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Armand S, Langley C, Johansen A, Ozenne B, Overgaard-Hansen O, Larsen K, Jensen PS, Knudsen GM, Sahakian BJ, Stenbæk DS, Fisher PM. Functional brain responses to emotional faces after three to five weeks of intake of escitalopram in healthy individuals: a double-blind, placebo-controlled randomised study. Sci Rep 2024; 14:3149. [PMID: 38326352 PMCID: PMC10850508 DOI: 10.1038/s41598-024-51448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Short-term intake of selective serotonin reuptake inhibitors (SSRIs) modulates threat-related amygdala responses in healthy individuals. However, how SSRI intake over a clinically relevant time period modulates threat-related amygdala responses is less clear. In a semi-randomised, double-blind, placebo-controlled study of 64 healthy individuals (SSRI n = 32, placebo n = 32), we examined the effect of 3-5 weeks of SSRI escitalopram (20 mg daily) on brain response to angry, fearful and neutral faces using BOLD fMRI. Data was analysed using a whole-brain region-wise approach extracting standardised effects (i.e., Cohen's D). The study was conducted at the Copenhagen University Hospital. A priori, we hypothesised that SSRI would attenuate amygdala responses to angry and fearful faces but not to neutral ones. Whether SSRI modulates correlations between amygdala responses to emotional faces and negative mood states was also explored. Compared to placebo, 3-5 weeks of SSRI intake did not significantly affect the amygdala response to angry, fearful, or neutral faces (|Cohen's D|< 0.2, PFWER = 1). Whole-brain, region-wise analyses revealed significant differences in frontal (|Cohen's D|< 0.6, PFWER < .01) and occipital regions (|Cohen's D|< 0.5, PFWER < .01). SSRI did not modulate correlations between amygdala responses to emotional faces and negative mood states. Our findings indicate that a 3-5 week SSRI intake impacts cortical responses to emotional stimuli, an effect possibly involved in SSRI's therapeutic efficacy.Trial registration Clinical Trials NCT04239339.
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Affiliation(s)
- Sophia Armand
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Annette Johansen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Overgaard-Hansen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kristian Larsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Steen Jensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dea Siggard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Patrick MacDonald Fisher
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Johansen A, Armand S, Plavén-Sigray P, Nasser A, Ozenne B, Petersen IN, Keller SH, Madsen J, Beliveau V, Møller K, Vassilieva A, Langley C, Svarer C, Stenbæk DS, Sahakian BJ, Knudsen GM. Effects of escitalopram on synaptic density in the healthy human brain: a randomized controlled trial. Mol Psychiatry 2023; 28:4272-4279. [PMID: 37814129 PMCID: PMC10827655 DOI: 10.1038/s41380-023-02285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are widely used for treating neuropsychiatric disorders. However, the exact mechanism of action and why effects can take several weeks to manifest is not clear. The hypothesis of neuroplasticity is supported by preclinical studies, but the evidence in humans is limited. Here, we investigate the effects of the SSRI escitalopram on presynaptic density as a proxy for synaptic plasticity. In a double-blind placebo-controlled study (NCT04239339), 32 healthy participants with no history of psychiatric or cognitive disorders were randomized to receive daily oral dosing of either 20 mg escitalopram (n = 17) or a placebo (n = 15). After an intervention period of 3-5 weeks, participants underwent a [11C]UCB-J PET scan (29 with full arterial input function) to quantify synaptic vesicle glycoprotein 2A (SV2A) density in the hippocampus and the neocortex. Whereas we find no statistically significant group difference in SV2A binding after an average of 29 (range: 24-38) days of intervention, our secondary analyses show a time-dependent effect of escitalopram on cerebral SV2A binding with positive associations between [11C]UCB-J binding and duration of escitalopram intervention. Our findings suggest that brain synaptic plasticity evolves over 3-5 weeks in healthy humans following daily intake of escitalopram. This is the first in vivo evidence to support the hypothesis of neuroplasticity as a mechanism of action for SSRIs in humans and it offers a plausible biological explanation for the delayed treatment response commonly observed in patients treated with SSRIs. While replication is warranted, these results have important implications for the design of future clinical studies investigating the neurobiological effects of SSRIs.
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Affiliation(s)
- Annette Johansen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sophia Armand
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pontus Plavén-Sigray
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Arafat Nasser
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ida N Petersen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sune H Keller
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jacob Madsen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vincent Beliveau
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kirsten Møller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroanaesthesiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alexandra Vassilieva
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroanaesthesiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Claus Svarer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dea S Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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3
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Zhang X, Yang M, Zhang J, Ye P, Wong RMY, Cheung WH, Armstrong E, Johansen A, Ivers R, Wu X, Tian M. Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry. Osteoporos Int 2023; 34:1763-1770. [PMID: 37341729 DOI: 10.1007/s00198-023-06832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China.
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Affiliation(s)
- X Zhang
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - M Yang
- National Centre of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China.
| | - J Zhang
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - P Ye
- National Centre for Non-communicable Diseases Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - R M Y Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - W-H Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - E Armstrong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia
| | - A Johansen
- University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK
| | - R Ivers
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - X Wu
- National Centre of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China
| | - M Tian
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China.
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
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Laurell GL, Plavén-Sigray P, Johansen A, Raval NR, Nasser A, Aabye Madsen C, Madsen J, Hansen HD, Donovan LL, Knudsen GM, Lammertsma AA, Ogden RT, Svarer C, Schain M. Kinetic models for estimating occupancy from single-scan PET displacement studies. J Cereb Blood Flow Metab 2023; 43:1544-1556. [PMID: 37070382 PMCID: PMC10414003 DOI: 10.1177/0271678x231168591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 04/19/2023]
Abstract
The traditional design of PET target engagement studies is based on a baseline scan and one or more scans after drug administration. We here evaluate an alternative design in which the drug is administered during an on-going scan (i.e., a displacement study). This approach results both in lower radiation exposure and lower costs. Existing kinetic models assume steady state. This condition is not present during a drug displacement and consequently, our aim here was to develop kinetic models for analysing PET displacement data. We modified existing compartment models to accommodate a time-variant increase in occupancy following the pharmacological in-scan intervention. Since this implies the use of differential equations that cannot be solved analytically, we developed instead one approximate and one numerical solution. Through simulations, we show that if the occupancy is relatively high, it can be estimated without bias and with good accuracy. The models were applied to PET data from six pigs where [11C]UCB-J was displaced by intravenous brivaracetam. The dose-occupancy relationship estimated from these scans showed good agreement with occupancies calculated with Lassen plot applied to baseline-block scans of two pigs. In summary, the proposed models provide a framework to determine target occupancy from a single displacement scan.
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Affiliation(s)
- Gjertrud Louise Laurell
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | | | - Annette Johansen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Nakul Ravi Raval
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Arafat Nasser
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Clara Aabye Madsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Jacob Madsen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University, Copenhagen, Denmark
| | - Hanne Demant Hansen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Lene Lundgaard Donovan
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Adriaan A Lammertsma
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - R Todd Ogden
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Molecular Imaging and Neuropathology Division, The New York State Psychiatric Institute, New York, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - Claus Svarer
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Schain
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Antaros Medical, Mölndal, Sweden
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5
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Fox F, Drew S, Gregson CL, Patel R, Chesser TJS, Johansen A, Javaid MK, Griffin XL, Gooberman-Hill R. Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery. BMC Musculoskelet Disord 2023; 24:128. [PMID: 36797702 PMCID: PMC9933012 DOI: 10.1186/s12891-023-06164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/16/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Hip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care. METHODS Interviews were conducted with 40 staff delivering hip fracture care in four UK hospitals. Twenty-three anonymised British Orthopaedic Association reports addressing under-performing hip fracture services were analysed. Following Thematic Analysis of both data sources, themes were transposed onto domains both along and across the hip fracture care pathway. RESULTS Effective pre-operative care required early alert of patient admission and the availability of staff in emergency departments to undertake assessments, investigations and administer analgesia. Coordinated decision-making between medical and surgical teams regarding surgery was key, with strategies to ensure flexible but efficient trauma lists. Orthogeriatric services were central to effective service delivery, with collaborative working and supervision of junior doctors, specialist nurses and therapists. Information sharing via multidisciplinary meetings was facilitated by joined up information and technology systems. Service provision was improved by embedding hip fracture pathway documents in induction and training and ensuring their consistent use by the whole team. Hospital executive leadership was important in prioritising hip fracture care and advocating service improvement. Nominated specialty leads, who jointly owned the pathway and met regularly, actively steered services and regularly monitored performance, investigating lapses and consistently feeding back to the multidisciplinary team. CONCLUSION Findings highlight the importance of representation from all teams and departments involved in the multidisciplinary care pathway, to deliver integrated hip fracture care. Complex, potentially modifiable, barriers and facilitators to care delivery were identified, informing recommendations to improve effective hip fracture care delivery, and assist hospital services when re-designing and implementing service improvements.
