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Babikow E, Ghaltakhchyan N, Livingston T, Qu Y, Liu C, Hoxie A, Sulkowski T, Bocklage C, Marsh A, Phillips ST, Mitchell KB, Ribeiro ADA, Jackson TH, Roach J, Wu D, Divaris K, Jacox LA. Longitudinal Microbiome Changes in Supragingival Biofilm Transcriptomes Induced by Orthodontics. JDR Clin Trans Res 2023:23800844231199393. [PMID: 37876206 DOI: 10.1177/23800844231199393] [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: 10/26/2023] Open
Abstract
INTRODUCTION Common oral diseases are known to be associated with dysbiotic shifts in the supragingival microbiome, yet most oral microbiome associations with clinical end points emanate from cross-sectional studies. Orthodontic treatment is an elective procedure that can be exploited to prospectively examine clinically relevant longitudinal changes in the composition and function of the supragingival microbiome. METHODS A longitudinal cohort study was conducted among 24 adolescent orthodontic patients who underwent saliva and plaque sampling and clinical examinations at time points: before fixed appliance bonding and at 1, 6, and 12 wk thereafter. Clinical indices included bleeding on probing (BOP), mean gingival index (GI), probing depths (PDs), and plaque index (PI). To study the biologically (i.e., transcriptionally) active microbial communities, RNA was extracted from plaque and saliva for RNA sequencing and microbiome bioinformatics analysis. Longitudinal changes in microbiome beta diversity were examined using PERMANOVA tests, and the relative abundance of microbial taxa was measured using Kruskal-Wallis tests, Wilcoxon rank-sum tests, and negative binomial and zero-inflated mixed models. RESULTS Clinical measures of oral health deteriorated over time-the proportion of sites with GI and PI ≥1 increased by over 70% between prebonding and 12 wk postbonding while the proportion of sites with PD ≥4 mm increased 2.5-fold. Streptococcus sanguinis, a health-associated species that antagonizes cariogenic pathogens, showed a lasting decrease in relative abundance during orthodontic treatment. Contrarily, caries- and periodontal disease-associated taxa, including Selenomonas sputigena, Leptotrichia wadei, and Lachnoanaerobaculum saburreum, increased in abundance after bonding. Relative abundances of Stomatobaculum longum and Mogibacterium diversum in prebonding saliva predicted elevated BOP 12 wk postbonding, whereas Neisseria subflava was associated with lower BOP. CONCLUSIONS This study offers insights into longitudinal community and species-specific changes in the supragingival microbiome transcriptome during fixed orthodontic treatment, advancing our understanding of microbial dysbioses and identifying targets of future health-promoting clinical investigations. KNOWLEDGE TRANSFER STATEMENT Bonding braces was associated with subsequent changes in the oral microbiome characterized by increases in disease-associated species, decreases in health-associated species, and worsened clinical measures of oral health.
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Affiliation(s)
- E Babikow
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - N Ghaltakhchyan
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - T Livingston
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
- Selden Orthodontics, Huntersville, NC, USA
| | - Y Qu
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - C Liu
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - A Hoxie
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - T Sulkowski
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
- University of Buffalo, School of Dental Medicine, Buffalo, NY, USA
| | - C Bocklage
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - A Marsh
- Microbiome Core Facility, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - S T Phillips
- GoHealth Clinical Research Unit, Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - K B Mitchell
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - A De A Ribeiro
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - T H Jackson
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
- Align Technology, Morrisville, NC, USA
| | - J Roach
- Microbiome Core Facility, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - D Wu
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - K Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - L A Jacox
- Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Azcarate-Peril MA, Roach J, Marsh A, Chey WD, Sandborn WJ, Ritter AJ, Savaiano DA, Klaenhammer TR. A double-blind, 377-subject randomized study identifies Ruminococcus, Coprococcus, Christensenella, and Collinsella as long-term potential key players in the modulation of the gut microbiome of lactose intolerant individuals by galacto-oligosaccharides. Gut Microbes 2022; 13:1957536. [PMID: 34365905 PMCID: PMC8354614 DOI: 10.1080/19490976.2021.1957536] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background. Our recent publication (Chey et al., Nutrients 2020) showed that a 30-day administration of pure galacto-oligosaccharides (GOS) significantly reduced symptoms and altered the fecal microbiome in patients with lactose intolerance (LI). Results. In this addendum, we performed an in-depth analysis of the fecal microbiome of the 377 LI patients randomized to one of two GOS doses (Low, 10-15 grams/day or High, 15-20 grams/day), or placebo in a multi-center, double-blinded, placebo-controlled trial. Sequencing of 16S rRNA amplicons was done on GOS or placebo groups at weeks zero (baseline), four (end of treatment), nine, 16 and 22. Taxa impacted by treatment and subsequent dairy consumption included lactose-fermenting species of Bifidobacterium, Lactobacillus, Lactococcus, and Streptococcus. Increased secondary fermentation microorganisms included Coprococcus and Ruminococcus species, Blautia producta, and Methanobrevibacterium. Finally, tertiary fermenters that use acetate to generate butyrate were also increased, including Faecalibacterium prausnitzii, Roseburia faecis, and C. eutactus. Conclusions. Results confirmed and expanded data on GOS microbiome modulation in LI individuals. Microbiome analysis at 16 and 22 weeks after treatment further suggested relatively long-term benefits when individuals continued consumption of dairy products.
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Affiliation(s)
- M. A. Azcarate-Peril
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,CONTACT M. A. Azcarate-Peril Department of Medicine, School of Medicine, University of North Carolina, 332 Isaac Taylor Hall, Chapel Hill, NC27599-7545
| | - J. Roach
- UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,UNC Information Technology Services and Research Computing, University of North Carolina, Chapel Hill, NC, USA
| | - A. Marsh
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - William D. Chey
- Departments of Internal Medicine and Nutritional Sciences, University of Michigan Health System, Ann Arbor, MI, USA
| | - William J. Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | | | - Dennis A. Savaiano
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - T. R. Klaenhammer
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA
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Diaz T, Strong KL, Cao B, Guthold R, Moran AC, Moller AB, Requejo J, Sadana R, Thiyagarajan JA, Adebayo E, Akwara E, Amouzou A, Aponte Varon JJ, Azzopardi PS, Boschi-Pinto C, Carvajal L, Chandra-Mouli V, Crofts S, Dastgiri S, Dery JS, Elnakib S, Fagan L, Jane Ferguson B, Fitzner J, Friedman HS, Hagell A, Jongstra E, Kann L, Chatterji S, English M, Glaziou P, Hanson C, Hosseinpoor AR, Marsh A, Morgan AP, Munos MK, Noor A, Pavlin BI, Pereira R, Porth TA, Schellenberg J, Siddique R, You D, Vaz LME, Banerjee A. A call for standardised age-disaggregated health data. Lancet Healthy Longev 2021; 2:e436-e443. [PMID: 34240065 PMCID: PMC8245325 DOI: 10.1016/s2666-7568(21)00115-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The 2030 Sustainable Development Goals agenda calls for health data to be disaggregated by age. However, age groupings used to record and report health data vary greatly, hindering the harmonisation, comparability, and usefulness of these data, within and across countries. This variability has become especially evident during the COVID-19 pandemic, when there was an urgent need for rapid cross-country analyses of epidemiological patterns by age to direct public health action, but such analyses were limited by the lack of standard age categories. In this Personal View, we propose a recommended set of age groupings to address this issue. These groupings are informed by age-specific patterns of morbidity, mortality, and health risks, and by opportunities for prevention and disease intervention. We recommend age groupings of 5 years for all health data, except for those younger than 5 years, during which time there are rapid biological and physiological changes that justify a finer disaggregation. Although the focus of this Personal View is on the standardisation of the analysis and display of age groups, we also outline the challenges faced in collecting data on exact age, especially for health facilities and surveillance data. The proposed age disaggregation should facilitate targeted, age-specific policies and actions for health care and disease management.
