of Johannesburg,
South Africa
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Bryce-Atkinson A, Wilson L, Osorio EV, Russell T, Pirlepesov F, Green A, Faught A, Mccabe M, Merchant T, Van Herk M, Aznar M. Spatial normalisation for novel MR-image based data mining in children with brain tumours. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.031] [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: 11/16/2022]
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Alejo A, Ahmed H, Krygier AG, Clarke R, Freeman RR, Fuchs J, Green A, Green JS, Jung D, Kleinschmidt A, Morrison JT, Najmudin Z, Nakamura H, Norreys P, Notley M, Oliver M, Roth M, Vassura L, Zepf M, Borghesi M, Kar S. Stabilized Radiation Pressure Acceleration and Neutron Generation in Ultrathin Deuterated Foils. Phys Rev Lett 2022; 129:114801. [PMID: 36154426 DOI: 10.1103/physrevlett.129.114801] [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] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2022] [Accepted: 04/28/2022] [Indexed: 06/16/2023]
Abstract
Premature relativistic transparency of ultrathin, laser-irradiated targets is recognized as an obstacle to achieving a stable radiation pressure acceleration in the "light sail" (LS) mode. Experimental data, corroborated by 2D PIC simulations, show that a few-nm thick overcoat surface layer of high Z material significantly improves ion bunching at high energies during the acceleration. This is diagnosed by simultaneous ion and neutron spectroscopy following irradiation of deuterated plastic targets. In particular, copious and directional neutron production (significantly larger than for other in-target schemes) arises, under optimal parameters, as a signature of plasma layer integrity during the acceleration.
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Affiliation(s)
- A Alejo
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
- Instituto Galego de Física de Altas Enerxías, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - H Ahmed
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - A G Krygier
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - R Clarke
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - R R Freeman
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - J Fuchs
- LULI-CNRS, CEA, UPMC Univ Paris 06: Sorbonne Université, Ecole Polytechnique, Institut Polytechnique de Paris, F-91128 Palaiseau cedex, France
| | - A Green
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J S Green
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - D Jung
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A Kleinschmidt
- Institut für Kernphysik, TU Darmstadt, D-64289 Darmstadt, Germany
| | - J T Morrison
- Propulsion Systems Directorate, Air Force Research Lab, Wright Patterson Air Force Base, Ohio 45433, USA
| | - Z Najmudin
- The John Adams Institute for Accelerator Science, Blackett Laboratory, Imperial College London, SW7 2AZ, United Kingdom
| | - H Nakamura
- The John Adams Institute for Accelerator Science, Blackett Laboratory, Imperial College London, SW7 2AZ, United Kingdom
| | - P Norreys
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
- Department of Physics, University of Oxford, Oxford OX1 3PU, United Kingdom
| | - M Notley
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - M Oliver
- Department of Physics, University of Oxford, Oxford OX1 3PU, United Kingdom
| | - M Roth
- Institut für Kernphysik, TU Darmstadt, D-64289 Darmstadt, Germany
| | - L Vassura
- LULI-CNRS, CEA, UPMC Univ Paris 06: Sorbonne Université, Ecole Polytechnique, Institut Polytechnique de Paris, F-91128 Palaiseau cedex, France
| | - M Zepf
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - M Borghesi
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - S Kar
- School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
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Ceranoglu T, Cassano P, Hutt Vater C, Green A, Dallenbach N, Disalvo M, Biederman J, Joshi G. Efficacy of tPBM on ADHD symptoms and Executive Function Deficits in Adults with high-functioning Autism Spectrum Disorder. Eur Psychiatry 2022. [PMCID: PMC9568161 DOI: 10.1192/j.eurpsy.2022.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Executive function (EF) deficits are often associated with Autism Spectrum Disorder (ASD), even in the absence of Attention Deficit Hyperactivity Disorder (ADHD) diagnosis. To date, no approved medication treatments exist for EF deficits associated with ASD.
Objectives
To assess the efficacy of transcranial photobiomodulation (tPBM) on EF in adults with ASD.
Methods
Adults (18-59) with high-functioning (HF)-ASD received twice a week tPBM for 8 weeks in an open-label single group design. ASD and EF deficits were assessed by clinician-rated Clinical Global Impression Scale and patient-rated scales of Behavior Rating Inventory of Executive Function-Adult (BRIEF-A).
Results
Eleven participants were enrolled. Ten participants completed the study. Nine participants who completed the study had comorbid ADHD diagnosis. All 10 participants were included in efficacy analyses of EF deficits. Statistically significant improvements in executive function deficits were found in BRIEF-A total score and in subdomains of Inhibition, Emotional Control, Planning and Organization, Organization of Materials, Behavioral Regulation, Metacognitive Index and Global Executive Control. All participants were found to have mild to moderate improvement in their ADHD symptom severity per clinician rated CGIs. Statistically significant improvements in ADHD symptoms were noted in self-rated scales. No adverse events required changes in tPBM protocol.
Conclusions
tPBM is a safe and feasible treatment approach that has the potential to treat core features of ASD. Further research is necessary and warranted.