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Affiliation(s)
- F Fox
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - S Drew
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK
| | - CL Gregson
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK
| | - R Patel
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK
| | - TJS Chesser
- grid.418484.50000 0004 0380 7221Department of Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK
| | - A Johansen
- grid.5600.30000 0001 0807 5670University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK
| | - MK Javaid
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - XL Griffin
- grid.4868.20000 0001 2171 1133Bone and Joint Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK ,grid.139534.90000 0001 0372 5777Barts Health NHS Trust, London, UK
| | - R Gooberman-Hill
- grid.5337.20000 0004 1936 7603Bristol Medical School, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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Drew S, Fox F, Gregson CL, Patel R, Judge A, Johansen A, Marques EMR, Barbosa EC, Griffin J, Bradshaw M, Whale K, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gooberman-Hill R. 995 MULTIPLE ORGANISATIONAL FACTORS IMPROVE MULTI-DISCIPLINARY CARE DELIVERY TO PATIENTS WITH HIP FRACTURES: A QUALITATIVE STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Hip fractures are devastating injuries which incur high healthcare costs. Despite national standards and guidelines, there is substantial variation in hospital delivery of hip fracture care and in patient outcomes. This study aimed to understand organisational processes that facilitate successful delivery of hip fracture services.
Method
Forty qualitative interviews were conducted with healthcare professionals involved in delivering hip fracture care at four English hospitals. Interview data were supplemented with documentary analysis of 23 anonymised British Orthopaedic Association hospital-initiated peer-review reports of services. Data were analysed thematically, with themes transposed onto key components of the care pathway.
Results
We identified multiple aspects of service organisation that facilitated good care delivery. At admission, standardisation of training in nerve block administration impacted care delivery. During hospital stays, service delivery was improved by integrated, shared-care between orthopaedics and orthogeriatrics, and by strategies to improve trauma list efficiency. Adequately staffed orthogeriatric services and the ‘right’ skills and seniority mix were important to holistic care provision. Placing patients on designated hip fracture wards concentrated staff expertise. Collaborative working was achieved through multi-disciplinary team (MDT) meetings between key staff, protocols and care pathways that defined roles and responsibilities, MDT documentation, ‘joined-up’ IT systems within hospitals and with primary care, and shared working spaces such as shared offices and onwards. Trauma and hip fracture coordinators organised care processes and provided a valuable central point of contact within teams. Nominated leads, representing diverse specialties, worked together in MDT planning meetings to develop joint protocols, establish audit priorities, and agree shared goals. Routine, comprehensive monitoring and evaluation of service delivery, with findings shared throughout the MDT, was beneficial.
Conclusion
Our study has characterised potentially modifiable elements of successful hip fracture service delivery. Findings are intended to help services overcome organisational barriers towards delivery of high-quality hip fracture services.
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Affiliation(s)
| | | | | | | | | | - A Johansen
- Cardiff University and University Hospital of Wales
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Poacher A, Ojeda-Thies C, Hall A, Ahern E, Brent L, Costa M, Johansen A. 1027 DEVELOPING A MINIMUM COMMON DATASET FOR HIP FRACTURE AUDIT. Age Ageing 2022. [DOI: 10.1093/ageing/afac125.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
National hip fracture audits share a common heritage in the work of Rikshöft and the Standardised Audit of Hip Fracture in Europe. However, as more countries develop audit programmes and these evolve to address local needs, divergence in the data they collect compromises their scope for learning from clinical, audit and quality improvement work in other nations.
Method
In 2021 we compared all ten established national hip fracture audits: England/Wales/Northern Ireland; Scotland; Australia/New Zealand; Ireland; Germany; the Netherlands; Sweden; Norway; Denmark; Spain. We tabulated all questions included in each, and cross-referenced them against the 32 questions of the minimum common dataset (MCD) defined by the global Fragility Fracture Network (FFN) in 2014. We identified those consistently used in most national audits, and additional fields that might need to form part of a revised MCD. Any MCD must meet the needs of both developed and developing countries. We presented these findings at the Asia-Pacific FFN meeting, and used an online questionnaire to capture feedback from different countries. A draft revision was presented at the Global FFN conference in September 2021, with feedback again used to finalise this revised MCD.
Results
We tabulated a total of 215 possible questions. Only 72 (34%) were used in >1 national audit, and only 32 (15%) by more than half of audits. Adherence to the 2014 MCD was disappointing; all 32 fields were used by at least one audit, but 5/32 only by one audit. Only 21/32 (65%) were used in the majority, and only three (anaesthetic grade, operation and date/time of surgery) by all ten established audits.
Discussion
This revised MCD will help aspirant nations establish new audit programmes, facilitate the integration of novel analytic techniques and greater multinational collaboration, and serve as an internationally-accepted standard for monitoring and improving hip fracture services.
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Affiliation(s)
- A Poacher
- University Hospital of Wales and School of Medicine, Cardiff University , UK
| | - C Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre , Madrid, Spain
| | - A Hall
- Department of Orthopaedics & Trauma , University of Edinburgh, and Scottish Hip Fracture Audit (SHFA), Edinburgh, Scotland, , Republic of Ireland
- UK Cork University Hospital , University of Edinburgh, and Scottish Hip Fracture Audit (SHFA), Edinburgh, Scotland, , Republic of Ireland
| | - E Ahern
- National Office of Clinical Audit (NOCA) , Republic of Ireland
| | - L Brent
- National Office of Clinical Audit (NOCA) , Republic of Ireland
| | - M Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
| | - A Johansen
- University Hospital of Wales and School of Medicine, Cardiff University , UK
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Patel R, Judge A, Johansen A, Marques EMR, Barbosa EC, Griffin J, Bhimjiyani A, Bradshaw M, Whale K, Drew, Gooberman-Hill R, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gregson CL. 946 MULTIPLE ORGANISATIONAL FACTORS ARE ASSOCIATED WITH ADVERSE PATIENT OUTCOMES POST HIP FRACTURE IN HOSPITALS IN ENGLAND & WALES. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Older adults who sustain a hip fracture require complex multidisciplinary care, which can challenge organisational structures within hospitals. Despite standards and guidelines, substantial variation remains in hip fracture care delivery across the UK. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the post injury period.
Method
A cohort of 178,757 patients aged 60+ years in England and Wales (2016–19) who sustained a hip fracture was examined. Patient-level Hospital Episodes Statistics, National Hip Fracture Database, and mortality data were linked to metrics from 18 hospital-level organisational audits/reports/series. Multilevel models determined the organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality, and emergency 30-day readmission.
Results
Overall LOS was mean 21 days (standard deviation, 20); 13,126 (7.3%) died within 30-days; and 25,239 (15.3%) were readmitted. 25 organisational factors independently predicted LOS: for example, a hospital’s ability to promptly mobilise ≥90% of patients was associated with a 2-day (95%CI:1.3–2.7) shorter LOS, and hospitals where all patients received orthogeriatric assessment within 72 hours of admission had mean 1.5-day (95%CI:0.6–2.3) shorter LOS. Ten organisational factors independently predicted 30-day mortality: providing prompt surgery (≤36 hours from admission) to >80% patients was associated with the same 10% reduction in mortality (95%CI:4–15%), as was discussion of ‘patient experience’ feedback at clinical governance meetings (95%CI:5–15%). Nine organisational factors independently predicted readmission: knowledge of time from discharge to start of community therapy was associated with 17% (95%CI:9–24%) lower readmission rates. Organisational delivery of clinical governance, surgery, and physiotherapy were associated with all outcomes.
Conclusion
Multiple, potentially modifiable, organisational factors are associated with important patient outcomes post-hip fracture. These factors, if causal, indicate auditable components of hospital care where interventions can be targeted to reduce variability in hip fracture care delivery, to improve patient outcomes.
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Affiliation(s)
| | | | - A Johansen
- Cardiff University and University Hospital of Wales
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9
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Mohsin Z, Javaid K, Johansen A. 994 CURRENT SECONDARY PREVENTION AFTER HIP FRACTURE IN ENGLAND AND WALES—RESULTS FROM THE NATIONAL HIP FRACTURE DATABASE (NHFD). Age Ageing 2022. [DOI: 10.1093/ageing/afac125.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
National clinical audit seeks to enhance the quality of care of the 75,000 people who break their hip in the UK each year. A key aim for the National Hip Fracture Database (NHFD) is to encourage secondary fracture prevention through bone health assessment and the appropriate provision of anti-osteoporosis medication (AOM). We set out to describe trends in anti-osteoporosis medication prescription, and to examine the types of oral and injectable AOM being prescribed both before and after a hip fracture.