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Affiliation(s)
- Theresa Diaz
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Kathleen L Strong
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Bochen Cao
- Data and Analytics Department, WHO, Geneva, Switzerland
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Allisyn C Moran
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | | | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elsie Akwara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Agbessi Amouzou
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Peter S Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Adolescent Health and Wellbeing Program, Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Department of Pediatrics, VIC, Australia
- University of Melbourne, VIC, Australia
| | - Cynthia Boschi-Pinto
- Department of Epidemiology and Biostatistics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Liliana Carvajal
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Venkatraman Chandra-Mouli
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shatha Elnakib
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Laura Fagan
- UN Major Group for Children and Youth, New York, NY, USA
| | | | - Julia Fitzner
- Global Infectious Hazard Preparedness Department, WHO, Geneva, Switzerland
| | | | - Ann Hagell
- Association for Young People's Health, London, UK
| | | | | | | | | | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Andrew Marsh
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Alison P Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, VIC, Australia
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Melinda K Munos
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Boris I Pavlin
- Health Emergency Information and Risk Assessment Department, WHO, Geneva, Switzerland
| | | | - Tyler A Porth
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | | | | | - Danzhen You
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Lara M E Vaz
- Population Reference Bureau, Washington, DC, USA
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
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Batbayar K, Ye K, Waldman S, Marsh A, Shi M, Siddiqui T, Suzuki M, Desai A, Patel D, Patel J, Dobkin J, Sadoughi A, Shah C, Yakov P, Vijig J, Spivack S. P58.02 Bronchial Field Progenitor Basal Cells Show Methylome-Wide Characteristics Reflective of Lung Cancer Case-Control, Age, and Smoking Status. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.950] [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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Rindfleish S, Bennett K, Marsh A, Chachay V. Outcomes of dietary management approaches in active ulcerative colitis: A systematic review. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.734] [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]
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Marsh A, Hirve S, Lele P, Chavan U, Bhattacharjee T, Nair H, Juvekar S, Campbell H. Determinants and patterns of care-seeking for childhood illness in rural Pune District, India. J Glob Health 2020; 10:010601. [PMID: 32082546 PMCID: PMC7020658 DOI: 10.7189/jogh.10.010601] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND An estimated 1.2 million children under five years of age die each year in India, with pneumonia and diarrhea among the leading causes. Increasing care-seeking is important to reduce mortality and morbidity from these causes. This paper explores the determinants and patterns of care-seeking for childhood illness in rural Pune district, India. METHODS Mothers having at least one child <5 years from the study area of the Vadu Health and Demographic Surveillance System were enrolled in a prospective cohort study. Household sociodemographic information was collected through a baseline questionnaire administered at enrollment. Participants were visited up to six times between July 2015 and February 2016 to collect information on recent childhood acute illness and associated care-seeking behavior. Multivariate logistic regression explored the associations between care-seeking and child, participant, and household characteristics. RESULTS We enrolled 743 mothers with 1066 eligible children, completing 2585 follow-up interviews (90% completion). Overall acute illness prevalence in children was 26% with care sought from a health facility during 71% of episodes. Multivariable logistic regression showed care-seeking was associated with the number of reported symptoms (Odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.5-3.9) and household insurance coverage (OR = 2.2, 95% CI = 1.1-4.3). We observed an interaction between the associations of illness severity and maternal employment on care-seeking. Somewhat-to-very severe illness was associated with increased care-seeking among both employed (OR = 5.0, 95% CI = 2.2-11.1) and currently unemployed mothers (OR = 7.0, 95% CI = 3.9-12.6). Maternal employment was associated with reduced care-seeking for non-severe illness (OR = 0.3, 95% CI = 0.1-0.7), but not associated with care-seeking for somewhat-to-very severe illness. Child sex was not associated with care-seeking. CONCLUSIONS This study demonstrates the importance of illness characteristics in determining facility-based care-seeking while also suggesting that maternal employment resulted in decreased care-seeking among non-severe illness episodes. The nature of the association between maternal employment and care-seeking is unclear and should be explored through additional studies. Similarly, the absence of male bias in care-seeking should be examined to assess for potential bias at other stages in the management of childhood illness.
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Affiliation(s)
- Andrew Marsh
- Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- KEM Hospital Research Centre, Rasta Peth, Pune, India
| | | | - Pallavi Lele
- KEM Hospital Research Centre, Rasta Peth, Pune, India
| | | | - Tathagata Bhattacharjee
- KEM Hospital Research Centre, Rasta Peth, Pune, India
- INDEPTH Network, East Legon, Accra, Ghana
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Rasta Peth, Pune, India
- INDEPTH Network, East Legon, Accra, Ghana
- Joint last author with equal contributions
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, UK
- Joint last author with equal contributions
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Marsh A, Hirve S, Lele P, Chavan U, Bhattacharjee T, Nair H, Campbell H, Juvekar S. Validating a GPS-based approach to detect health facility visits against maternal response to prompted recall survey. J Glob Health 2020; 10:010602. [PMID: 32426124 PMCID: PMC7211413 DOI: 10.7189/jogh.10.010602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Common approaches to measure health behaviors rely on participant responses and are subject to bias. Technology-based alternatives, particularly using GPS, address these biases while opening new channels for research. This study describes the development and implementation of a GPS-based approach to detect health facility visits in rural Pune district, India. Methods Participants were mothers of under-five year old children within the Vadu Demographic Surveillance area. Participants received GPS-enabled smartphones pre-installed with a location-aware application to continuously record and transmit participant location data to a central server. Data were analyzed to identify health facility visits according to a parameter-based approach, optimal thresholds of which were calibrated through a simulation exercise. Lists of GPS-detected health facility visits were generated at each of six follow-up home visits and reviewed with participants through prompted recall survey, confirming visits which were correctly identified. Detected visits were analyzed using logistic regression to explore factors associated with the identification of false positive GPS-detected visits. Results We enrolled 200 participants and completed 1098 follow-up visits over the six-month study period. Prompted recall surveys were completed for 694 follow-up visits with one or more GPS-detected health facility visits. While the approach performed well during calibration (positive predictive value (PPV) 78%), performance was poor when applied to participant data. Only 440 of 22 251 detected visits were confirmed (PPV 2%). False positives increased as participants spent more time in areas of high health facility density (odds ratio (OR) = 2.29, 95% confidence interval (CI) = 1.62-3.25). Visits detected at facilities other than hospitals and clinics were also more likely to be false positives (OR = 2.78, 95% CI = 1.65-4.67) as were visits detected to facilities nearby participant homes, with the likelihood decreasing as distance increased (OR = 0.89, 95% CI = 0.82-0.97). Visit duration was not associated with confirmation status. Conclusions The optimal parameter combination for health facility visits simulated by field workers substantially overestimated health visits from participant GPS data. This study provides useful insights into the challenges in detecting health facility visits where providers are numerous, highly clustered within urban centers and located near residential areas of the population which they serve.
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Affiliation(s)
- Andrew Marsh
- Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,KEM Hospital Research Centre, Sardar Moodliar Road, Rasta Peth, Pune, India
| | | | - Pallavi Lele
- KEM Hospital Research Centre, Sardar Moodliar Road, Rasta Peth, Pune, India
| | - Uddhavi Chavan
- KEM Hospital Research Centre, Sardar Moodliar Road, Rasta Peth, Pune, India
| | - Tathagata Bhattacharjee
- KEM Hospital Research Centre, Sardar Moodliar Road, Rasta Peth, Pune, India.,INDEPTH Network, 40 Mensah Wood Street, East Legon, Accra, Ghana
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Sardar Moodliar Road, Rasta Peth, Pune, India.,INDEPTH Network, 40 Mensah Wood Street, East Legon, Accra, Ghana
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Apte A, Ingole V, Lele P, Marsh A, Bhattacharjee T, Hirve S, Campbell H, Nair H, Chan S, Juvekar S. Ethical considerations in the use of GPS-based movement tracking in health research - lessons from a care-seeking study in rural west India. J Glob Health 2020; 9:010323. [PMID: 31275566 PMCID: PMC6596313 DOI: 10.7189/jogh.09.010323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aditi Apte
- KEM Hospital Research Centre (KEMHRC), Vadu Rural Health Program, India
| | - Vijendra Ingole
- KEM Hospital Research Centre (KEMHRC), Vadu Rural Health Program, India.,ISGlobal, Barcelona, Spain
| | - Pallavi Lele
- KEM Hospital Research Centre (KEMHRC), Vadu Rural Health Program, India
| | - Andrew Marsh
- KEM Hospital Research Centre (KEMHRC), Vadu Rural Health Program, India.,Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tathagata Bhattacharjee
- KEM Hospital Research Centre (KEMHRC), Vadu Rural Health Program, India.,INDEPTH Network, East Legon, Accra, Ghana
| | | | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburg, Scotland, UK
| | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburg, Scotland, UK
| | - Sarah Chan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburg, Scotland, UK
| | - Sanjay Juvekar
- KEM Hospital Research Centre (KEMHRC), Vadu Rural Health Program, India
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Greenaway RL, Santolini V, Szczypiński FT, Bennison MJ, Little MA, Marsh A, Jelfs KE, Cooper AI. Organic Cage Dumbbells. Chemistry 2020; 26:3718-3722. [PMID: 32011048 DOI: 10.1002/chem.201905623] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/12/2019] [Indexed: 01/22/2023]
Abstract
Molecular dumbbells with organic cage capping units were synthesised via a multi-component imine condensation between a tri-topic amine and di- and tetra-topic aldehydes. This is an example of self-sorting, which can be rationalised by computational modelling.