Disclosure
This work is funded by Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder and the MGH Pediatric Psychopharmacology Council Fund.
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Sargeant C, Green A, Chuter R, McWilliam A. PD-0071 A novel method for evaluating CBCT-based synthetic CTs. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02741-4] [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: 11/16/2022]
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Vasquez Osorio E, Abravan A, Green A, van Herk M, Ganderton D, McPartlin A. OC-0255 Dysphagia at 1 year is associated with mean dose to the inferior section of the brainstem. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02513-0] [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: 11/29/2022]
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McSweeney D, Radhakrishna G, Green A, Bromiley P, van Herk M, McWilliam A. PO-1286 Skeletal muscle measured at T12 is a prognostic biomarker in oesophageal cancer patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wilson L, Bryce-Atkinson A, Green A, Merchant T, van Herk M, Vasquez Osorio E, Faught A, Aznar M. PO-1780 Image-based data mining for radiation outcomes research applies to data from children. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03744-6] [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: 11/29/2022]
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Berry S, Ijas N, Davies M, Green A, Howatson A. P.193 Postpartum aortic dissection in a patient with previously undiagnosed Marfan syndrome. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103489] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Martin P, Ahmed H, Doria D, Alejo A, Clarke R, Ferguson S, Fernández-Tobias J, Freeman RR, Fuchs J, Green A, Green JS, Gwynne D, Hanton F, Jarrett J, Jung D, Kakolee KF, Krygier AG, Lewis CLS, McIlvenny A, McKenna P, Morrison JT, Najmudin Z, Naughton K, Nersisyan G, Norreys P, Notley M, Roth M, Ruiz JA, Scullion C, Zepf M, Zhai S, Borghesi M, Kar S. Absolute calibration of Fujifilm BAS-TR image plate response to laser driven protons up to 40 MeV. Rev Sci Instrum 2022; 93:053303. [PMID: 35649771 DOI: 10.1063/5.0089402] [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] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/16/2022] [Indexed: 06/15/2023]
Abstract
Image plates (IPs) are a popular detector in the field of laser driven ion acceleration, owing to their high dynamic range and reusability. An absolute calibration of these detectors to laser-driven protons in the routinely produced tens of MeV energy range is, therefore, essential. In this paper, the response of Fujifilm BAS-TR IPs to 1-40 MeV protons is calibrated by employing the detectors in high resolution Thomson parabola spectrometers in conjunction with a CR-39 nuclear track detector to determine absolute proton numbers. While CR-39 was placed in front of the image plate for lower energy protons, it was placed behind the image plate for energies above 10 MeV using suitable metal filters sandwiched between the image plate and CR-39 to select specific energies. The measured response agrees well with previously reported calibrations as well as standard models of IP response, providing, for the first time, an absolute calibration over a large range of proton energies of relevance to current experiments.
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Affiliation(s)
- P Martin
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - H Ahmed
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - D Doria
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A Alejo
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - R Clarke
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - S Ferguson
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J Fernández-Tobias
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - R R Freeman
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - J Fuchs
- LULI - CNRS, CEA, UPMC Univ Paris 06 : Sorbonne Université, Ecole Polytechnique, Institut Polytechnique de Paris - F-91128 Palaiseau cedex, France
| | - A Green
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J S Green
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - D Gwynne
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - F Hanton
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - J Jarrett
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 0NG, United Kingdom
| | - D Jung
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - K F Kakolee
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A G Krygier
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - C L S Lewis
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - A McIlvenny
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - P McKenna
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 0NG, United Kingdom
| | - J T Morrison
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, Colorado 80523, USA
| | - Z Najmudin
- Blackett Laboratory, Department of Physics, Imperial College, London, SW7 2AZ, United Kingdom
| | - K Naughton
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - G Nersisyan
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - P Norreys
- Department of Physics, University of Oxford, Oxford, OX1 3PU, United Kingdom
| | - M Notley
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - M Roth
- Institut für Kernphysik, Technische Universität Darmstadt, Schloßgartenstrasse 9, 64289 Darmstadt, Germany
| | - J A Ruiz
- Instituto de Fusion Nuclear, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - C Scullion
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - M Zepf
- Helmholtz Institut Jena, 07743 Jena, Germany
| | - S Zhai