Method
We used data freely available from the NHFD www.nhfd.co.uk to analyse trends in oral and injectable AOM prescription across a quarter of a million patients presenting between 2016 and 2020, and more detailed information on the individual type of AOM prescribed for 63,284 patients from 171 hospitals in England and Wales who presented in 2020.
Results
Most patients (88.2%) were not taking any AOM when they presented with hip fracture. Half of all patients (49.9%) were prescribed AOM treatment by the time of discharge, but the proportion deemed ‘inappropriate for AOM’ varied hugely (0.2–83.6%) in different hospitals. Nearly two thirds (64%) of those who were previously taking an oral bisphosphonate were simply discharged on the same type of medication. The total number of patients started on oral medication fell by 11.4% over 5 years. The number started on injectable AOM almost doubled to 14.4% over the same period, but remains hugely variable across the country, with rates ranging 0–67% across different units.
Conclusion
A recent hip fracture is a strong risk factor for future fractures. If teams are to learn from each other’s experience and patients are to be protected against further fragility fractures the huge variability in approaches, and in particular to the use of injectables, in different trauma units across England and Wales requires further investigation.
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Affiliation(s)
- Z Mohsin
- Nuffield Department of Orthopaedics , Rheumatology and Musculoskeletal Sciences (NDORMS), , UK
- University of Oxford , Rheumatology and Musculoskeletal Sciences (NDORMS), , UK
| | - K Javaid
- Nuffield Department of Orthopaedics , Rheumatology and Musculoskeletal Sciences (NDORMS), , UK
- University of Oxford , Rheumatology and Musculoskeletal Sciences (NDORMS), , UK
- Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians , London, UK
| | - A Johansen
- Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians , London, UK
- University Hospital of Wales and School of Medicine, Cardiff University , UK
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10
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Probert A, Davis K, Singh I, Holleyman R, Gregson C, Johansen A. 996 EFFECT OF COVID-19 ON HIP FRACTURE CARE IN WALES - AN ANALYSIS OF HOW ORGANISATION OF SERVICES AFFECTED HOSPITAL LENGTH OF STAY. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The National Hip Fracture Database (NHFD) report that length of stay (LOS) fell (from 19.7 to 16.9 days) in the first year of the COVID-19 pandemic, as patients, families, cares, and staff in health and social care responded to this challenge. This analysis examines trends in Wales where LOS can be profiled very completely as it predominantly remains within a single health board.
Method
We used data from the NHFD www.nhfd.co.uk to define pre-pandemic LOS (in the year to 1st March 2020) and compare this with the following 18 months. We set figures for all 12 hospitals in Wales against the changes in service organisation which each reported to the NHFD's 2020 Facilities Survey, and against the local incidence of COVID-19 among their hip fracture patients.
Results
Monthly LOS fell markedly at the pandemic's onset; the national figure falling 8.3 days (from 31.2–22.9 days) between February and June 2020. Overall LOS in Wales fell by 1.6 days across the year as a whole, but this ranged from a fall of 6.3 days in one hospital to a rise of 4.5 days in another. Five hospitals reported a rise in LOS. These hospitals had either never had orthogeriatric support, or lost this to COVID-19 duties, they did not achieve the initial fall in LOS in response to the pandemic, and they reported pressures with ‘outliers’ after the first wave. Unlike other units in Wales they cited problems with workload, particularly in terms of physiotherapy.
Discussion
NHFD data provide a detailed picture of hospitals’ response to the COVID-19 pandemic, and allow us to examine service factors underpinning their resilience in the face of this challenge. More detailed work should be carried out for the 150 hospitals in England using the same sources of data.
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Affiliation(s)
- A Probert
- Cardiff and Vale University Health Board , Cardiff, UK
| | - K Davis
- Cardiff and Vale University Health Board , Cardiff, UK
| | - I Singh
- Aneurin Bevan University Health Board , Gwent, UK
| | - R Holleyman
- Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust , UK
| | - C Gregson
- Musculoskeletal Research Unit , Bristol Medical School, , Bristol, UK
- University of Bristol , Bristol Medical School, , Bristol, UK
| | - A Johansen
- University Hospital of Wales , and School of Medicine, , UK
- Cardiff University , and School of Medicine, , UK
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11
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Goubar A, Ayis S, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ. The impact of the frequency, duration and type of physiotherapy on discharge after hip fracture surgery: a secondary analysis of UK national linked audit data. Osteoporos Int 2022; 33:839-850. [PMID: 34748023 PMCID: PMC8930962 DOI: 10.1007/s00198-021-06195-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Additional physiotherapy in the first postoperative week was associated with fewer days to discharge after hip fracture surgery. A 7-day physiotherapy service in the first postoperative week should be considered as a new key performance indicator in evaluating the quality of care for patients admitted with a hip fracture. INTRODUCTION To examine the association between physiotherapy in the first week after hip fracture surgery and discharge from acute hospital. METHODS We linked data from the UK Physiotherapy Hip Fracture Sprint Audit to hospital records for 5395 patients with hip fracture in May and June 2017. We estimated the association between the number of days patients received physiotherapy in the first postoperative week; its overall duration (< 2 h, ≥ 2 h; 30-min increment) and type (mobilisation alone, mobilisation and exercise) and the cumulative probability of discharge from acute hospital over 30 days, using proportional odds regression adjusted for confounders and the competing risk of death. RESULTS The crude and adjusted odds ratios of discharge were 1.24 (95% CI 1.19-1.30) and 1.26 (95% CI 1.19-1.33) for an additional day of physiotherapy, 1.34 (95% CI 1.18-1.52) and 1.33 (95% CI 1.12-1.57) for ≥ 2 versus < 2 h physiotherapy, and 1.11 (95% CI 1.08-1.15) and 1.10 (95% CI 1.05-1.15) for an additional 30-min of physiotherapy. Physiotherapy type was not associated with discharge. CONCLUSION We report an association between physiotherapy and discharge after hip fracture. An average UK hospital admitting 375 patients annually may save 456 bed-days if current provision increased so all patients with hip fracture received physiotherapy on 6-7 days in the first postoperative week. A 7-day physiotherapy service totalling at least 2 h in the first postoperative week may be considered a key performance indicator of acute care quality after hip fracture.
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Affiliation(s)
- A Goubar
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - L Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Johansen
- Cardiff Trauma Unit, University Hospital of Wales, Cardiff, UK
| | - M T Kristensen
- Department of Physical & Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK
- Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - E Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - T O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - K J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, King's College London, London, UK.
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12
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Volkmer B, Sadler E, Lambe K, Martin FC, Ayis S, Beaupre L, Cameron ID, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Sackley C, Smith TO, Sobolev B. 660 PHYSIOTHERAPISTS PERCEPTIONS OF MECHANISMS FOR OBSERVED VARIATION IN PRACTICE DURING EARLY POSTOPERATIVE PHASE AFTER HIP FRACTURE. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To explore physiotherapists’ perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit.
Methods
A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings.
Results
Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting ‘postoperative physiotherapy’ as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services.
Conclusion
Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles.
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13
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Shah A, Hawley S, Inman DS, Cooper C, Fagan E, Johansen A, Judge A. Geographical variation in surgical care and mortality following hip fracture in England: a cohort study using the National Hip Fracture Database (NHFD). Osteoporos Int 2021; 32:1989-1998. [PMID: 33768343 DOI: 10.1007/s00198-021-05922-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
UNLABELLED We describe variation across geographical regions of England in operations undertaken following presentation of hip fracture and in 30-day mortality. Some significant geographic variation in 30-day mortality was observed particularly for patients with trochanteric hip fractures and warrants further investigation of other aspects of post-hip fracture care INTRODUCTION: Mortality after hip fracture has improved considerably in the UK over recent decades. Our aim here was to describe geographical variation in type of operation performed and 30-day mortality amongst patients in England with hip fracture. METHODS The National Hip Fracture Database was used to carry out a prospective cohort study of nearly all over-60 year olds with hip fracture in England. These data were linked to Hospital Episode Statistics (HES), allowing us to explore regional variation in the operations performed for three fracture types (intracapsular, trochanteric and subtrochanteric), and use logistic regression models adjusted for demographic and clinical factors to describe associated 30-day mortality. RESULTS NHFD recorded data for 64,211 patients who underwent surgery in England during 2017. Most had an intracapsular (59%) or trochanteric fracture (35%), and we found significant geographical variation across regions of England in use of total hip replacement (THR) (ranging from 10.1 to 17.4%) for intracapsular fracture and in intermedullary nailing (ranging from 14.9 to 27.0%) of trochanteric fracture. Some geographical variation in mortality amongst intracapsular fracture patients was found, with slightly higher mortality in the East of England (adjusted odds ratio [aOR]: 1.22, 95% CI: 1.02-1.46). Trochanteric fractures showed slightly more variation, with higher 30-day mortality (aOR: 1.40, 95%CI: 1.05-1.88) in the East of England and significantly lower mortality in the North East (aOR: 0.65, 95%CI: 0.46-0.93). CONCLUSIONS We have identified regional differences in operation type and 30-day mortality amongst hip fracture patients in England. The relationship between surgical approach and mortality has been explored, but the extent to which differential mortality reflects variation in approach to medical assessment, anaesthesia and other aspects of care warrants further investigation.