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Affiliation(s)
- Rebecca L Greenaway
- Department of Chemistry and Materials Innovation Factory, University of Liverpool, 51 Oxford Street, Liverpool, L7 3NY, UK
| | - Valentina Santolini
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 0BZ, UK
| | - Filip T Szczypiński
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 0BZ, UK
| | - Michael J Bennison
- Department of Chemistry and Materials Innovation Factory, University of Liverpool, 51 Oxford Street, Liverpool, L7 3NY, UK
| | - Marc A Little
- Department of Chemistry and Materials Innovation Factory, University of Liverpool, 51 Oxford Street, Liverpool, L7 3NY, UK
| | - Andrew Marsh
- Department of Chemistry and Materials Innovation Factory, University of Liverpool, 51 Oxford Street, Liverpool, L7 3NY, UK
| | - Kim E Jelfs
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 0BZ, UK
| | - Andrew I Cooper
- Department of Chemistry and Materials Innovation Factory, University of Liverpool, 51 Oxford Street, Liverpool, L7 3NY, UK
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Athithan L, Kanagala P, Singh A, Gulsin GS, Graham-Brown MPM, Mcadam J, Marsh A, Parke K, Wormleighton J, Arnold JR, Squire IB, Ng LL, Mccann GP. P598Correlation between arterial stiffness using oscillometry and cardiovascular magnetic resonance in a population with heart failure with preserved ejection fraction (HFpEF). Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Athithan
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - P Kanagala
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - A Singh
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - G S Gulsin
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - M P M Graham-Brown
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - J Mcadam
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - A Marsh
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - K Parke
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - J Wormleighton
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - J R Arnold
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - I B Squire
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - L L Ng
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - G P Mccann
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
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Athithan L, Kanagala PK, Singh A, Gulsin GS, Graham-Brown MPM, Marsh A, Mcadam J, Parke K, Wormleighton J, Arnold JR, Squire IB, Ng LL, Mccann GP. 348Association of arterial stiffness with left ventricular remodelling in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Athithan
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - P K Kanagala
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - A Singh
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - G S Gulsin
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - M P M Graham-Brown
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - A Marsh
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - J Mcadam
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - K Parke
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - J Wormleighton
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - J R Arnold
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - I B Squire
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - L L Ng
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - G P Mccann
- University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Department of Cardiovascular Sciences, Leicester, United Kingdom of Great Britain & Northern Ireland
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Hirve S, Marsh A, Lele P, Chavan U, Bhattacharjee T, Nair H, Campbell H, Juvekar S. Concordance between GPS-based smartphone app for continuous location tracking and mother's recall of care-seeking for child illness in India. J Glob Health 2018; 8:020802. [PMID: 30410742 PMCID: PMC6209739 DOI: 10.7189/jogh.08.020802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/23/2023] Open
Abstract
Background Traditionally, health care-seeking behaviour for child illness is assessed through population-based national demographic and health surveys. GPS-based technologies are increasingly used in human behavioural research including tracking human mobility and spatial behaviour. This paper assesses how well a care-seeking event to a health care facility for child illness, as recalled by the mother in a survey setting using questions sourced from Demographic and Health Surveys, concurs with one that is identified by TrackCare, a GPS-based location-aware smartphone application. Methods Mothers residing in the Vadu HDSS area in Pune district, India having at least one young child were randomly assigned to receive a GPS-enabled smartphone with a pre-installed TrackCare app configured to record the device location data at one-minute intervals over a 6-month period. Spatio-temporal parameters were derived from the location data and used to detect a care-seeking event to any of the health care facilities in the area. Mothers were asked to recall a child illness and if, where and when care was sought, using a questionnaire during monthly visits over a 6-month period. Concordance between the mother's recall and the TrackCare app to identify a care-seeking event was estimated according to percent positive agreement. Results Mean concordance for a care-seeking event between the two methods (mother's recall and TrackCare location data) ranged up to 45%, was significantly higher (P-value <0.001) for care-seeking at a hospital as compared to a clinic and for a health care facility in the private sector compared to that in the public sector. Overall, the proportion of disagreement for a care-seeking event not detected by TrackCare but reported by mother ranged up to 77% and was significantly higher (P-value <0.001) compared to those not reported by mother but detected by TrackCare. Conclusions Given the uncertainty and limitations in use of continuous location tracking data in a field setting and the complexity of classifying human activity patterns, additional research is needed before continuous location tracking can serve as a gold standard substitute for other methods to determine health care-seeking behaviour. Future performance may be improved by incorporating other smartphone-based sensors, such as Wi-Fi and Bluetooth, to obtain more precise location estimates in areas where GPS signal is weakest.
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Affiliation(s)
- Siddhivinayak Hirve
- KEM Hospital Research Centre, Pune, India.,Joint first author with equal contributions
| | - Andrew Marsh
- KEM Hospital Research Centre, Pune, India.,Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Joint first author with equal contributions
| | | | | | | | - Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK.,Joint last author with equal contributions
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, India.,INDEPTH Network, East Legon, Accra, Ghana.,Joint last author with equal contributions
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Nair H, Williams LJ, Marsh A, Lele P, Bhattacharjee T, Chavan U, Hirve S, Campbell H, Juvekar S. Assessing the reactivity to mobile phones and repeated surveys on reported care-seeking for common childhood illnesses in rural India. J Glob Health 2018; 8:020807. [PMID: 30254745 PMCID: PMC6150610 DOI: 10.7189/jogh.08.020807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Traditionally, health care-seeking for child illness is assessed through population-based and nationally representative demographic and health surveys (DHS) that are conducted once every five to seven years and are based on maternal recall. These maternal reports are subject to recall bias. Mobile phones (with the use of GPS technology) have the potential to constantly track movements of phone owners and provide high quality and more accurate data at a population level in low and middle income countries (LMICs) to assess the validity of maternal recall. We provided a group of mothers with smartphones installed with a location-aware application and visited them monthly to administer a survey questionnaire on care-seeking for diarrhoea, fever and cough with fever. This paper assesses for any reactivity to smartphones or repeated study contacts for measuring care-seeking and if this resulted in change in health care provider preference. Methods We enrolled 749 mothers from rural areas of Pune district in Maharashtra, India and randomly allocated them to one of three groups – a longitudinal phone group, a longitudinal control group and a cross-sectional control group. We collected baseline information from mothers, including individual and household demographic and socio-economic characteristics and care-seeking preferences for child illness. We followed up both longitudinal groups monthly and each cross-sectional sub-group once over a period of 6 months. At each follow up, we administered questions identical to those in the National Family Health Survey (NFHS) questionnaire to determine an episode of diarrhoea, fever or cough within the last 15 days, care seeking for the same, and the type of provider. The data were analysed using the χ2 test or Fisher Exact Test for categorical variables, or with the Kruskall-Wallis non-parametric test for continuous variables (due to the non-normal nature of the data). Multivariable joint models of group and visit time were analysed with logistic regression methods. Results All three groups were similar in their socio-demographic characteristics at baseline. We did not observe any significant difference in care seeking for diarrhoea, fever or cough with fever between groups. Also, we did not observe any significant difference in proportion of children seeking care from the private sector. Conclusions We did not observe any reactivity in this study due to the presence of the phone (Hawthorne effect) or repeated study visits. The study also shows the potential of using GPS enabled smartphones to enrich DHS surveys in LMICs like India. However, further studies need to be conducted in other population groups before the findings can be generalised.
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Affiliation(s)
- Harish Nair
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Linda J Williams
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Marsh
- Institute for International Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,KEM Hospital Research Centre, Pune, India
| | | | | | | | | | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.,Joint senior authorship
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, India.,INDEPTH Network, East Legon, Accra, Ghana.,Joint senior authorship
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15
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Quareshy M, Prusinska J, Kieffer M, Fukui K, Pardal AJ, Lehmann S, Schafer P, del Genio CI, Kepinski S, Hayashi K, Marsh A, Napier RM. The Tetrazole Analogue of the Auxin Indole-3-acetic Acid Binds Preferentially to TIR1 and Not AFB5. ACS Chem Biol 2018; 13:2585-2594. [PMID: 30138566 DOI: 10.1021/acschembio.8b00527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Indole-3-acetic acid (auxin) is considered one of the cardinal hormones in plant growth and development. It regulates a wide range of processes throughout the plant. Synthetic auxins exploit the auxin-signaling pathway and are valuable as herbicidal agrochemicals. Currently, despite a diversity of chemical scaffolds all synthetic auxins have a carboxylic acid as the active core group. By applying bio-isosteric replacement we discovered that indole-3-tetrazole was active by surface plasmon resonance spectrometry, showing that the tetrazole could initiate assembly of the Transport Inhibitor Resistant 1 (TIR1) auxin coreceptor complex. We then tested the tetrazole's efficacy in a range of whole plant physiological assays and in protoplast reporter assays, which all confirmed auxin activity, albeit rather weak. We then tested indole-3-tetrazole against the AFB5 homologue of TIR1, finding that binding was selective against TIR1, absent with AFB5. The kinetics of binding to TIR1 are contrasted to those for the herbicide picloram, which shows the opposite receptor preference, as it binds to AFB5 with far greater affinity than to TIR1. The basis of the preference of indole-3-tetrazole for TIR1 was revealed to be a single residue substitution using molecular docking, and assays using tir1 and afb5 mutant lines confirmed selectivity in vivo. Given the potential that a TIR1-selective auxin might have for unmasking receptor-specific actions, we followed a rational design, lead optimization campaign, and a set of chlorinated indole-3-tetrazoles was synthesized. Improved affinity for TIR1 and the preference for binding to TIR1 was maintained for 4- and 6-chloroindole-3-tetrazoles, coupled with improved efficacy in vivo. This work expands the range of auxin chemistry for the design of receptor-selective synthetic auxins.