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - M Borghesi
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
| | - S Kar
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, United Kingdom
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Rankin A, Henderson E, Umney O, Bryce-Atkinson A, Green A, Vásquez Osorio E. PD-0069 Automatic detection of facial landmarks in paediatric CT scans using a convolutional neural network. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bryce-Atkinson A, Wilson L, Vasquez Osorio E, Green A, Whitfield G, McCabe M, Merchant T, van Herk M, Faught A, Aznar M. PO-1626 Automatic brain structure segmentation in children with brain tumours. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03590-3] [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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Henderson E, Green A, van Herk M, Vasquez Osorio E. PD-0317 A novel method to predict OAR contour errors without a ground truth using geometric learning. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pappot H, Holländer-Mieritz C, Steen-Olsen E, Green A, Kristensen C, Vogelius I. PO-1441 Remote monitoring during radiotherapy – recruitment for an eHealth study under the Covid19 pandemic. Radiother Oncol 2022. [PMCID: PMC9153879 DOI: 10.1016/s0167-8140(22)03405-3] [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: 11/16/2022]
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Vasquez Osorio E, Ganderton D, Abravan A, Green A, McPartlin A. PO-1106 HPV Status and Fitness Associated With Aspiration Risk at One Year After Head and Neck Radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03070-5] [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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Page D, McWilliam A, Chuter R, Green A. PO-1478 Convolutional recurrent neural networks for future anatomy prediction. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thiong'o C, McWilliam A, Price G, Davey A, Green A. PO-1781 Radiomic features are minimally repeatable in test-retest MR images of cervical cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03745-8] [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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McWilliam A, McSweeney D, Banfill K, van Herk M, Faivre-Finn C, Green A. MO-0391 Predicting early mortality using muscle characteristics for patients with lung cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02357-x] [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: 11/24/2022]
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22
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Ritchie CW, Waymont JMJ, Pennington C, Draper K, Borthwick A, Fullerton N, Chantler M, Porteous ME, Danso SO, Green A, McWhirter L, Muniz Terrera G, Simpson S, Thompson G, Trépel D, Quinn TJ, Kilgour A. The Scottish Brain Health Service Model: Rationale and Scientific Basis for a National Care Pathway of Brain Health Services in Scotland. J Prev Alzheimers Dis 2022; 9:348-358. [PMID: 35543009 DOI: 10.14283/jpad.2021.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 06/14/2023]
Abstract
In order to address the oft-cited societal, economic, and health and social care impacts of neurodegenerative diseases, such as Alzheimer's disease, we must move decisively from reactive to proactive clinical practice and to embed evidence-based brain health education throughout society. Most disease processes can be at least partially prevented, slowed, or reversed. We have long neglected to intervene in neurodegenerative disease processes, largely due to a misconception that their predominant symptom - cognitive decline - is a normal, age-related process, but also due to a lack of multi-disciplinary collaboration. We now understand that there are modifiable risk factors for neurodegenerative diseases, that successful management of common comorbidities (such as diabetes and hypertension) can reduce the incidence of neurodegenerative disease, and that disease processes begin (and, crucially, can be detected, reduced, and delayed, prevented, or treated) decades earlier in life than had previously been appreciated. Brain Health Scotland, established by Scottish Government and working in partnership with Alzheimer Scotland, propose far-reaching public health and clinical practice approaches to reduce neurodegenerative disease incidence. Focusing here on Brain Health Scotland's clinical offerings, we present the Scottish Model for Brain Health Services. To our knowledge, the Scottish Model for Brain Health, built on foundations of personalised risk profiling, targeted risk reduction and prevention, early disease detection, equity of access, and harnessing comprehensive data to assist in clinical decision-making, marks the first example of a nationwide approach to overhauling clinical, societal, and political approaches to the prevention, assessment, and treatment of neurodegenerative disease.
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Affiliation(s)
- C W Ritchie
- Prof. Craig Ritchie, University of Edinburgh, United Kingdom,
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Green A, Aznar MC, Muirhead R, Vasquez Osorio EM. Reading the Mind of a Machine: Hopes and Hypes of Artificial Intelligence for Clinical Oncology Imaging. Clin Oncol (R Coll Radiol) 2021; 34:e130-e134. [PMID: 34906408 DOI: 10.1016/j.clon.2021.11.008] [Citation(s) in RCA: 1] [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] [Received: 11/13/2019] [Revised: 10/21/2021] [Accepted: 11/10/2021] [Indexed: 12/21/2022]
Affiliation(s)
- A Green
- Radiotherapy Related Research Department, Division of Cancer Sciences, The University of Manchester, Manchester, UK; Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK.