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Affiliation(s)
- A Shah
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - S Hawley
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - D S Inman
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
- Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - C Cooper
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E Fagan
- Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - A Johansen
- Care Quality Improvement Department, Royal College of Physicians, London, UK
- Trauma Unit, University Hospital of Wales, Cardiff, UK
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - A Judge
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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14
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Raval NR, Johansen A, Donovan LL, Ros NF, Ozenne B, Hansen HD, Knudsen GM. A Single Dose of Psilocybin Increases Synaptic Density and Decreases 5-HT 2A Receptor Density in the Pig Brain. Int J Mol Sci 2021; 22:E835. [PMID: 33467676 PMCID: PMC7830000 DOI: 10.3390/ijms22020835] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
A single dose of psilocybin, a psychedelic and serotonin 2A receptor (5-HT2AR) agonist, may be associated with antidepressant effects. The mechanism behind its antidepressive action is unknown but could be linked to increased synaptogenesis and down-regulation of cerebral 5-HT2AR. Here, we investigate if a single psychedelic dose of psilocybin changes synaptic vesicle protein 2A (SV2A) and 5-HT2AR density in the pig brain. Twenty-four awake pigs received either 0.08 mg/kg psilocybin or saline intravenously. Twelve pigs (n = 6/intervention) were euthanized one day post-injection, while the remaining twelve pigs were euthanized seven days post-injection (n = 6/intervention). We performed autoradiography on hippocampus and prefrontal cortex (PFC) sections with [3H]UCB-J (SV2A), [3H]MDL100907 (5-HT2AR antagonist) and [3H]Cimbi-36 (5-HT2AR agonist). One day post psilocybin injection, we observed 4.42% higher hippocampal SV2A density and lowered hippocampal and PFC 5-HT2AR density (-15.21% to -50.19%). These differences were statistically significant in the hippocampus for all radioligands and in the PFC for [3H]Cimbi-36 only. Seven days post-intervention, there was still significantly higher SV2A density in the hippocampus (+9.24%) and the PFC (+6.10%), whereas there were no longer any differences in 5-HT2AR density. Our findings suggest that psilocybin causes increased persistent synaptogenesis and an acute decrease in 5-HT2AR density, which may play a role in psilocybin's antidepressive effects.
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Affiliation(s)
- Nakul Ravi Raval
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (N.R.R.); (A.J.); (L.L.D.); (N.F.R.); (B.O.); (H.D.H.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Annette Johansen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (N.R.R.); (A.J.); (L.L.D.); (N.F.R.); (B.O.); (H.D.H.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lene Lundgaard Donovan
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (N.R.R.); (A.J.); (L.L.D.); (N.F.R.); (B.O.); (H.D.H.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Nídia Fernandez Ros
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (N.R.R.); (A.J.); (L.L.D.); (N.F.R.); (B.O.); (H.D.H.)
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (N.R.R.); (A.J.); (L.L.D.); (N.F.R.); (B.O.); (H.D.H.)
- Department of Public Health, Section of Biostatistics, Faculty of Health and Medical Sciences, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Hanne Demant Hansen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (N.R.R.); (A.J.); (L.L.D.); (N.F.R.); (B.O.); (H.D.H.)
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (N.R.R.); (A.J.); (L.L.D.); (N.F.R.); (B.O.); (H.D.H.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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15
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Hansen HD, Lindberg U, Ozenne B, Fisher PM, Johansen A, Svarer C, Keller SH, Hansen AE, Knudsen GM. Visual stimuli induce serotonin release in occipital cortex: A simultaneous positron emission tomography/magnetic resonance imaging study. Hum Brain Mapp 2020; 41:4753-4763. [PMID: 32813903 PMCID: PMC7555083 DOI: 10.1002/hbm.25156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/25/2020] [Accepted: 07/21/2020] [Indexed: 12/27/2022] Open
Abstract
Endogenous serotonin (5-HT) release can be measured noninvasively using positron emission tomography (PET) imaging in combination with certain serotonergic radiotracers. This allows us to investigate effects of pharmacological and nonpharmacological interventions on brain 5-HT levels in living humans. Here, we study the neural responses to a visual stimulus using simultaneous PET/MRI. In a cross-over design, 11 healthy individuals were PET/MRI scanned with the 5-HT1B receptor radioligand [11 C]AZ10419369, which is sensitive to changes in endogenous 5-HT. During the last part of the scan, participants either viewed autobiographical images with positive valence (n = 11) or kept their eyes closed (n = 7). The visual stimuli increased cerebral blood flow (CBF) in the occipital cortex, as measured with pseudo-continuous arterial spin labeling. Simultaneously, we found decreased 5-HT1B receptor binding in the occipital cortex (-3.6 ± 3.6%), indicating synaptic 5-HT release. Using a linear regression model, we found that the change in 5-HT1B receptor binding was significantly negatively associated with change in CBF in the occipital cortex (p = .004). For the first time, we here demonstrate how cerebral 5-HT levels change in response to nonpharmacological stimuli in humans, as measured with PET. Our findings more directly support a link between 5-HT signaling and visual processing and/or visual attention.
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Affiliation(s)
- Hanne Demant Hansen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Massachusetts, Massachusetts
| | - Ulrich Lindberg
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Patrick MacDonald Fisher
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Annette Johansen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Svarer
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sune Høgild Keller
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Kaalund SS, Johansen A, Fabricius K, Pakkenberg B. Untreated Patients Dying With AIDS Have Loss of Neocortical Neurons and Glia Cells. Front Neurosci 2020; 13:1398. [PMID: 32009881 PMCID: PMC6974793 DOI: 10.3389/fnins.2019.01398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/12/2019] [Indexed: 11/13/2022] Open
Abstract
Untreated human immunodeficiency virus (HIV) depletes its host CD4 cells, ultimately leading to acquired immunodeficiency syndrome (AIDS). In brain, the HIV confines itself to astrocytes and microglia, the resident brain macrophages, but does not infect oligodendrocytes and neurons. Nonetheless, cognitive symptoms associated with HIV and AIDS are attributed to loss of axons and white matter damage. We used design-based stereology to estimate the numbers of neocortical neurons and glial cells (astrocytes, oligodendrocytes, and microglia), in a series of 12 patients dying with AIDS before the era of retroviral treatments, and in 13 age-matched control brains. Relative to the control material, there was a 19% loss of neocortical neuron (p = 0.04) and a 29% reduction of oligodendrocytes (p = 0.003) in the patients with AIDS, whereas astrocyte and microglia numbers did not differ between patients and controls. Furthermore, we saw a 17% reduction in mean hemispheric volume in the AIDS group (p = 0.0015), which was driven by neocortical and white matter loss (p < 0.05), while the archicortex, subcortical gray matter, and ventricular volumes were within normal limits. Our results confirm previous reports of neuronal loss in AIDS. The new finding of oligodendrocyte loss supports the proposal that HIV in the brain provokes demyelination and axonal dysfunction and suggests that remyelination treatment strategies may be beneficial to patients suffering from HIV-associated neurocognitive deficits.