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Affiliation(s)
| | | | - Martin Kieffer
- Centre for Plant Sciences, University of Leeds, Leeds LS2 9JT, U.K
| | - Kosuke Fukui
- Department of Biochemistry, Okayama University of Science, 1-1 Ridaicho, Kita-ku, Okayama-shi Okayama 700-0005, Japan
| | | | - Silke Lehmann
- Warwick Integrative Synthetic Biology Centre, Coventry CV4 7AL, U.K
| | - Patrick Schafer
- Warwick Integrative Synthetic Biology Centre, Coventry CV4 7AL, U.K
| | | | - Stefan Kepinski
- Centre for Plant Sciences, University of Leeds, Leeds LS2 9JT, U.K
| | - Kenichiro Hayashi
- Department of Biochemistry, Okayama University of Science, 1-1 Ridaicho, Kita-ku, Okayama-shi Okayama 700-0005, Japan
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16
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Neniškis A, Račkauskaitė D, Shi Q, Robertson AJ, Marsh A, Ulčinas A, Valiokas R, Brown SP, Wärnmark K, Orentas E. Frontispiece: A Tautoleptic Approach to Chiral Hydrogen‐Bonded Supramolecular Tubular Polymers with Large Cavity. Chemistry 2018. [DOI: 10.1002/chem.201885364] [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: 11/10/2022]
Affiliation(s)
| | | | - Qixun Shi
- Center for Analysis and SynthesisDepartment of ChemistryLund University Lund Sweden
| | - Aiden J. Robertson
- Department of Physics and Department of ChemistryUniversity of Warwick Coventry UK
| | - Andrew Marsh
- Department of Physics and Department of ChemistryUniversity of Warwick Coventry UK
| | - Artūras Ulčinas
- Department of NanoengineeringCenter for Physical Sciences and Technology Vilnius Lithuania
| | - Ramūnas Valiokas
- Department of NanoengineeringCenter for Physical Sciences and Technology Vilnius Lithuania
| | - Steven P. Brown
- Department of Physics and Department of ChemistryUniversity of Warwick Coventry UK
| | - Kenneth Wärnmark
- Center for Analysis and SynthesisDepartment of ChemistryLund University Lund Sweden
| | - Edvinas Orentas
- Department of Organic ChemistryVilnius University Vilnius Lithuania
- Department of NanoengineeringCenter for Physical Sciences and Technology Vilnius Lithuania
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17
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Neniškis A, Račkauskaitė D, Shi Q, Robertson AJ, Marsh A, Ulčinas A, Valiokas R, Brown SP, Wärnmark K, Orentas E. A Tautoleptic Approach to Chiral Hydrogen-Bonded Supramolecular Tubular Polymers with Large Cavity. Chemistry 2018; 24:14028-14033. [PMID: 30070741 PMCID: PMC6391958 DOI: 10.1002/chem.201803701] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Indexed: 11/12/2022]
Abstract
A new strategy towards tubular hydrogen-bonded polymers based on the self-assembly of isocytosine tautomers in orthogonal directions is proposed and experimentally verified, including by 1 H fast magic-angle spinning (MAS) solid-state NMR. The molecular tubes obtained possess large internal diameter and tailor-made outer functionalities rendering them potential candidates for a number of applications.
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Affiliation(s)
- Algirdas Neniškis
- Department of Organic Chemistry, Vilnius University, Vilnius, Lithuania
| | | | - Qixun Shi
- Center for Analysis and Synthesis, Department of Chemistry, Lund University, Lund, Sweden
| | - Aiden J Robertson
- Department of Physics and Department of Chemistry, University of Warwick, Coventry, UK
| | - Andrew Marsh
- Department of Physics and Department of Chemistry, University of Warwick, Coventry, UK
| | - Artūras Ulčinas
- Department of Nanoengineering, Center for Physical Sciences and Technology, Vilnius, Lithuania
| | - Ramūnas Valiokas
- Department of Nanoengineering, Center for Physical Sciences and Technology, Vilnius, Lithuania
| | - Steven P Brown
- Department of Physics and Department of Chemistry, University of Warwick, Coventry, UK
| | - Kenneth Wärnmark
- Center for Analysis and Synthesis, Department of Chemistry, Lund University, Lund, Sweden
| | - Edvinas Orentas
- Department of Organic Chemistry, Vilnius University, Vilnius, Lithuania.,Department of Nanoengineering, Center for Physical Sciences and Technology, Vilnius, Lithuania
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18
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Amouzou A, Kanyuka M, Hazel E, Heidkamp R, Marsh A, Mleme T, Munthali S, Park L, Banda B, Moulton LH, Black RE, Hill K, Perin J, Victora CG, Bryce J. Independent Evaluation of the Integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design. Am J Trop Med Hyg 2018; 94:1434-1435. [PMID: 27252480 PMCID: PMC4889770 DOI: 10.4269/ajtmh.16-0110b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | | | | | | | - Andrew Marsh
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mails: , , and
| | - Tiope Mleme
- National Statistical Office, Zomba, Malawi. E-mail:
| | - Spy Munthali
- Chancellor College, University of Malawi, Zomba, Malawi. E-mail:
| | - Lois Park
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mail:
| | | | | | | | | | - Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mails: , , , and
| | | | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. E-mail:
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Kilsby A, Brooke S, Patchett C, Marsh A, Page C, George J. 2IMPROVING THE RECORDING OF COMPREHENSIVE GERIATRIC ASSESSMENT AND SAFETY FACTORS BY USE OF A CHECKLIST. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.2] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
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20
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Rejeski W, Marsh A, Barnard R, Fanning J, Ip E. ANIMATED VIDEO TECHNOLOGY: ADVANCING THE ASSESSMENT OF MOBILITY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2376] [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: 11/12/2022] Open
Affiliation(s)
- W. Rejeski
- Wake Forest University, Winston-Salen, North Carolina
| | - A. Marsh
- Wake Forest University, Winston-Salen, North Carolina
| | - R. Barnard
- Wake Forest University, Winston-Salen, North Carolina
| | - J. Fanning
- Wake Forest University, Winston-Salen, North Carolina
| | - E. Ip
- Wake Forest University, Winston-Salen, North Carolina
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21
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Solomkin J, Evans D, Slepavicius A, Lee P, Marsh A, Tsai L, Sutcliffe JA, Horn P. Assessing the Efficacy and Safety of Eravacycline vs Ertapenem in Complicated Intra-abdominal Infections in the Investigating Gram-Negative Infections Treated With Eravacycline (IGNITE 1) Trial: A Randomized Clinical Trial. JAMA Surg 2017; 152:224-232. [PMID: 27851857 DOI: 10.1001/jamasurg.2016.4237] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Eravacycline is a novel, fully synthetic fluorocycline antibiotic of the tetracycline class with in vitro activity against clinically important gram-negative, gram-positive aerobic, and facultative bacteria including most of those resistant to cephalosporins, fluoroquinolones, β-lactam/β-lactamase inhibitors, multidrug resistant strains and carbapenem-resistant Enterobacteriaceae, and most anaerobic pathogens. Objective To evaluate the efficacy and safety of eravacycline compared with ertapenem in adult hospitalized patients with complicated intra-abdominal infections (cIAIs). Design, Setting, and Participants This was a phase III, randomized, double-blind, multicenter study that evaluated the efficacy and safety of eravacycline in comparison with ertapenem in patients with cIAI requiring surgical or percutaneous intervention. The test-of-cure evaluation was conducted 25 to 31 days after the first dose of the study drug and the follow-up visit was conducted 38 to 50 days after the first dose of the study drug. All patients recruited into this study were hospitalized. Five hundred forty-one patients were recruited for this study; 270 patients were randomized to receive eravacycline, and 271 patients were randomized to receive ertapenem. Patients had to meet all of the following criteria: hospitalized for cIAI requiring intervention; 18 years or older; evidence of systemic inflammatory response; pain caused by cIAI; able to provide informed consent; and diagnosis of cIAI with sonogram or radiographic imaging or visual confirmation. Analyses were done in intent-to-treat and evaluable populations. Interventions Patients received eravacycline, 1.0 mg/kg every 12 hours, or ertapenem, 1.0 g every 24 hours, for a minimum of four 24-hour dosing cycles. Main Outcomes and Measures Clinical outcome assessments were made at the end of treatment, test of cure, and follow-up visits and were classified as clinical cure, clinical failure, or indeterminate/missing. Results In total, 541 patients were randomly assigned to treatment: 270 in the eravacycline group and 271 in the ertapenem group. The mean ages were 54.9 years and 55.4 years for the eravacycline and ertapenem groups, respectively. Most patients were white (263 of 270 patients [97.4%] in the eravacycline group and 260 of 271 patients [95.9%] in the ertapenem group). For the microbiological intent-to-treat population, the rates of clinical cure at the test-of-cure visit were 86.8% in the eravacycline group and 87.6% in the ertapenem group. The difference in clinical cure rates between the groups was -0.80% (95% CI, -7.1% to 5.5%), meeting the prespecified noninferiority margin and allowing for statistical noninferiority of eravacycline to ertapenem to be declared for this study. Both study drugs were well tolerated. Conclusions and Relevance Overall, eravacycline demonstrated noninferiority to ertapenem for the treatment of patients with cIAI. Trial Registration Clinicaltrials.gov Identifier: NCT01844856.