| | - M C Aznar
- Radiotherapy Related Research Department, Division of Cancer Sciences, The University of Manchester, Manchester, UK; Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK; Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - R Muirhead
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E M Vasquez Osorio
- Radiotherapy Related Research Department, Division of Cancer Sciences, The University of Manchester, Manchester, UK; Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
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Amugongo L, Osorio EV, Green A, Cobben D, van Herk M, McWilliam A. Impact of registration uncertainties on the prediction of early tumour response to radiotherapy in NSCLC patients. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00120-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tzilivakis J, Warner DJ, Green A, Lewis KA. A broad-scale spatial analysis of the environmental benefits of fertiliser closed periods implemented under the Nitrates Directive in Europe. J Environ Manage 2021; 299:113674. [PMID: 34492440 DOI: 10.1016/j.jenvman.2021.113674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Nutrient pollution from agriculture has been an ongoing challenge for decades, contributing to numerous negative environmental impacts. In the European Union policies have been developed to address nutrient pollution, including Nitrate Action Programmes under Council Directive 91/676/EEC. Although Member States report on progress on implementation, there have been few studies that explore how measures have been implemented; the environmental implications of any differences; and how they vary spatially on a European scale. This study aims to address this gap with respect to fertiliser closed periods (1155 different closed periods across 69 Nitrate Action Programmes). This included the development of an approach that can be applied using readily available spatial data. Each closed period was scored for its coverage of risk periods for losses of nitrate; organic material; nitrous oxide and ammonia. Closed periods were then matched to relevant combinations of spatial data for each environmental zone and fertiliser type. The scores for each combination were used to create maps and calculate spatial statistics. The results show that in addition to nitrate, closed periods also reduce the risk of organic material run-off, emissions of nitrous oxide and to a lesser extent ammonia. However, risk reduction is spatially variable across all the impacts and the scope for synergy is also variable (e.g. nitrate loss does not always correlate with nitrous oxide or ammonia risk reduction). Regions in the Atlantic, Lustanian and some areas within the Mediterranean zones appear to provide the greatest combined risk reduction, with other zones, especially in eastern Europe, having a lower combined risk reduction (due to a combination of different risk periods coupled with lower coverage of individual risks). The spatial analysis within this study is relatively simple; is based on a snapshot of closed periods during 2019-2020; and only explores one measure. However, it does provide some useful data and insights that could support policy development in the future. This includes scope for Member States and regions to learn from others where greater coverage of risk periods has been achieved; and highlighting how a more holistic perspective can be taken to the environmental management of nutrients. As we strive towards developing sustainable production systems, farmers and policy makers need to take a more integrated approach to incorporate additional environmental objectives; which increases the complexity of the challenge. Consequently, the demand for pragmatic approaches that take a more holistic approach is likely to increase in the future.
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Affiliation(s)
- J Tzilivakis
- Agriculture and Environment Research Unit (AERU), School of Life and Medical Sciences, University of Hertfordshire, AL10 9AB, United Kingdom.
| | - D J Warner
- Agriculture and Environment Research Unit (AERU), School of Life and Medical Sciences, University of Hertfordshire, AL10 9AB, United Kingdom
| | - A Green
- Agriculture and Environment Research Unit (AERU), School of Life and Medical Sciences, University of Hertfordshire, AL10 9AB, United Kingdom
| | - K A Lewis
- Agriculture and Environment Research Unit (AERU), School of Life and Medical Sciences, University of Hertfordshire, AL10 9AB, United Kingdom
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Green S, Tuck S, Long J, Green T, Green A, Ellis P, Haire A, Moss C, Cahill F, McCartan N, Brown L, Santaolalla A, Marsden T, Justo MR, Hadley J, Punwani S, Attard G, Ahmed H, Moore CM, Emberton M, Van Hemelrijck M. ReIMAGINE: a prostate cancer research consortium with added value through its patient and public involvement and engagement. Res Involv Engagem 2021; 7:81. [PMID: 34789334 PMCID: PMC8596340 DOI: 10.1186/s40900-021-00322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND ReIMAGINE aims to improve the current prostate specific antigen (PSA)/biopsy risk stratification for prostate cancer (PCa) and develop a new image-based method (with biomarkers) for diagnosing high/low risk PCa in men. ReIMAGINE's varied patient and public involvement (PPI) and engagement (PE) strategy maximises the impact of its scientific output by informing and shaping the different stages of research. AIMS Through including the voice of patients and the public, the ReIMAGINE Consortium aims to translate these different perspectives into the design and implementation process. This will improve the overall quality of the research by: reflecting the needs and priorities of patients and the public, ensuring methods and procedures are feasible and appropriate ensuring information is relevant and accessible to those being recruited to the study identifying dissemination channels relevant to patients/the public and developing outputs that are accessible to a lay audience With support from our patient/user groups, the ReIMAGINE Consortium aims to improve our ability to derive prognostic information and allocate men to the most appropriate and effective therapies, using a novel image-based risk stratification with investigation of non-imaging biomarkers. FINDINGS We have been working with patients and the public from initiation of the project to ensure that the research is relevant to men and their families. Our PPI Sub-Committee, led by a PCa patient, has been involved in our dissemination strategy, outreach activities, and study design recommendations. For example, the sub-committee have developed a variety of informative videos relevant and accessible to those being recruited, and organised multiple online research engagement events that are accessible to a lay audience. As quoted by one of the study participants, "the more we present the benefits and opportunities to patients and the public, the more research commitment we obtain, and the sooner critical clinical questions such as PCa diagnostics will be addressed".
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Affiliation(s)
- S Green
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - S Tuck
- ReIMAGINE Consortium Patient Representative, London, UK
| | - J Long
- ReIMAGINE Consortium Patient Representative, London, UK
| | - T Green
- ReIMAGINE Consortium Patient Representative, London, UK
| | - A Green
- ReIMAGINE Consortium Patient Representative, London, UK
| | - P Ellis
- ReIMAGINE Consortium Patient Representative, London, UK
| | - A Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - C Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - F Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - N McCartan
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - L Brown
- MRC Clinical Trials Unit, University College London, London, UK
| | - A Santaolalla
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - T Marsden
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Rodriquez Justo
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Hadley
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - G Attard
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
| | - H Ahmed
- Imperial College, London, UK
| | - C M Moore
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Emberton
- UCL Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
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Abravan A, Vasquez Osorio E, Green A, McPartlin A, van Herk M. Anatomical Association of Dose Distribution With Radiotherapy-Related Lymphopenia in Oropharynx Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Phan H, Daines C, Green A, Camick N, Goodman A, Woo T, Riekert K. 290: Feasibility and acceptability of a medication schedule mobile application as part of CF care: A pilot, real-world, mobile health study in CF clinics. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01715-x] [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: 10/20/2022]
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Jegatheeswaran L, Choi B, Rocha MF, Green A. 1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.570] [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
Aim
The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals.