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Affiliation(s)
- Sanne Simone Kaalund
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Annette Johansen
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katrine Fabricius
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Gubra, Hørsholm, Denmark
| | - Bente Pakkenberg
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Johansen MP, Child DP, Cresswell T, Harrison JJ, Hotchkis MAC, Howell NR, Johansen A, Sdraulig S, Thiruvoth S, Young E, Whiting SD. Plutonium and other radionuclides persist across marine-to-terrestrial ecotopes in the Montebello Islands sixty years after nuclear tests. Sci Total Environ 2019; 691:572-583. [PMID: 31325857 DOI: 10.1016/j.scitotenv.2019.06.531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/12/2019] [Revised: 06/29/2019] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
Since the 1956 completion of nuclear testing at the Montebello Islands, Western Australia, this remote uninhabited island group has been relatively undisturbed (no major remediations) and currently functions as high-value marine and terrestrial habitat within the Montebello/Barrow Islands Marine Conservation Reserves. The former weapons testing sites, therefore, provide a unique opportunity for assessing the fate and behaviour of Anthropocene radionuclides subjected to natural processes across a range of shallow-marine to island-terrestrial ecological units (ecotopes). We collected soil, sediment and biota samples and analysed their radionuclide content using gamma and alpha spectrometry, photostimulated luminescence autoradiography and accelerator mass spectrometry. We found the activity levels of the fission and neutron-activation products have decreased by ~hundred-fold near the ground zero locations. However, Pu concentrations remain elevated, some of which are high relative to most other Australian and international sites (up to 25,050 Bq kg-1 of 239+240+241Pu). Across ecotopes, Pu ranked from highest to lowest in the following order: island soils > dunes > foredunes > marine sediments > and beach intertidal zone. Low values of Pu and other radionuclides were detected in all local wildlife tested including endangered species. Activity concentrations ranked (highest to lowest) terrestrial arthropods > terrestrial mammal and reptile bones > algae > oyster flesh > whole crab > sea turtle bone > stingray and teleost fish livers > sea cucumber flesh > sea turtle skin > teleost fish muscle. The three detonations (one from within a ship and two from 30 m towers) resulted in differing contaminant forms, with the ship detonation producing the highest activity concentrations and finer more inhalable particulate forms. The three sites are distinct in their 240/239Pu and 241/239Pu atom ratios, including the Pu transported by natural process or within migratory living organisms.
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Affiliation(s)
| | | | | | | | | | | | | | - S Sdraulig
- Australian Radiation Protection and Nuclear Safety Agency, Yallambie, Australia
| | | | | | - S D Whiting
- Department of Biodiversity, Conservation and Attractions, Kensington, WA, Australia
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18
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Morales JC, Mustill AJ, Ribas I, Davies MB, Reiners A, Bauer FF, Kossakowski D, Herrero E, Rodríguez E, López-González MJ, Rodríguez-López C, Béjar VJS, González-Cuesta L, Luque R, Pallé E, Perger M, Baroch D, Johansen A, Klahr H, Mordasini C, Anglada-Escudé G, Caballero JA, Cortés-Contreras M, Dreizler S, Lafarga M, Nagel E, Passegger VM, Reffert S, Rosich A, Schweitzer A, Tal-Or L, Trifonov T, Zechmeister M, Quirrenbach A, Amado PJ, Guenther EW, Hagen HJ, Henning T, Jeffers SV, Kaminski A, Kürster M, Montes D, Seifert W, Abellán FJ, Abril M, Aceituno J, Aceituno FJ, Alonso-Floriano FJ, Ammler-von Eiff M, Antona R, Arroyo-Torres B, Azzaro M, Barrado D, Becerril-Jarque S, Benítez D, Berdiñas ZM, Bergond G, Brinkmöller M, Del Burgo C, Burn R, Calvo-Ortega R, Cano J, Cárdenas MC, Guillén CC, Carro J, Casal E, Casanova V, Casasayas-Barris N, Chaturvedi P, Cifuentes C, Claret A, Colomé J, Czesla S, Díez-Alonso E, Dorda R, Emsenhuber A, Fernández M, Fernández-Martín A, Ferro IM, Fuhrmeister B, Galadí-Enríquez D, Cava IG, Vargas MLG, Garcia-Piquer A, Gesa L, González-Álvarez E, Hernández JIG, González-Peinado R, Guàrdia J, Guijarro A, de Guindos E, Hatzes AP, Hauschildt PH, Hedrosa RP, Hermelo I, Arabi RH, Otero FH, Hintz D, Holgado G, Huber A, Huke P, Johnson EN, de Juan E, Kehr M, Kemmer J, Kim M, Klüter J, Klutsch A, Labarga F, Labiche N, Lalitha S, Lampón M, Lara LM, Launhardt R, Lázaro FJ, Lizon JL, Llamas M, Lodieu N, López Del Fresno M, Salas JFL, López-Santiago J, Madinabeitia HM, Mall U, Mancini L, Mandel H, Marfil E, Molina JAM, Martín EL, Martín-Fernández P, Martín-Ruiz S, Martínez-Rodríguez H, Marvin CJ, Mirabet E, Moya A, Naranjo V, Nelson RP, Nortmann L, Nowak G, Ofir A, Pascual J, Pavlov A, Pedraz S, Medialdea DP, Pérez-Calpena A, Perryman MAC, Rabaza O, Ballesta AR, Rebolo R, Redondo P, Rix HW, Rodler F, Trinidad AR, Sabotta S, Sadegi S, Salz M, Sánchez-Blanco E, Carrasco MAS, Sánchez-López A, Sanz-Forcada J, Sarkis P, Sarmiento LF, Schäfer S, Schlecker M, Schmitt JHMM, Schöfer P, Solano E, Sota A, Stahl O, Stock S, Stuber T, Stürmer J, Suárez JC, Tabernero HM, Tulloch SM, Veredas G, Vico-Linares JI, Vilardell F, Wagner K, Winkler J, Wolthoff V, Yan F, Osorio MRZ. A giant exoplanet orbiting a very-low-mass star challenges planet formation models. Science 2019; 365:1441-1445. [PMID: 31604272 DOI: 10.1126/science.aax3198] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023]
Abstract
Surveys have shown that super-Earth and Neptune-mass exoplanets are more frequent than gas giants around low-mass stars, as predicted by the core accretion theory of planet formation. We report the discovery of a giant planet around the very-low-mass star GJ 3512, as determined by optical and near-infrared radial-velocity observations. The planet has a minimum mass of 0.46 Jupiter masses, very high for such a small host star, and an eccentric 204-day orbit. Dynamical models show that the high eccentricity is most likely due to planet-planet interactions. We use simulations to demonstrate that the GJ 3512 planetary system challenges generally accepted formation theories, and that it puts constraints on the planet accretion and migration rates. Disk instabilities may be more efficient in forming planets than previously thought.
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Affiliation(s)
- J C Morales
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain. .,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - A J Mustill
- Lund Observatory, Department of Astronomy and Theoretical Physics, Lund University, Box 43, SE-221 00 Lund, Sweden
| | - I Ribas
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - M B Davies
- Lund Observatory, Department of Astronomy and Theoretical Physics, Lund University, Box 43, SE-221 00 Lund, Sweden
| | - A Reiners
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - F F Bauer
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - D Kossakowski
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - E Herrero
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - E Rodríguez
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - M J López-González
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - C Rodríguez-López
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - V J S Béjar
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - L González-Cuesta
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - R Luque
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - E Pallé
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - M Perger
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - D Baroch
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - A Johansen
- Lund Observatory, Department of Astronomy and Theoretical Physics, Lund University, Box 43, SE-221 00 Lund, Sweden
| | - H Klahr
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - C Mordasini
- Physikalisches Institut, Universität Bern, CH-3012 Bern, Switzerland
| | - G Anglada-Escudé
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain.,School of Physics and Astronomy, Queen Mary University of London, London E1 4NS, UK
| | - J A Caballero
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain
| | - M Cortés-Contreras
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain
| | - S Dreizler
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - M Lafarga
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - E Nagel
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - V M Passegger
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - S Reffert
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - A Rosich
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - A Schweitzer
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - L Tal-Or
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany.,Department of Geophysics, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - T Trifonov
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - M Zechmeister
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - A Quirrenbach
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - P J Amado
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - E W Guenther
- Thüringer Landessternwarte Tautenburg, D-07778 Tautenburg, Germany
| | - H-J Hagen
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - T Henning
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - S V Jeffers
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - A Kaminski
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - M Kürster
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - D Montes
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - W Seifert
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - F J Abellán
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Departamento de Astronomía y Astrofísica, Universidad de Valencia, E-46100 Burjassot, Spain
| | - M Abril
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - J Aceituno
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain.,Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - F J Aceituno
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - F J Alonso-Floriano
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Leiden Observatory, Leiden University, 2300 RA Leiden, Netherlands
| | - M Ammler-von Eiff
- Thüringer Landessternwarte Tautenburg, D-07778 Tautenburg, Germany.,Max Planck Institute for Solar System Research, D-37077 Göttingen, Germany
| | - R Antona
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - B Arroyo-Torres
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - M Azzaro
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - D Barrado
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain
| | - S Becerril-Jarque
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - D Benítez
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - Z M Berdiñas
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain.,Departamento de Astronomía, Universidad de Chile, Camino El Observatorio, 1515 Las Condes, Santiago, Chile
| | - G Bergond
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - M Brinkmöller
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - C Del Burgo
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Santa María Tonantzintla, Puebla, Mexico
| | - R Burn
- Physikalisches Institut, Universität Bern, CH-3012 Bern, Switzerland
| | - R Calvo-Ortega
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - J Cano
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - M C Cárdenas
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - C Cardona Guillén
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - J Carro
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - E Casal
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - V Casanova
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - N Casasayas-Barris
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - P Chaturvedi
- Thüringer Landessternwarte Tautenburg, D-07778 Tautenburg, Germany
| | - C Cifuentes
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain.,Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - A Claret
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - J Colomé
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - S Czesla
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - E Díez-Alonso
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Departamento de Explotación y Prospeción de Minas, Escuela de Minas, Energía y Materiales, Universidad de Oviedo, E-33003 Oviedo, Asturias, Spain
| | - R Dorda
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain.,Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - A Emsenhuber
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | - M Fernández
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - A Fernández-Martín
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - I M Ferro
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - B Fuhrmeister
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - D Galadí-Enríquez
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - I Gallardo Cava
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Observatorio Astronómico Nacional (OAN-Instituto Geográfico Nacional), E-28803 Alcalá de Henares, Spain