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Affiliation(s)
- Joseph Solomkin
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David Evans
- Ohio State University School of Medicine, Columbus
| | | | - Patrick Lee
- Baystate Medical Center, Springfield, Massachusetts
| | - Andrew Marsh
- Tetraphase Pharmaceuticals Inc, Watertown, Massachusetts
| | - Larry Tsai
- Tetraphase Pharmaceuticals Inc, Watertown, Massachusetts
| | | | - Patrick Horn
- Tetraphase Pharmaceuticals Inc, Watertown, Massachusetts
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22
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Dilly SJ, Clark AJ, Marsh A, Mitchell DA, Cain R, Fishwick CW, Taylor PC. A chemical genomics approach to drug reprofiling in oncology: Antipsychotic drug risperidone as a potential adenocarcinoma treatment. Cancer Lett 2017; 393:16-21. [DOI: 10.1016/j.canlet.2017.01.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 01/05/2023]
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23
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Reddy GNM, Huqi A, Iuga D, Sakurai S, Marsh A, Davis JT, Masiero S, Brown SP. Cover Picture: Co-existence of Distinct Supramolecular Assemblies in Solution and in the Solid State (Chem. Eur. J. 10/2017). Chemistry 2017. [DOI: 10.1002/chem.201605967] [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: 11/06/2022]
Affiliation(s)
- G. N. Manjunatha Reddy
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
| | - Aida Huqi
- Dipartimento di Chimica “Giacomo Ciamician”, Alma Mater Studiorum; Università di Bologna; 40126 Bologna Italy
| | - Dinu Iuga
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
| | - Satoshi Sakurai
- JEOL (UK), Silver Court, Watchmead; Welwyn Garden City AL7 1LT UK
| | - Andrew Marsh
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
| | - Jeffery T. Davis
- Department of Chemistry and Biochemistry; University of Maryland; College Park MD 20742 USA
| | - Stefano Masiero
- Dipartimento di Chimica “Giacomo Ciamician”, Alma Mater Studiorum; Università di Bologna; 40126 Bologna Italy
| | - Steven P. Brown
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
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24
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Reddy GNM, Huqi A, Iuga D, Sakurai S, Marsh A, Davis JT, Masiero S, Brown SP. Coexistence of Distinct Supramolecular Assemblies in Solution and in the Solid State. Chemistry 2017. [DOI: 10.1002/chem.201605975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G. N. Manjunatha Reddy
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
| | - Aida Huqi
- Dipartimento di Chimica “Giacomo Ciamician”, Alma Mater Studiorum; Università di Bologna; 40126 Bologna Italy
| | - Dinu Iuga
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
| | - Satoshi Sakurai
- JEOL (UK), Silver Court, Watchmead; Welwyn Garden City AL7 1LT UK
| | - Andrew Marsh
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
| | - Jeffery T. Davis
- Department of Chemistry and Biochemistry; University of Maryland; College Park MD 20742 USA
| | - Stefano Masiero
- Dipartimento di Chimica “Giacomo Ciamician”, Alma Mater Studiorum; Università di Bologna; 40126 Bologna Italy
| | - Steven P. Brown
- Department of Physics and Department of Chemistry; University of; Warwick, Coventry CV4 7AL UK
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25
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Reddy GNM, Huqi A, Iuga D, Sakurai S, Marsh A, Davis JT, Masiero S, Brown SP. Co-existence of Distinct Supramolecular Assemblies in Solution and in the Solid State. Chemistry 2016; 23:2315-2322. [PMID: 27897351 PMCID: PMC5396329 DOI: 10.1002/chem.201604832] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 10/14/2016] [Indexed: 11/24/2022]
Abstract
The formation of distinct supramolecular assemblies, including a metastable species, is revealed for a lipophilic guanosine (G) derivative in solution and in the solid state. Structurally different G‐quartet‐based assemblies are formed in chloroform depending on the nature of the cation, anion and the salt concentration, as characterized by circular dichroism and time course diffusion‐ordered NMR spectroscopy data. Intriguingly, even the presence of potassium ions that stabilize G‐quartets in chloroform was insufficient to exclusively retain such assemblies in the solid state, leading to the formation of mixed quartet and ribbon‐like assemblies as revealed by fast magic‐angle spinning (MAS) NMR spectroscopy. Distinct N−H⋅⋅⋅N and N−H⋅⋅⋅O intermolecular hydrogen bonding interactions drive quartet and ribbon‐like self‐assembly resulting in markedly different 2D 1H solid‐state NMR spectra, thus facilitating a direct identification of mixed assemblies. A dissolution NMR experiment confirmed that the quartet and ribbon interconversion is reversible–further demonstrating the changes that occur in the self‐assembly process of a lipophilic nucleoside upon a solid‐state to solution‐state transition and vice versa. A systematic study for complexation with different cations (K+, Sr2+) and anions (picrate, ethanoate and iodide) emphasizes that the existence of a stable solution or solid‐state structure may not reflect the stability of the same supramolecular entity in another phase.
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Affiliation(s)
- G N Manjunatha Reddy
- Department of Physics and Department of Chemistry, University of, Warwick, Coventry, CV4 7AL, UK
| | - Aida Huqi
- Dipartimento di Chimica "Giacomo Ciamician", Alma Mater Studiorum, Università di Bologna, 40126, Bologna, Italy
| | - Dinu Iuga
- Department of Physics and Department of Chemistry, University of, Warwick, Coventry, CV4 7AL, UK
| | - Satoshi Sakurai
- JEOL (UK), Silver Court, Watchmead, Welwyn Garden City, AL7 1LT, UK
| | - Andrew Marsh
- Department of Physics and Department of Chemistry, University of, Warwick, Coventry, CV4 7AL, UK
| | - Jeffery T Davis
- Department of Chemistry and Biochemistry, University of Maryland, College Park, MD, 20742, USA
| | - Stefano Masiero
- Dipartimento di Chimica "Giacomo Ciamician", Alma Mater Studiorum, Università di Bologna, 40126, Bologna, Italy
| | - Steven P Brown
- Department of Physics and Department of Chemistry, University of, Warwick, Coventry, CV4 7AL, UK
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Reddy GNM, Malon M, Marsh A, Nishiyama Y, Brown SP. Fast Magic-Angle Spinning Three-Dimensional NMR Experiment for Simultaneously Probing H—H and N—H Proximities in Solids. Anal Chem 2016; 88:11412-11419. [DOI: 10.1021/acs.analchem.6b01869] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | - Michal Malon
- JEOL RESONANCE Inc., Musashino, Akishima,
Tokyo 196-8558, Japan
- RIKEN CLST-JEOL Collaboration Centre, Yokohama, Kanagawa 230-0045, Japan
| | | | - Yusuke Nishiyama
- JEOL RESONANCE Inc., Musashino, Akishima,
Tokyo 196-8558, Japan
- RIKEN CLST-JEOL Collaboration Centre, Yokohama, Kanagawa 230-0045, Japan
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Marsh A, Casey-Green K, Probert F, Withall D, Mitchell DA, Dilly SJ, James S, Dimitri W, Ladwa SR, Taylor PC, Singer DRJ. Simvastatin Sodium Salt and Fluvastatin Interact with Human Gap Junction Gamma-3 Protein. PLoS One 2016; 11:e0148266. [PMID: 26863535 PMCID: PMC4749215 DOI: 10.1371/journal.pone.0148266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 01/15/2016] [Indexed: 11/26/2022] Open
Abstract
Finding pleiomorphic targets for drugs allows new indications or warnings for treatment to be identified. As test of concept, we applied a new chemical genomics approach to uncover additional targets for the widely prescribed lipid-lowering pro-drug simvastatin. We used mRNA extracted from internal mammary artery from patients undergoing coronary artery surgery to prepare a viral cardiovascular protein library, using T7 bacteriophage. We then studied interactions of clones of the bacteriophage, each expressing a different cardiovascular polypeptide, with surface-bound simvastatin in 96-well plates. To maximise likelihood of identifying meaningful interactions between simvastatin and vascular peptides, we used a validated photo-immobilisation method to apply a series of different chemical linkers to bind simvastatin so as to present multiple orientations of its constituent components to potential targets. Three rounds of biopanning identified consistent interaction with the clone expressing part of the gene GJC3, which maps to Homo sapiens chromosome 7, and codes for gap junction gamma-3 protein, also known as connexin 30.2/31.3 (mouse connexin Cx29). Further analysis indicated the binding site to be for the N-terminal domain putatively ‘regulating’ connexin hemichannel and gap junction pores. Using immunohistochemistry we found connexin 30.2/31.3 to be present in samples of artery similar to those used to prepare the bacteriophage library. Surface plasmon resonance revealed that a 25 amino acid synthetic peptide representing the discovered N-terminus did not interact with simvastatin lactone, but did bind to the hydrolysed HMG CoA inhibitor, simvastatin acid. This interaction was also seen for fluvastatin. The gap junction blockers carbenoxolone and flufenamic acid also interacted with the same peptide providing insight into potential site of binding. These findings raise key questions about the functional significance of GJC3 transcripts in the vasculature and other tissues, and this connexin’s role in therapeutic and adverse effects of statins in a range of disease states.