Method
An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020.
Results
In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November.
Conclusions
Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.
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Affiliation(s)
| | - B Choi
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - M F Rocha
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A Green
- Imperial College Healthcare NHS Trust, London, United Kingdom
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Warr H, Murray O, McSweeney D, McWilliam A, Green A. PD-0783 Automated sarcopenia assessment in the neck and survival analysis in head and neck cancer patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07062-6] [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: 10/20/2022]
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Robbins J, Argota-Perez R, Green A, van Herk M, Korreman S, Vasquez Osorio E. OC-0363 Evaluation of how well a PCA model represents anatomical variations during H&N radiation treatment. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06878-x] [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: 11/28/2022]
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McSweeney D, Bromiley P, van Herk M, Green A, McWilliam A. PO-1673 Improving data collection for deep-learning auto-segmentation models. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08124-x] [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: 11/29/2022]
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Henderson E, Vasquez Osorio E, van Herk M, Brouwer C, Steenbakkers R, Green A. PO-1695 Accurate H&N 3D segmentation with limited training data using 2-stage CNNs. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08146-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hague C, McPartlin A, Lee LW, Hughes C, Mullan D, Beasley W, Green A, Price G, Whitehurst P, Slevin N, van Herk M, West C, Chuter R. An evaluation of MR based deep learning auto-contouring for planning head and neck radiotherapy. Radiother Oncol 2021; 158:112-117. [PMID: 33636229 DOI: 10.1016/j.radonc.2021.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Auto contouring models help consistently define volumes and reduce clinical workload. This study aimed to evaluate the cross acquisition of a Magnetic Resonance (MR) deep learning auto contouring model for organ at risk (OAR) delineation in head and neck radiotherapy. METHODS Two auto contouring models were evaluated using deep learning contouring expert (DLCExpert) for OAR delineation: a CT model (modelCT) and an MR model (modelMRI). Models were trained to generate auto contours for the bilateral parotid glands and submandibular glands. Auto-contours for modelMRI were trained on diagnostic images and tested on 10 diagnostic, 10 MR radiotherapy planning (RTP), eight MR-Linac (MRL) scans and, by modelCT, on 10 CT planning scans. Goodness of fit scores, dice similarity coefficient (DSC) and distance to agreement (DTA) were calculated for comparison. RESULTS ModelMRI contours improved the mean DSC and DTA compared with manual contours for the bilateral parotid glands and submandibular glands on the diagnostic and RTP MRs compared with the MRL sequence. There were statistically significant differences seen for modelMRI compared to modelCT for the left parotid (mean DTA 2.3 v 2.8 mm), right parotid (mean DTA 1.9 v 2.7 mm), left submandibular gland (mean DTA 2.2 v 2.4 mm) and right submandibular gland (mean DTA 1.6 v 3.2 mm). CONCLUSION A deep learning MR auto-contouring model shows promise for OAR auto-contouring with statistically improved performance vs a CT based model. Performance is affected by the method of MR acquisition and further work is needed to improve its use with MRL images.
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Affiliation(s)
- C Hague
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - A McPartlin
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - L W Lee
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - C Hughes
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - D Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK.
| | - W Beasley
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
| | - A Green
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - G Price
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - P Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
| | - N Slevin
- Department of Head and Neck Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M van Herk
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - C West
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
| | - R Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
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Heyneke L, Green A. The prevalence and severity of lower back pain in South African university rowers. S Afr J Sports Med 2021; 33:v33i1a9323. [PMID: 36816898 PMCID: PMC9924537 DOI: 10.17159/2078-516x/2021/v33i1a9323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Low back pain (LBP) is a condition prevalent among rowers due to the repetitive and physically demanding nature of rowing. Information concerning LBP among university-level rowers is, however, outdated and not widely available. Objective To determine the prevalence, severity and disabilities of LBP among university-level rowers in South Africa. Methods An online questionnaire, including the Athlete Disability Index (ADI) Questionnaire, was distributed to nine South African university rowing clubs. One-hundred participants aged between 18 to 30 years completed the online questionnaires. Results Eighty-seven rowers admitted to sustaining LBP either at the time of the study or previously in their university rowing career. These rowers (n=87) completed the Athlete Disability Index (ADI) Questionnaire which provided a moderate LBP disability score (ADI score: 8.1±6.0; ADI %: 24.7%±18.1). Rowers who had been rowing for a longer duration reported a higher severity of LBP (p=0.001). There was no statistically significant difference for LBP prevalence (p=0.584), or severity (p=0.445) between the sexes. A small significant correlation between age and the ADI score (r=0.25, p= 0.021) was reported. The high prevalence and moderate severity highlight the significance of LBP among university rowers. Conclusion This study illustrates the prevalence of LBP with moderate severity among university rowers. Future research on LBP risk factors and aetiology is recommended to decrease the negative impact of this condition.