| | | | - A Garcia-Piquer
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - L Gesa
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - E González-Álvarez
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), E-28850 Torrejón de Ardoz, Madrid, Spain
| | - J I González Hernández
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - R González-Peinado
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - J Guàrdia
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - A Guijarro
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - E de Guindos
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - A P Hatzes
- Thüringer Landessternwarte Tautenburg, D-07778 Tautenburg, Germany
| | - P H Hauschildt
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - R P Hedrosa
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - I Hermelo
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - R Hernández Arabi
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - F Hernández Otero
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - D Hintz
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - G Holgado
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain.,Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - A Huber
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - P Huke
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - E N Johnson
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - E de Juan
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - M Kehr
- Thüringer Landessternwarte Tautenburg, D-07778 Tautenburg, Germany
| | - J Kemmer
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - M Kim
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany.,Institut für Theoretische Physik und Astrophysik, D-24118 Kiel, Germany
| | - J Klüter
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany.,Zentrum für Astronomie der Universität Heidelberg, Astronomisches Rechen-Institut, D-69120 Heidelberg, Germany
| | - A Klutsch
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Institut für Astronomie und Astrophysik, Eberhard Karls Universität, D-72076 Tübingen, Germany
| | - F Labarga
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - N Labiche
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - S Lalitha
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - M Lampón
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - L M Lara
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - R Launhardt
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - F J Lázaro
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - J-L Lizon
- European Organisation for Astronomical Research in the Southern Hemisphere, D-85748 Garching bei München, Germany
| | - M Llamas
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - N Lodieu
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - M López Del Fresno
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain
| | - J F López Salas
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - J López-Santiago
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Department of Signal Theory and Communications, Universidad Carlos III de Madrid, E-28911 Leganés, Madrid, Spain.,Gregorio Marañón Health Research Institute, E-28007 Madrid, Spain
| | - H Magán Madinabeitia
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain.,Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - U Mall
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - L Mancini
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany.,Department of Physics, University of Rome Tor Vergata, I-00133 Roma, Italy.,Istituto Nazionale di Astrofisica-Osservatorio Astrofisico di Torino, I-10025 Pino Torinese, Italy.,International Institute for Advanced Scientific Studies, I-84019 Vietri sul Mare (SA), Italy
| | - H Mandel
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - E Marfil
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain
| | - J A Marín Molina
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - E L Martín
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), E-28850 Torrejón de Ardoz, Madrid, Spain
| | - P Martín-Fernández
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - S Martín-Ruiz
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - H Martínez-Rodríguez
- Departamento de Física de la Tierra y Astrofísica, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Instituto de Física de Partículas y del Cosmos, Facultad de Ciencias Físicas, Universidad Complutense de Madrid, E-28040 Madrid, Spain.,Department of Physics and Astronomy and Pittsburgh Particle Physics, Astrophysics and Cosmology Center, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - C J Marvin
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - E Mirabet
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain.,Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - A Moya
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain.,School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Stellar Astrophysics Centre, Department of Physics and Astronomy, Aarhus University, DK-8000 Aarhus C, Denmark
| | - V Naranjo
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - R P Nelson
- School of Physics and Astronomy, Queen Mary University of London, London E1 4NS, UK
| | - L Nortmann
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - G Nowak
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - A Ofir
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, Rehovot 76100, Israel
| | - J Pascual
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - A Pavlov
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - S Pedraz
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - D Pérez Medialdea
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | | | - M A C Perryman
- School of Physics, University College Dublin, Belfield Downs, Dublin D14 YH57, Ireland
| | - O Rabaza
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain.,Dpto. Ingeniería Civil, Universidad de Granada, E-18071 Granada, Spain
| | - A Ramón Ballesta
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - R Rebolo
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain.,Departamento de Astrofísica, Universidad de La Laguna, E-38206 La Laguna, Tenerife, Spain
| | - P Redondo
- Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife, Spain
| | - H-W Rix
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - F Rodler
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain.,European Southern Observatory, Vitacura, Casilla 19001, Santiago de Chile
| | - A Rodríguez Trinidad
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - S Sabotta
- Thüringer Landessternwarte Tautenburg, D-07778 Tautenburg, Germany
| | - S Sadegi
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany.,Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - M Salz
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | | | - M A Sánchez Carrasco
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - A Sánchez-López
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - J Sanz-Forcada
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain
| | - P Sarkis
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - L F Sarmiento
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - S Schäfer
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - M Schlecker
- Max-Planck-Institut für Astronomie, D-69117 Heidelberg, Germany
| | - J H M M Schmitt
- Hamburger Sternwarte, Universität Hamburg, D-21029 Hamburg, Germany
| | - P Schöfer
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - E Solano
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), European Space Astronomy Centre Campus (European Space Agency), E-28692 Villanueva de la Cañada, Spain
| | - A Sota
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain
| | - O Stahl
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - S Stock
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - T Stuber
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - J Stürmer
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany.,Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL 60637, USA
| | - J C Suárez
- Instituto de Astrofísica de Andalucía (Consejo Superior de Investigaciones Científicas), E-18008 Granada, Spain.,Dpto. Física Teórica y del Cosmos, Universidad de Granada, E-18071 Granada, Spain
| | - H M Tabernero
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), E-28850 Torrejón de Ardoz, Madrid, Spain
| | - S M Tulloch
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, UK
| | - G Veredas
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - J I Vico-Linares
- Centro Astronómico Hispano-Alemán (Consejo Superior de Investigaciones Científicas-Max-Planck-Gesellschaft), Observatorio Astronómico de Calar Alto, Sierra de los Filabres, E-04550 Gérgal, Almería, Spain
| | - F Vilardell
- Institut de Ciències de l'Espai (Consejo Superior de Investigaciones Científicas), Campus Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.,Institut d'Estudis Espacials de Catalunya, E-08034 Barcelona, Spain
| | - K Wagner
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - J Winkler
- Thüringer Landessternwarte Tautenburg, D-07778 Tautenburg, Germany
| | - V Wolthoff
- Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, D-69117 Heidelberg, Germany
| | - F Yan
- Institut für Astrophysik, Georg-August-Universität, D-37077 Göttingen, Germany
| | - M R Zapatero Osorio
- Centro de Astrobiología (Consejo Superior de Investigaciones Científicas-Instituto Nacional de Técnica Aeroespacial), E-28850 Torrejón de Ardoz, Madrid, Spain
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19
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Singh I, Hooton K, Edwards C, Lewis B, Anwar A, Johansen A. 75INPATIENT HIP FRACTURES: DEMOGRAPHIC PROFILE, CLINICAL OUTCOMES AND RISK FACTORS. Age Ageing 2019. [DOI: 10.1093/ageing/afz059.06] [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)
- I Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Heath Board, Wales
| | - K Hooton
- Quality and Patient Safety, Aneurin Bevan University Health Board, Wales
| | - C Edwards
- Royal Gwent Hospital, Newport, Aneurin Bevan University Health Board, Wales
| | - B Lewis
- Quality and Patient Safety, Aneurin Bevan University Health Board, Wales
| | - A Anwar
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Heath Board, Wales
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20
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Hoskins HC, Protty MB, Hickey B, Lewns GJ, Pettit R, Saad T, Johansen A. 72THE IMPACT OF ADOPTING LOW MOLECULAR WEIGHT HEPARIN IN PLACE OF ASPIRIN AS ROUTINE THROMBOPROPHYLAXIS FOR PATIENTS WITH HIP FRACTURE. Age Ageing 2019. [DOI: 10.1093/ageing/afz059.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - M B Protty
- Systems Immunity University Research Institute, Cardiff University
| | - B Hickey
- University Hospital of Wales, Cardiff
| | - G J Lewns
- University Hospital of Wales, Cardiff
| | - R Pettit
- University Hospital of Wales, Cardiff
| | - T Saad
- University Hospital of Wales, Cardiff
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21
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Randby Å, Nadeau E, Karlsson L, Johansen A. Effect of maturity stage at harvest and kernel processing of whole crop wheat silage on digestibility by dairy cows. Anim Feed Sci Technol 2019. [DOI: 10.1016/j.anifeedsci.2019.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Johansen A, Christensen SJ, Scheie D, Højgaard JLS, Kondziella D. Neuromuscular adverse events associated with anti-PD-1 monoclonal antibodies: Systematic review. Neurology 2019; 92:663-674. [PMID: 30850443 DOI: 10.1212/wnl.0000000000007235] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/10/2019] [Indexed: 11/15/2022] Open
Abstract
Neuromuscular adverse events following cancer treatment with anti-programmed cell death protein 1 (PD-1) monoclonal antibodies are relatively rare, yet potentially fatal. We performed a systematic review to characterize the clinical presentation, diagnostic workup, and management of neuromuscular disorders (NMDs) in patients treated with nivolumab or pembrolizumab monotherapy or concurrent with other immunologic agents, such as ipilimumab. Sixty-one publications on 85 patients (mean age 66.9 years [range 34-86]; male/female 2.6:1; 59% metastatic melanoma) were identified from selected indexing databases until June 2018. Forty-eight patients had received nivolumab and 39 pembrolizumab. The mean number of PD-1 inhibitor treatment cycles prior to onset of symptoms was 3.6 (range 1-28). Symptoms included oculomotor (47%), respiratory (43%), bulbar (35%), and proximal weakness (35%), as well as muscle pain (28%). Diagnoses were categorized as myasthenia gravis (27%), neuropathy (23%), myopathy (34%), or a combination of these (16%). After a critical review of the data, however, evidence did not support the stated NMD diagnosis in 13% of cases, while up to 25% of patients had signs of additional NMDs. Cardiac complications occurred in more than 30% of patients diagnosed with myasthenia gravis or myositis. Mortality was high in these patients, despite adequate treatment strategies including corticosteroid, IV immunoglobulins, and plasma exchange. The clinical presentation of NMDs associated with PD-1 inhibitors is often atypical, with considerable overlap between myasthenia gravis and myopathy, and cardiac/respiratory complications are common.