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Affiliation(s)
- Andrew Marsh
- Department of Chemistry, University of Warwick, Coventry, CV4 7AL, United Kingdom
- * E-mail: (AM); (DRJS)
| | | | - Fay Probert
- Department of Chemistry, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - David Withall
- Department of Chemistry, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Daniel A. Mitchell
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, United Kingdom
| | - Suzanne J. Dilly
- Tangent Reprofiling Ltd, c/o SEEK, Central Point, 45 Beech Street, London, EC2Y 8AD, United Kingdom
| | - Sean James
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - Wade Dimitri
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - Sweta R. Ladwa
- Tangent Reprofiling Ltd, c/o SEEK, Central Point, 45 Beech Street, London, EC2Y 8AD, United Kingdom
| | - Paul C. Taylor
- Department of Chemistry, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Donald R. J. Singer
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
- Fellowship of Postgraduate Medicine, 11 Chandos St, London W1G 9EB, United Kingdom
- Division of Metabolic and Vascular Health, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, United Kingdom
- * E-mail: (AM); (DRJS)
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Amouzou A, Kanyuka M, Hazel E, Heidkamp R, Marsh A, Mleme T, Munthali S, Park L, Banda B, Moulton LH, Black RE, Hill K, Perin J, Victora CG, Bryce J. Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design. Am J Trop Med Hyg 2016; 94:574-583. [PMID: 26787158 PMCID: PMC4775894 DOI: 10.4269/ajtmh.15-0584] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/03/2015] [Indexed: 12/03/2022] Open
Abstract
We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. “Dose” variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. “Response” variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2–59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to “hard-to-reach” areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jennifer Bryce
- *Address correspondence to Jennifer Bryce, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail:
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Silva R, Amouzou A, Munos M, Marsh A, Hazel E, Victora C, Black R, Bryce J. Can Community Health Workers Report Accurately on Births and Deaths? Results of Field Assessments in Ethiopia, Malawi and Mali. PLoS One 2016; 11:e0144662. [PMID: 26731544 PMCID: PMC4701186 DOI: 10.1371/journal.pone.0144662] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/20/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Most low-income countries lack complete and accurate vital registration systems. As a result, measures of under-five mortality rates rely mostly on household surveys. In collaboration with partners in Ethiopia, Ghana, Malawi, and Mali, we assessed the completeness and accuracy of reporting of births and deaths by community-based health workers, and the accuracy of annualized under-five mortality rate estimates derived from these data. Here we report on results from Ethiopia, Malawi and Mali. Method In all three countries, community health workers (CHWs) were trained, equipped and supported to report pregnancies, births and deaths within defined geographic areas over a period of at least fifteen months. In-country institutions collected these data every month. At each study site, we administered a full birth history (FBH) or full pregnancy history (FPH), to women of reproductive age via a census of households in Mali and via household surveys in Ethiopia and Malawi. Using these FBHs/FPHs as a validation data source, we assessed the completeness of the counts of births and deaths and the accuracy of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FBH/FPH for rolling twelve-month periods. For each method we calculated total cost, average annual cost per 1,000 population, and average cost per vital event reported. Results On average, CHWs submitted monthly vital event reports for over 95 percent of catchment areas in Ethiopia and Malawi, and for 100 percent of catchment areas in Mali. The completeness of vital events reporting by CHWs varied: we estimated that 30%-90% of annualized expected births (i.e. the number of births estimated using a FPH) were documented by CHWs and 22%-91% of annualized expected under-five deaths were documented by CHWs. Resulting annualized under-five mortality rates based on the CHW vital events reporting were, on average, under-estimated by 28% in Ethiopia, 32% in Malawi, and 9% in Mali relative to comparable FPHs. Costs per vital event reported ranged from $21 in Malawi to $149 in Mali. Discussion Our findings in Mali suggest that CHWs can collect complete and high-quality vital events data useful for monitoring annual changes in under-five mortality rates. Both the supervision of CHWs in Mali and the rigor of the associated field-based data quality checks were of a high standard, and the size of the pilot area in Mali was small (comprising of approximately 53,205 residents in 4,200 households). Hence, there are remaining questions about whether this level of vital events reporting completeness and data quality could be maintained if the approach was implemented at scale. Our experience in Malawi and Ethiopia suggests that, in some settings, establishing and maintaining the completeness and quality of vital events reporting by CHWs over time is challenging. In this sense, our evaluation in Mali falls closer to that of an efficacy study, whereas our evaluations in Ethiopia and Malawi are more akin to an effectiveness study. Our overall findings suggest that no one-size-fits-all approach will be successful in guaranteeing complete and accurate reporting of vital events by CHWs.
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Affiliation(s)
- Romesh Silva
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Economic and Social Commission for Western Asia, United Nations, Beirut, Lebanon
- * E-mail:
| | - Agbessi Amouzou
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Data, Research and Policy, UNICEF, New York, New York United States of America
| | - Melinda Munos
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew Marsh
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Robert Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Robertson AJ, Pandey MK, Marsh A, Nishiyama Y, Brown SP. The use of a selective saturation pulse to suppress t1 noise in two-dimensional (1)H fast magic angle spinning solid-state NMR spectroscopy. J Magn Reson 2015; 260:89-97. [PMID: 26432398 DOI: 10.1016/j.jmr.2015.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 05/27/2015] [Revised: 09/01/2015] [Accepted: 09/07/2015] [Indexed: 06/05/2023]
Abstract
A selective saturation pulse at fast magic angle spinning (MAS) frequencies (60+kHz) suppresses t1 noise in the indirect dimension of two-dimensional (1)H MAS NMR spectra. The method is applied to a synthetic nucleoside with an intense methyl (1)H signal due to triisopropylsilyl (TIPS) protecting groups. Enhanced performance in terms of suppressing the methyl signal while minimising the loss of signal intensity of nearby resonances of interest relies on reducing spin diffusion--this is quantified by comparing two-dimensional (1)H NOESY-like spin diffusion spectra recorded at 30-70 kHz MAS. For a saturation pulse centred at the methyl resonance, the effect of changing the nutation frequency at different MAS frequencies as well as the effect of changing the pulse duration is investigated. By applying a pulse of duration 30 ms and nutation frequency 725 Hz at 70 kHz MAS, a good compromise of significant suppression of the methyl resonance combined with the signal intensity of resonances greater than 5 ppm away from the methyl resonance being largely unaffected is achieved. The effectiveness of using a selective saturation pulse is demonstrated for both homonuclear (1)H-(1)H double quantum (DQ)/single quantum (SQ) MAS and (14)N-(1)H heteronuclear multiple quantum coherence (HMQC) two-dimensional solid-state NMR experiments.
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Affiliation(s)
- Aiden J Robertson
- Department of Physics, University of Warwick, Coventry CV4 7AL, United Kingdom; Department of Chemistry, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Manoj Kumar Pandey
- RIKEN CLST-JEOL Collaboration Centre, Yokohama, Kanagawa 230-0045, Japan
| | - Andrew Marsh
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Yusuke Nishiyama
- RIKEN CLST-JEOL Collaboration Centre, Yokohama, Kanagawa 230-0045, Japan; JEOL RESONANCE Inc., Musashino, Akishima, Tokyo 196-8558, Japan
| | - Steven P Brown
- Department of Physics, University of Warwick, Coventry CV4 7AL, United Kingdom.