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Abstract
Background The purpose of the on-field referee is to implement the laws of the game. For the referee to do this successfully, he is required to keep up with the pace of play. Objectives The aim of this study was to determine the physical attributes of sub-elite rugby union referees of inland provinces in South Africa. Methods A total of 82 referees (age: 26.5 ± 6.4 years; stature: 177.3 ± 6.8 cm; body mass: 79.1 ± 14.7 kg) were assessed with a reliable testing battery. Results The participants showed a refined aerobic capacity (VO2max: 61.8 ± 11.0 mL·min-1·kg-1) and good agility (Illinois Agility Test: 17.2 ± 3.8 s). A two-way unbalanced ANOVA was performed for all referees' attributes between qualification levels (levels 1-4) and union affiliations (three unions) at a significance level of p<0.05. The results yielded significant differences across the three unions in age (p=0.002), Yo-Yo distance (p=0.0001), aerobic capacity (p=0.0001), plank time (p=0.0001) and agility (p=0.027). Similarly, differences were reported across the four qualifications in aerobic capacity (p=0.0001) and agility (p=0.037). Conclusion These differences may be due to the diverse training programmes offered by the various unions. Additionally, an increased level of physical fitness may occur when progressing up the qualification levels.
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Welby-Everard P, Quantick O, Green A. Emergency preparedness, resilience and response to a biological outbreak. BMJ Mil Health 2020; 166:37-41. [PMID: 31999617 DOI: 10.1136/jramc-2019-001323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/04/2019] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 11/04/2022]
Abstract
Major disease outbreaks continue to be a significant risk to public health, with pandemic influenza or an emerging infectious disease outbreak at the top of the UK National Risk Register. The risk of deliberate release of a biological agent is lower but remains possible and may only be recognised after casualties seek medical attention. In this context the emergency preparedness, resilience and response (EPRR) process protects the public from high consequence infectious diseases, other infectious disease outbreaks and biological agent release. The core elements of the EPRR response are recognition of an outbreak, isolation of patients, appropriate personal protective equipment for medical staff and actions to minimise further disease spread. The paper discusses how high-threat agents may be recognised by clinicians, the initial actions to be taken on presentation and how the public health system is notified and responds. It draws on the national pandemic influenza plans to describe the wider response to a major disease outbreak and discusses training requirements and the potential role of the military.
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Affiliation(s)
- P Welby-Everard
- Anaesthetics Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - O Quantick
- Public Health, Royal Army Medical Corps, Camberley, UK
| | - A Green
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
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Elfassy MD, Duncan LJ, Green A, Sun H, Guimond T, Tzanetos K, Nyhof-Young J. Patients as teachers: Evaluating the experiences of volunteer inpatients during medical student clinical skills training. Can Med Educ J 2020; 11:e8-e16. [PMID: 33349749 PMCID: PMC7749683 DOI: 10.36834/cmej.70158] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Early patient encounters in medical education are an important element of clinical skill development. This study explores the experiences of volunteer inpatients (VIPs) participating in clinical skills training with junior medical students (JMS) solely for educational purposes. METHODS Following first-year medical students practicing history taking and clinical examinations with VIPs at Toronto General Hospital (TGH) and Toronto Western Hospital (TWH), patients completed a questionnaire and a short audio-recorded interview. This study used a mixed methodological approach. A 5-point Likert-scaled survey queried satisfaction regarding the recruitment process, student and faculty interactions and patient demographics (e.g. age and educational background). A 10-minute follow-up interview investigated patient perspectives. Survey responses were correlated to patient demographics and descriptive thematic analysis summarized trends in patient perspectives. RESULTS Of 93 consenting VIPs, 66% were male and 58% participated at TGH. The mean overall experience was positive (4.76 and 4.93 at TGH and TWH, respectively). Three themes emerging through thematic analysis were Not "Just" a Medical Student, Patient as Teacher, and Promoting Best Practices. VIPs reported positive experiences when they were adequately informed of the VIP role during recruitment, and when students exhibited confidence, interest, and respect throughout the session. CONCLUSION Study results provide clarity about VIP experiences with JMS and lay a foundation for improved patient satisfaction and best practices within clinical skills curricula in the health professions.