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Affiliation(s)
- Annette Johansen
- From the Departments of Neurology (A.J., S.J.C., J.L.S.H., D.K.) and Pathology (D.S.), Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Søren Just Christensen
- From the Departments of Neurology (A.J., S.J.C., J.L.S.H., D.K.) and Pathology (D.S.), Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - David Scheie
- From the Departments of Neurology (A.J., S.J.C., J.L.S.H., D.K.) and Pathology (D.S.), Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Joan L S Højgaard
- From the Departments of Neurology (A.J., S.J.C., J.L.S.H., D.K.) and Pathology (D.S.), Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Daniel Kondziella
- From the Departments of Neurology (A.J., S.J.C., J.L.S.H., D.K.) and Pathology (D.S.), Rigshospitalet, Copenhagen University Hospital, Denmark
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23
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Johansen A, Liddicoat M, Boulton C, White P, Ten Hove R. 38“HIP SPRINT” USING THE 2017 NATIONAL AUDIT OF PHYSIOTHERAPY TO DEVELOP QUALITY STANDARDS FOR PHYSIOTHERAPY AFTER HIP FRACTURE. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Johansen
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London
| | - M Liddicoat
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London
| | - C Boulton
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London
| | - P White
- Chartered Society of Physiotherapy
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24
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Johansen A, Liddicoat M, Hannaford J, Wakeman R, Boulton C, Dickinson R. 66INTRODUCING A NATIONAL PROGRAMME OF SCREENING WITH THE 4A TEST TO IDENTIFY DELIRIUM - THE COMMONEST COMPLICATION OF HIP FRACTURE SURGERY. Age Ageing 2019. [DOI: 10.1093/ageing/afy214.03] [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)
- A Johansen
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - M Liddicoat
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - J Hannaford
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - R Wakeman
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - C Boulton
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
| | - R Dickinson
- National Hip Fracture Database (NHFD), Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London
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25
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Birkebaek NH, Kahlert J, Bjarnason R, Drivvoll AK, Johansen A, Konradsdottir E, Pundziute-Lyckå A, Samuelsson U, Skrivarhaug T, Svensson J. Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA 1c and other predictors of increasing BMISDS. Pediatr Diabetes 2018; 19:1198-1205. [PMID: 29781227 DOI: 10.1111/pedi.12693] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/30/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intensified insulin therapy may increase body weight and cause obesity. This study compared body mass index standard deviation score (BMISDS) and obesity rate in children with type 1 diabetes (T1D) in Denmark, Iceland, Norway and Sweden, and uncovered predictors for increasing BMISDS. METHODS Data registered in the Nordic national childhood diabetes databases during the period 2008-2012 on children below 15 years with T1D for more than 3 months were compiled, including information on gender, age, diabetes duration, hemoglobin A1c (HbA1c ), insulin dose, severe hypoglycemia (SH), treatment modality, height and weight. The Swedish reference chart for BMI was used for calculating BMISDS. RESULTS Totally, 11 025 children (48% females) (30 994 registrations) were included. Medians by the last recorded examination were: age, 13.5 years; diabetes duration, 4.3 years; HbA1c , 7.9% (63 mmol/mol); insulin dose, 0.8 IU/kg/d and BMISDS, 0.70. Obesity rate was 18.5%. Adjusted mean BMISDS (BMISDS adj) was inversely related to HbA1c and directly to diabetes duration. Higher BMISDS adj was found in those with an insulin dose above 0.6 IU/kg/d, and in girls above 10 years. Pump users had higher BMISDS adj than pen users, and patients with registered SH had higher BMISDS adj than patients without SH (both P < .001). CONCLUSION Obesity rate in children with T1D in the Nordic countries is high, however, with country differences. Low HbA1c , long diabetes duration, higher insulin dose, pump treatment and experiencing a SH predicted higher BMISDS. Diabetes caregivers should balance the risk of obesity and the benefit of a very low HbA1c.
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Affiliation(s)
- N H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - R Bjarnason
- Landspitali University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A K Drivvoll
- Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - A Johansen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - E Konradsdottir
- Landspitali University Hospital, and School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - U Samuelsson
- Department of Pediatrics, Linköbing University Hospital, Linköping, Sweden
| | - T Skrivarhaug
- Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - J Svensson
- Department of Paediatrics, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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26
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Chen I, Wind K, Dehlendorff C, Sørensen B, Vittrup B, Johansen A, Pfeiffer P, Bjerregaard J, Bojesen S, Nielsen S, Holländer N, Yilmaz M, Rasmussen L, Pallisgaard N, Johansen J, Spindler KL. Clinical utility of plasma cell-free DNA in patients with pancreatic cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.098] [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: 11/14/2022] Open
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27
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Chen I, Willumsen N, Dehlendorff C, Johansen A, Vittrup B, Krüger M, Pfeiffer P, Bjerregaard J, Bojesen S, Nielsen S, Holländer N, Yilmaz M, Rasmussen L, Karsdal M, Johansen J. Clinical utility of serum type III collagen in patients with pancreatic carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Hansen HD, Svarer C, Lehel S, Leth-Petersen S, Kristensen JL, Gillings N, Knudsen GM. The importance of small polar radiometabolites in molecular neuroimaging: A PET study with [ 11C]Cimbi-36 labeled in two positions. J Cereb Blood Flow Metab 2018; 38:659-668. [PMID: 29215308 PMCID: PMC5888860 DOI: 10.1177/0271678x17746179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022]
Abstract
[11C]Cimbi-36, a 5-HT2A receptor agonist PET radioligand, contains three methoxy groups amenable to [11C]-labeling. In pigs, [11C]Cimbi-36 yields a polar (M1) and a less polar (M2) radiometabolite fraction, while changing the labeling to [11C]Cimbi-36_5 yields only the M1 fraction. We investigate whether changing the labeling position of [11C]Cimbi-36 eliminates M2 in humans, and if this changes the signal-to-background ratio. Six healthy volunteers each underwent two dynamic PET scans; after injection of [11C]Cimbi-36, both the M1 and M2 fraction appeared in plasma, whereas only the M1 appeared after [11C]Cimbi-36_5 injection. [11C]Cimbi-36_5 generated higher uptake than [11C]Cimbi-36 in both neocortex and cerebellum. With the simplified reference tissue model mean neocortical non-displaceable binding potential for [11C]Cimbi-36 was 1.38 ± 0.07, whereas for [11C]Cimbi-36_5, it was 1.18 ± 0.14. This significant difference can be explained by higher non-displaceable binding caused by demethylation products in the M1 fraction such as [11C]formaldehyde and/or [11C]carbon dioxide/bicarbonate. Although often considered without any impact on binding measures, we show that small polar radiometabolites can substantially decrease the signal-to-background ratio of PET radioligands for neuroimaging. Further, we find that [11C]Cimbi-36 has a better signal-to-background ratio than [11C]Cimbi-36_5, and thus will be more sensitive to changes in 5-HT2A receptor levels in the brain.