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Marsh A, Adin C. Tunneling Under the Digastricus Muscle Increases Salivary Duct Exposure and Completeness of Excision in Mandibular and Sublingual Sialoadenectomy in Dogs. Vet Surg 2015; 42:238-42. [DOI: 10.1111/j.1532-950x.2013.12000.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 04/01/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Marsh
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus, Ohio
| | - Christopher Adin
- Department of Veterinary Clinical Sciences; The Ohio State University; Columbus, Ohio
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Peters GM, Skala LP, Plank TN, Oh H, Manjunatha Reddy GN, Marsh A, Brown SP, Raghavan SR, Davis JT. G4-Quartet·M+ Borate Hydrogels. J Am Chem Soc 2015; 137:5819-27. [DOI: 10.1021/jacs.5b02753] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Gretchen Marie Peters
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Luke P. Skala
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Taylor N. Plank
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Hyuntaek Oh
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - G. N. Manjunatha Reddy
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Andrew Marsh
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Steven P. Brown
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Srinivasa R. Raghavan
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Jeffery T. Davis
- Department of Chemistry & Biochemistry and ‡Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Physics and #Department of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
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Reddy GNM, Cook DS, Iuga D, Walton RI, Marsh A, Brown SP. An NMR crystallography study of the hemihydrate of 2', 3'-O-isopropylidineguanosine. Solid State Nucl Magn Reson 2015; 65:41-48. [PMID: 25686689 DOI: 10.1016/j.ssnmr.2015.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 09/09/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 06/04/2023]
Abstract
An NMR crystallography study of the hemihydrate of 2', 3'-O-isopropylidineguanosine (Gace) is presented, together with powder X-ray diffraction and thermogravimetric analysis. (1)H double-quantum and (14)N-(1)H HMQC spectra recorded at 850MHz and 75kHz MAS (using a JEOL 1mm probe) are presented together with a (1)H-(13)C refocused INEPT spectrum recorded at 500MHz and 12.5kHz MAS using eDUMBO-122(1)H homonuclear decoupling. NMR chemical shieldings are calculated using the GIPAW (gauge-including projector augmented wave) method; good two-dimensional agreement between calculation and experiment is observed for (13)C and (1)H chemical shifts for directly bonded CH and CH3 peaks. There are two Gace molecules in the asymmetric unit cell: differences in specific (1)H chemical shifts are rationalised in terms of the strength of CH-π and intermolecular hydrogen bonding interactions.
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Affiliation(s)
| | - Daniel S Cook
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
| | - Dinu Iuga
- Department of Physics, University of Warwick, Coventry CV4 7AL, UK
| | - Richard I Walton
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
| | - Andrew Marsh
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
| | - Steven P Brown
- Department of Physics, University of Warwick, Coventry CV4 7AL, UK.
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Garcia M, Kempe K, Haddleton DM, Khan A, Marsh A. Templated polymerizations on solid supports mediated by complementary nucleoside interactions. Polym Chem 2015. [DOI: 10.1039/c4py01783h] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The preparation of immobilized poly(methacryloyl nucleosides) and their abilities for template polymerizations is discussed.
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Affiliation(s)
| | | | | | - Afzal Khan
- Department of Chemistry
- University of Warwick
- Coventry
- UK
| | - Andrew Marsh
- Department of Chemistry
- University of Warwick
- Coventry
- UK
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Peters GM, Skala LP, Plank TN, Hyman BJ, Manjunatha Reddy GN, Marsh A, Brown SP, Davis JT. A G4·K+ Hydrogel Stabilized by an Anion. J Am Chem Soc 2014; 136:12596-9. [DOI: 10.1021/ja507506c] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gretchen Marie Peters
- Department
of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, United States
| | - Luke P. Skala
- Department
of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, United States
| | - Taylor N. Plank
- Department
of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, United States
| | - Brooke J. Hyman
- Department
of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, United States
| | | | - Andrew Marsh
- Department
of Chemistry, University of Warwick, Coventry CV4 7AL, U.K
| | - Steven P. Brown
- Department
of Physics, University of Warwick, Coventry CV4 7AL, U.K
| | - Jeffery T. Davis
- Department
of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, United States
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Cole P, Hallard R, Broughton J, Coates R, Croft J, Davies K, Devine I, Lewis C, Marsden P, Marsh A, McGeary R, Riley P, Rogers A, Rycraft H, Shaw A. Developing the radiation protection safety culture in the UK. J Radiol Prot 2014; 34:469-484. [PMID: 24894330 DOI: 10.1088/0952-4746/34/2/469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the UK, as elsewhere, there is potential to improve how radiological challenges are addressed through improvement in, or development of, a strong radiation protection (RP) safety culture. In preliminary work in the UK, two areas have been identified as having a strong influence on UK society: the healthcare and nuclear industry sectors. Each has specific challenges, but with many overlapping common factors. Other sectors will benefit from further consideration.In order to make meaningful comparisons between these two principal sectors, this paper is primarily concerned with cultural aspects of RP in the working environment and occupational exposures rather than patient doses.The healthcare sector delivers a large collective dose to patients each year, particularly for diagnostic purposes, which continues to increase. Although patient dose is not the focus, it must be recognised that collective patient dose is inevitably linked to collective occupational exposure, especially in interventional procedures.The nuclear industry faces major challenges as work moves from operations to decommissioning on many sites. This involves restarting work in the plants responsible for the much higher radiation doses of the 1960/70s, but also performing tasks that are considerably more difficult and hazardous than those original performed in these plants.Factors which influence RP safety culture in the workplace are examined, and proposals are considered for a series of actions that may lead to an improvement in RP culture with an associated reduction in dose in many work areas. These actions include methods to improve knowledge and awareness of radiation safety, plus ways to influence management and colleagues in the workplace. The exchange of knowledge about safety culture between the nuclear industry and medical areas may act to develop RP culture in both sectors, and have a wider impact in other sectors where exposures to ionising radiations can occur.
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Affiliation(s)
- P Cole
- Radiation Protection Office, University of Liverpool, Liverpool, L69 3BX, UK
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Gandhi M, Freitas D, Lewis M, Bolton L, Bhasin S, Leonard D, Marsh A. Who should answer the question: “Can I drive with this plaster cast?”. Surgeon 2014; 12:26-31. [DOI: 10.1016/j.surge.2013.05.006] [Citation(s) in RCA: 3] [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] [Received: 01/18/2013] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
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Millard A, Scanlan DJ, Gallagher C, Marsh A, Taylor PC. Unexpected evolutionary proximity of eukaryotic and cyanobacterial enzymes responsible for biosynthesis of retinoic acid and its oxidation. Mol BioSyst 2014; 10:380-3. [DOI: 10.1039/c3mb70447e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Beecham MP, Clarkson GJ, Hall G, Marsh A. Nanostructures from self-assembling triazine tertiary amine N-oxide amphiphiles. Chemphyschem 2013; 14:3909-15. [PMID: 24203796 DOI: 10.1002/cphc.201300775] [Citation(s) in RCA: 2] [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: 08/23/2013] [Indexed: 11/08/2022]
Abstract
A new set of amphiphilic tertiary amine N-oxides has been prepared and their self-assembly properties observed in aqueous solution by tensiometry, dynamic and static light scattering. X-ray crystallographic analysis of parent amines and sulfoxide congeners indicates the formation of hydrogen-bonded dimers as the primary assembly unit for formation of vesicles in preference to the compact micelles typical of lauryl dimethylamine N-oxide (LDAO). 6-Benzyloxy-N,N'-bis(5-diethylaminopentylamine oxide)[1,3,5]triazine-2,4-diamine forms a 1 μm vesicle observed to entrap fluorescein. The [1,3,5]triazine core thus allows variation of the new self-assembled structures from nano- to micrometre length scales.
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Affiliation(s)
- Matthew P Beecham
- Department of Chemistry, University of Warwick, Coventry, CV4 7AL (UK), Fax: (+44) 24 7652 4112
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Marsh A, Munos M, Baya B, Sanon D, Gilroy K, Bryce J. Using LiST to model potential reduction in under-five mortality in Burkina Faso. BMC Public Health 2013; 13 Suppl 3:S26. [PMID: 24564341 PMCID: PMC3847624 DOI: 10.1186/1471-2458-13-s3-s26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Under-five mortality remains high in Burkina Faso with significant reductions required to meet Millennium Development Goal 4. The Acceleration for Maternal, Newborn, and Child Health is being implemented to reduce child mortality in the North and Center North regions of Burkina Faso. Methods The Lives Saved Tool was used to determine the percent reduction in child mortality that can be achieved given baseline levels of coverage for interventions targeted by the Acceleration. Data were obtained from the Demographic and Health Survey 2003, the Multiple Indicator Cluster Survey 2006, and the baseline survey for the program from 2010. In addition to the scale up, scenarios were generated to examine the outcome if secular trends in intervention coverage change persisted and if intervention coverage levels remained constant. Results Scaling up all interventions to their target coverage level showed a potential reduction in under-five mortality of 22 percent, with district specific reductions in mortality ranging from 14 to 25 percent. The percent reduction in under-five mortality that might be attributable to the program was 16 percent and varied between 14 and 19 percent by district. Treatment of diarrhea with ORS and malaria with ACTs accounted for the majority of the reduction in mortality. Conclusions These findings suggest that significant reductions in under-five mortality may be achieved through the scale-up of the Acceleration. The Ministry of Health and its partners in Burkina Faso should continue their efforts to scale up these proven interventions to achieve and even exceed target levels for coverage.