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Affiliation(s)
- MD Elfassy
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - LJ Duncan
- Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - A Green
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - H Sun
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | | | - K Tzanetos
- Faculty of Medicine, University of Toronto, Ontario, Canada
- University Health Network, Ontario, Canada
| | - J Nyhof-Young
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Office of Assessment and Evaluation, MD Program, University of Toronto, Ontario, Canada
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Robbins J, Van Herk M, Green A, Eiben B, McPartlin A, Vásquez Osorio E. PO-1650: Evaluating plan robustness for organ deformation and set-up uncertainties in head and neck cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mcsweeney D, Green A, Bromiley P, Van Herk M, Mansoor W, Weaver J, McWilliam A. PD-0541: Transfer learning for automatic sarcopenia evaluation at T12 vertebral level. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Corden M, Chin S, Cree A, Hoskin P, McWilliam A, Satiti A, Song Y, Green A, Choudhury A. PO-1216: Can sarcopenia predict outcomes in bladder cancer patients treated with chemoradiotherapy? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Amugongo L, Vasquez Osorio E, Green A, Cobben D, Van Herk M, McWilliam A. PO-1569: Early prediction of tumour-response to radiotherapy in NSCLC patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01587-5] [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: 11/25/2022]
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Henderson E, Vasquez Osorio E, Van Herk M, Green A. PO-1755: Use of ‘Jigsaw puzzles’ to train convolutional neural networks for segmentation with limited data. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Green A, Van Herk M, Osorio EV, Weaver J, McWilliam A. PD-0428: Large scale evaluation of sarcopenia as prognostic factor in lung cancer radiotherapy patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Green A, Olsen K, Persson G, Bliddal M, Andersen K, Hallerbäck T, Jakobsen E. 1796P Treatment patterns and survival for small cell lung cancer patients: A nationwide Danish register study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1557] [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: 10/23/2022] Open
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Lewis A, Green A, Weaver J, Mansoor W, Cook N. 589P The impact of sarcopenia in patients enrolled in early phase cancer trials. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.703] [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: 10/23/2022] Open
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Bain SC, Bakhai A, Evans M, Green A, Menown I, Strain WD. An update to: Pharmacological treatment for type 2 diabetes integrating findings from cardiovascular outcome trials: an expert consensus in the UK. Diabet Med 2019; 36: 1063-1071. Diabet Med 2020; 37:1405-1407. [PMID: 31691349 DOI: 10.1111/dme.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- S C Bain
- Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK
| | - A Bakhai
- Department of Cardiology, Royal Free London Hospitals NHS Foundation Trust, Barnet General Hospital, Barnet, UK
| | - M Evans
- University Hospital Llandough, Cardiff, UK
| | - A Green
- The Hedon Group Practice, Hedon, UK
| | - I Menown
- Craigavon Cardiac Centre, Craigavon Hospital, Southern HSC Trust, Craigavon, UK
| | - W D Strain
- Institute of Biomedical and Clinical Science, Diabetes and Vascular Medicine, NIHR Exeter Clinical Research Facility and University of Exeter Medical School, Exeter, UK
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Fischer S, Clements S, Green A, McWilliam A, Descamps T, Oing C, Gillessen S. Influence of treatment with abiraterone and enzalutamide on development of sarcopenia in patients with metastatic castration resistant prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Charlton R, Green A, Shaddick G, Snowball J, Nightingale A, Tillett W, Smith C, Mchugh N, Tillett W. SAT0399 RISK OF OSTEOARTHRITIS IN AN INCIDENT COHORT OF PEOPLE WITH PSORIATIC ARTHRITIS: A POPULATION-BASED COHORT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that causes pain, stiffness and swelling around the joints. PsA is reported to affect between 10 and 40% of individuals with psoriasis1and in the majority of patients presents after, or synchronously with, psoriasis onset.2Osteoarthritis (OA) is a common form of non-inflammatory arthritis related to joint degeneration and typically commences late in the fifth decade. PsA and OA have long been considered two distinct arthropathies, however they do have some overlapping features and symptoms and in certain circumstances it can be difficult to differentiate between them, particularly in the small joints of the hands or spine.3Objectives:To determine the risk of a diagnosis of osteoarthritis in psoriatic arthritis patients compared to patients with psoriasis and a general population cohort.Methods:Incident PsA patients aged 18-89 years at diagnosis were identified from the UK Clinical Practice Research Datalink between 1998 and 2014. All PsA patients were matched to a cohort of patients with psoriasis and a general population cohort (with no psoriasis or PsA) at a 1:4 ratio based on index date, year of birth, sex and general practice. The baseline prevalence of OA of any site was calculated as a percentage for each study cohort and then those prevalent cases were excluded from the numerators and denominators of the incident calculations. The incidence of OA was calculated and relative risks (RRadj), adjusting for body mass index (BMI), were calculated using conditional Poisson