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Wilkins L, Watkins J, Marsh A, Singer D. PP091—Complex regulation of alpha-adrenoceptor-mediated vasoconstriction in human internal thoracic arteries. Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.125] [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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Britton A, Setchi R, Marsh A. Intuitive interaction with multifunctional mobile interfaces. Journal of King Saud University - Computer and Information Sciences 2013. [DOI: 10.1016/j.jksuci.2012.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Linette GP, Hamid O, Whitman ED, Nemunaitis JJ, Chesney J, Agarwala SS, Starodub A, Barrett JA, Marsh A, Martell LA, Cho A, Reed TD, Youssoufian H, Vergara-Silva A. A phase I open-label study of Ad-RTS-hIL-12, an adenoviral vector engineered to express hIL-12 under the control of an oral activator ligand, in subjects with unresectable stage III/IV melanoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3022 Background: IL-12 is a pleiotropic cytokine with known antitumor activity; however, clinical use was limited by toxicity when delivered systemically. Ad-RTS-hIL-12 is an adenoviral vector engineered for controlled expression of IL-12 with the RheoSwitch Therapeutic System (RTS) and an oral activator, INXN-1001. Methods: In a phase I, 3+3 dose escalation study, subjects with unresectable stage III/IV melanoma were administered 1e12 viral particles (Ad-RTS-hIL-12) intratumorally on the first day of up to six 21-day cycles, and INXN-1001 (5, 20, 100, and 160 mg) orally on days 1-7 of each cycle. Results: Dose escalation is complete with 14 subjects treated. Median prior therapeutic agents was 3 (range 1-4). Common related adverse events included chills (11, 78.6%), pyrexia (11, 78.6%), fatigue (10, 71.4%), and nausea (10, 71.4%). With a biologically effective dose of 160 mg, MTD for INXN-1001 was not reached. One death unrelated to study drug was secondary to septicemia. Clinical activity was observed in 5 of 7 subjects treated at doses of INXN-1001 ≥100 mg, but not at <100 mg, and included prominent inflammatory responses in injected and non-injected lesions, decreases in size of injected and non-injected lesions, and reduction in tumor-associated pain. One subject at the 160-mg dose had stable disease for 20 weeks. Clinical activity in dose cohorts ≥100 mg coincided with a 4-fold median increase from baseline in peak serum levels of IL-12 and IFN-γ compared with lower dose cohorts. Flow cytometric analyses of PBMCs revealed 7-fold (≥100 mg dose cohorts) median increases from baseline in peak levels of absolute numbers of CD3+ and CD8+ T cells. ELISPOT and T-cell proliferation assays for antigen-specific responses are ongoing. Conclusions: Intratumoral delivery of IL-12 via an adenoviral vector with RheoSwitch enabled finely-controlled expression of IL-12 levels by an oral ligand. Ad-RTS-hIL-12 plus INXN-1001 (160 mg) was well tolerated and induced biological and clinical activity in subjects with advanced melanoma. Phase II studies are ongoing at the biologically effective dose. Clinical trial information: NCT01397708.
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Affiliation(s)
| | - Omid Hamid
- The Angeles Clinic and Research Institute, Los Angeles, CA
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Birch MA, Couchman L, Pietromartire S, Karna T, Paton C, McAllister R, Marsh A, Flanagan RJ. False-Positive Buprenorphine by CEDIA in Patients Prescribed Amisulpride or Sulpiride. J Anal Toxicol 2013; 37:233-6. [DOI: 10.1093/jat/bkt016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Dobrzanska DA, Cooper AL, Dowson CG, Evans SD, Fox DJ, Johnson BR, Biggs CI, Randev RK, Stec HM, Taylor PC, Marsh A. Oxidation of tertiary amine-derivatized surfaces to control protein adhesion. Langmuir 2013; 29:2961-2970. [PMID: 23402628 DOI: 10.1021/la4003719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Selective oxidation of ω-tertiary amine self-assembled thiol monolayers to tertiary amine N-oxides is shown to transform the adhesion of model proteins lysozyme and fibrinogen upon them. Efficient preparation of both secondary and tertiary linker amides as judged by X-ray photoelectron spectroscopy (XPS) and water droplet contact angle was achieved with an improved amide bond formation on gold quartz crystal microbalance (QCM) sensors using 2-(1H-7-azabenzotriazol-1-yl)-1,1,3,3-tetramethyl hexafluorophosphate methanaminium uronium (HATU). Oxidation with hydrogen peroxide was similarly assessed, and adhesion of lysozyme and fibrinogen from phosphate buffered saline was then assayed by QCM and imaged by AFM. Tertiary amine-functionalized sensors adsorbed multilayers of aggregated lysozyme, whereas tertiary amine N-oxides and triethylene glycol-terminated monolayers are consistent with small protein aggregates. The surface containing a dimethylamine N-oxide headgroup and ethyl secondary amide linker showed the largest difference in adsorption of both proteins. Oxidation of tertiary amine decorated surfaces therefore holds the potential for selective deposition of proteins and cells through masking and other patterning techniques.
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Affiliation(s)
- Dorota A Dobrzanska
- Department of Chemistry, and School of Life Sciences, University of Warwick, Coventry CV4 7AL, United Kingdom
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Taylor PC, Clark AJ, Marsh A, Singer DRJ, Dilly SJ. A chemical genomics approach to identification of interactions between bioactive molecules and alternative reading frame proteins. Chem Commun (Camb) 2013; 49:9588-90. [DOI: 10.1039/c3cc44647f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Affiliation(s)
- G Smith
- Dudley Group NHS Foundation Trust, UK.
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Affiliation(s)
- G Smith
- Dudley Group NHS Foundation Trust, UK
| | - A Khan
- Dudley Group NHS Foundation Trust, UK
| | - A Marsh
- Dudley Group NHS Foundation Trust, UK
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Murray O, Christen K, Marsh A, Bayer J. Fracture clinic redesign: improving standards in patient care and interprofessional education. Swiss Med Wkly 2012; 142:w13630. [PMID: 22836731 DOI: 10.4414/smw.2012.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Current fracture clinic models, especially with the advent of reductions in junior doctors' hours, may limit outpatient trainee education and patient care. We have designed a new fracture clinic model, involving an initial consultant-led case review focused on patient management and trainee education. METHODS Prospective outcomes for all new patients attending the redesigned fracture clinic over a 3-week period in 2010 (n = 240) were compared with a historical cohort from the same period in 2009 (n = 296). The primary outcome measure was the proportion of patients with direct consultant input. Secondary outcome measures included patient discharge rates, return rates, use of the nurse-led fracture clinic and the incidence of adverse event reporting. Trainees attending each clinic completed a five-point Likert questionnaire assessing the adequacy of education, support, staff morale and standards of patient care, before and after introduction of the clinic redesign. Using a separate Likert questionnaire, emergency room (ER) staff were evaluated to determine the impact of the new style clinic on their education, daily practice and interprofessional relations. Adverse events were gathered from the 'incident record 1' (IR1) reporting system. RESULTS The percentage of cases given consultant input increased significantly from 33% in 2009 to 84% in 2010 (p <0.0001), while the proportion of patients requiring physical review by a consultant fell by 21% (p <0.0001). Return rates were reduced by 14% (p = 0.013) and use of the nurse-led fracture clinic improved by 10% (p = 0.0028). There was a median improvement in trainee perception of education from 2 (interquartile range 1.25-2.75) to 5 (4.25-5, p = 0.011), senior support from 2 (2-3) to 5 (4-5, p = 0.017) and patient care from 3 (3-4) to 5 (4-5, p = 0.015). ER staff found the new style clinic was educational, practice changing and improved interprofessional relations, but that it did not interfere with ER duties. The incidence of adverse incidents reported fell from 8 per year to 0 per year after the introduction of the new style clinic. CONCLUSIONS Our model of fracture-clinic redesign has significantly enhanced consultant input into patient care without additional funding. In addition, we have demonstrated increased service efficiency and significant improvements in staff support, morale and education. In the face of current economic and training challenges, we recommend this new model as a tool that will enhance patient and trainee experience.
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Affiliation(s)
- Odhrán Murray
- Forth Valley Royal Hospital, Larbert, Stirling, United Kingdom.
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