regression.Results:In total, 6,783 incident PsA patients were identified. The baseline prevalence of OA ranged from 22.1% (CI9521.1-23.1) in the PsA cohort to 12.6% (CI9512.2-13.0) and 11.0% (CI9510.6-11.3) in the psoriasis and general population cohorts respectively. The incidence of OA was significantly higher in the PsA cohort compared to the psoriasis and general population cohorts after adjusting for BMI (RRadj1.68 CI951.46-1.93 and RRadj1.86 CI951.62-2.14 respectively) (Tables 1 and 2).Conclusion:An increased risk of OA was observed in patients with PsA compared to patients with psoriasis alone and those in the general population. Further work is needed to determine whether this reflects a true increase in OA risk or misdiagnosed PsA and the extent to which it can be explained by differences in the opportunity for OA diagnosis between cohorts.Table 1.Incidence of osteoarthritis in the PsA, psoriasis and general population cohortsCasesMedian age (years) at diagnosis (IQR)Person yearsIncidence rate per10,000 person yearsCI95Any OAϮGeneral population137459 (51 - 66)125,798109.2(103.5 - 115.0)Psoriasis143259 (53 - 67)122,279117.1(111.0 - 123.2)PsA46459 (51 - 66)28,574162.4(147.6 - 177.2)Ϯincluding spondylosisReferences:[1]Ogdie A, Weiss P. Rheum Dis Clin North Am. 2015;41(4):545-568.[2]Tillett Wet al.Rheumatol. 2017;56(12):2109-2113.[3]McGonagle Det al. Rheumatology. 2015;54(1):29-38.Table 2.Risk of osteoarthritis in patients with PsA compared with patients in the general population and patients with psoriasisPsA compared with a general population cohortPsA compared with a psoriasis cohortUnadjustedAdjusted†UnadjustedAdjusted†RRCI95PRRCI95PRRCI95PRRCI95POA1.871.67-2.10<0.00011.861.62-2.14<0.00011.681.50-1.88<0.00011.681.46-1.93<0.0001†adjusted for BMI taken as the closest entry within 3 years of the index dateAcknowledgments:This report is independent research funded by the National Institute for Health Research, Programme Grants for Applied Research [Early detection to improve outcome in patients with undiagnosed PsA (‘PROMPT’), RP-PG-1212-20007]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Disclosure of Interests:None declared
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Green A, Sher S, Siri N, Mizrahci N, Koren O, Dagan Y. 0167 The Effect of Nocturnal Dinner Type “Light” Versus “Heavy” on Sleep, Attention and Microbial Composition. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.165] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Nutrition and sleep are two essential functions for the physiological existence of the organism. Furthermore, both have an acquired cultural, educational and social behavioral component. This study examined the effect of nocturnal dinner type (“light” vs. “heavy”) on the quality and quantity of sleep, attention abilities, fatigue, and mood in the following morning. In addition, the microbial composition was examined.
Methods
Twenty healthy subjects (10 men and 10 women), aged 25–33, were invited to two non-consecutive nights at the Sleep Institute for polysomnography test and filling out questionnaires: KSS; ESS; and Brief Symptom Inventory (BSI), attention abilities assessed with CPT-III. In one evening, the subjects consumed two hours before bedtime a “light” dinner based on vegetable ingredients (vegetables and vegetable proteins) with 342 calories that contained lentils, feta cheese, beet, and other vegetables. On the other evening, the subjects consumed two hours before bedtime a “heavy” dinner based on carbohydrates, fats, and animal protein with 501 calories that contained hamburger and French fries. In addition, subjects were required to give a microbial test before and after meals.
Results
There was no significant difference in the various sleep parameters between the two nights after each meal type: efficacy (t=-1.51,p=0.15); sleep latency stage 1 (t=1.81,p=0.08); sleep latency stage 2 (t=1.00,p=0.33); REM latency (t=0.57,p=0.57); total sleep time (t=-1.57,p=0.13); number of awakenings (t=0.30, p=0.76). No significant differences were found for: fatigue (KSS) (t=-0.30,p =0.77); sleepiness (ESS) (t=0.76,p =0.45); mood (BSI) (t=0.87,p =0.39); and attention deficit (CPT-III) (t=-0.68,p =0.50). The type of night meal did not show a significant effect on the microbial composition (H=0.059,p= 0.81).
Conclusion
The findings of this study show that, contrary to popular belief, “heavy” dinner did not affect the quality of sleep and functions measured in the study compared to a “light” dinner. In the current research, the population that was examined included only young and healthy subjects, therefore, the results may differ if the research in this field will extend and include other populations such as adults and subjects with different disorders. Future studies are needed to examine the relationships between sleep and nutrtion.
Support
No support
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Affiliation(s)
- A Green
- The Sleep and Fatigue Institute, Assuta Medical Center, Tel-Aviv, ISRAEL
- The Research Institute of Applied Chronobiology, The Academic College of Tel-Hai, Tel-Hay, ISRAEL
| | - S Sher
- The Research Institute of Applied Chronobiology, The Academic College of Tel-Hai, Tel-Hay, ISRAEL
| | - N Siri
- The Research Institute of Applied Chronobiology, The Academic College of Tel-Hai, Tel-Hay, ISRAEL
| | - N Mizrahci
- The Research Institute of Applied Chronobiology, The Academic College of Tel-Hai, Tel-Hay, ISRAEL
| | - O Koren
- Azrieli Faculty of Medicine, Bar-Ilan University, Safad, ISRAEL
| | - Y Dagan
- The Sleep and Fatigue Institute, Assuta Medical Center, Tel-Aviv, ISRAEL
- The Research Institute of Applied Chronobiology, The Academic College of Tel-Hai, Tel-Hay, ISRAEL
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