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Affiliation(s)
- Annette Johansen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanne D Hansen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark
| | - Claus Svarer
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark
| | - Szabolcs Lehel
- PET & Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Leth-Petersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper L Kristensen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nic Gillings
- PET & Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Johansen A, Chiletti R, Best D. The impact of extracorporeal life support (ECLS) on hypoplastic left heart syndrome (HLHS) patients long term survival: A 10-year experience. Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Holstein BE, Andersen A, Denbaek AM, Johansen A, Michelsen SI, Due P. Short communication: Persistent socio-economic inequality in frequent headache among Danish adolescents from 1991 to 2014. Eur J Pain 2018; 22:935-940. [PMID: 29349882 DOI: 10.1002/ejp.1179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between socio-economic status (SES) and headache among adolescents is an understudied issue, and no study has examined whether such an association changes over time. The aim was to examine trends in socio-economic inequality in frequent headache among 11- to 15-year-olds in Denmark from 1991 to 2014, using occupational social class (OSC) as indicator of SES. METHODS The study applies data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study. HBSC includes nationally representative samples of 11-, 13- and 15-year-olds. This study combines data from seven data survey years from 1991 to 2014, participation rate 88.6%, n = 31,102. We report absolute inequality as per cent difference in frequent headache between high and low OSC and relative inequality as odds ratio for frequent headache by OSC. RESULTS In the entire study population, 10.4% reported frequent headache. There was a significant increase in frequent headache from 8.0% in 1991 to 12.9% in 2014, test for trend, p < 0.0001. This increasing trend was significant in all OSCs. The prevalence of frequent headache was significantly higher in low than high OSC, OR = 1.50 (95% CI: 1.34-1.67). This socio-economic inequality in frequent headache was persistent from 1991 to 2014. CONCLUSION There was a significant and persistent socio-economic inequality, i.e. increasing prevalence of frequent headache with decreasing OSC. The association between socio-economic position and headache did not significantly change over time, i.e. the statistical interaction between OSC and survey year was insignificant. SIGNIFICANCE The prevalence of frequent headache among adolescents increases with decreasing SES. This socio-economic inequality has been persistent among adolescents in Denmark from 1991 to 2014. Clinicians should be aware of this social inequality.
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Affiliation(s)
- B E Holstein
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - A Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - A M Denbaek
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - A Johansen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - S I Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - P Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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ten Hove R, Johansen A, Liddicoat M, Boulton C. The national physiotherapy hip fracture sprint audit (PHFSA). Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tsang C, Boulton C, Burgon V, Johansen A, Wakeman R, Cromwell DA. Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model. Bone Joint Res 2017; 6:550-556. [PMID: 28947603 PMCID: PMC5630992 DOI: 10.1302/2046-3758.69.bjr-2017-0020.r1] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/28/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. METHODS Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models' coefficients. This was followed by testing the performance of these refined models in a second validation dataset. RESULTS The 30-day mortality rate was 5.36% in the validation dataset (n = 3861), slightly lower than the 6.40% in the development dataset (n = 4044). The NHFD and Nottingham models showed a slightly lower discrimination in the validation dataset compared with the development dataset, but both still displayed moderate discriminative power (c-statistic for NHFD = 0.71, 95% confidence interval (CI) 0.67 to 0.74; Nottingham model = 0.70, 95% CI 0.68 to 0.75). Both models defined similar ranges of predicted mortality risk (1% to 18%) in assessment of calibration. CONCLUSIONS Both models have limitations in predicting mortality for individual patients after hip fracture surgery, but the NHFD risk adjustment model performed as well as the widely-used Nottingham prognostic tool and is therefore a reasonable alternative for risk adjustment in the United Kingdom hip fracture population.Cite this article: Bone Joint Res 2017;6:550-556.
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Affiliation(s)
- C Tsang
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK and Honorary Lecturer, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - C Boulton
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 11 St Andrews Place, London NW1 4LE, UK
| | - V Burgon
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 11 St Andrews Place, London NW1 4LE, UK
| | - A Johansen
- Trauma Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - R Wakeman
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 11 St Andrews Place, London NW1 4LE, UK
| | - D A Cromwell
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK and Director of Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
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Johansen A, Boulton C, Burgon V, Rai S, Wakeman R. 21COGNITIVE IMPAIRMENT - PROFILING ITS IMPLICATIONS FOR PATIENTS WITH HIP FRACTURE. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Johansen A, Tsang C, Boulton C, Wakeman R, Moppett I. Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database. Anaesthesia 2017; 72:961-966. [DOI: 10.1111/anae.13908] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/05/2023]
Affiliation(s)
- A. Johansen
- University Hospital of Wales; Cardiff UK
- National Hip Fracture Database; Royal College of Physicians; London UK
| | - C. Tsang
- Clinical Effectiveness Unit; Royal College of Surgeons of England; London UK
| | - C. Boulton
- Falls and Fragility Fracture Audit Programme; Royal College of Physicians; London UK
| | - R. Wakeman
- National Hip Fracture Database; Royal College of Physicians; London UK
| | - I. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; Queen's Medical Centre; University of Nottingham; UK
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Boulton C, Burgon V, Johansen A, Martin F, Rai S, Stanley R, Wakeman R. 121DELIVERING “BEST PRACTICE” FOR PATIENTS WITH HIP FRACTURE - DOES ORTHOGERIATRICIAN ENGAGEMENT WITH NATIONAL CLINICAL AUDIT DATA IMPROVE PERFORMANCE? Age Ageing 2017. [DOI: 10.1093/ageing/afx072.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wilson H, Boulton C, Burgon V, Johansen A, Neuburger J, Rai S, Wakeman R. 42USING THE NATIONAL HIP FRACTURE DATABASE TO DEVELOP A CLASSIFICATION OF MODELS OF ORTHOGERIATRIC CARE. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Boulton C, Burgon V, Rai S, Wakeman R. 117HIP FRACTURE: DOES WEEK-DAY OF PRESENTATION AFFECT LENGTH OF STAY? Age Ageing 2017. [DOI: 10.1093/ageing/afx072.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. 127THE IMPACT OF SOCIAL DEPRIVATION ON MORTALITY FOLLOWING HIP FRACTURE IN ENGLAND AND WALES: A RECORD LINKAGE STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.127] [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: 11/14/2022] Open
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Johansen A, Boulton C, Burgon V, Neuburger J, Rai S, Wakeman R. 126HIP FRACTURES IN HOSPITAL AND CARE HOMES - USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO IDENTIFY A POSSIBLE CARE GAP. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boulton C, Burgon V, Johansen A, Martin F, Rai S, Stanley R, Wakeman R. 122AVOIDING DELAY IN SURGERY FOR HIP FRACTURE: USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO MONITOR AND IMPROVE COMPLIANCE WITH NATIONAL GUIDELINES. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lewis S, Edwards L, Glasbey J, Johansen A. 9MEASURING HEALTH-RELATED QUALITY OF LIFE IN HIP FRACTURE - A PILOT STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Birkebaek NH, Drivvoll AK, Aakeson K, Bjarnason R, Johansen A, Samuelsson U, Skrivarhaug T, Thorsson AV, Svensson J. Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008-2012: association with hemoglobin A 1c and treatment modality. BMJ Open Diabetes Res Care 2017; 5:e000377. [PMID: 28761652 PMCID: PMC5530237 DOI: 10.1136/bmjdrc-2016-000377] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Treatment of type 1 diabetes has been intensified aiming at normalizing blood glucose, which may increase the risk of severe hypoglycemia (SH). We aimed to compare the incidence of SH events in the four Nordic countries Denmark, Iceland, Norway and Sweden, and to assess the influence of hemoglobin A1c (HbA1c) and treatment modalities on the frequency of SH; particularly, to explore if a HbA1c target ≤6.7% (50 mmol/mol) is feasible. RESEARCH DESIGN AND METHODS Data on children below 15 years with a diabetes duration more than 1 year, registered in the national childhood diabetes databases in the four Nordic countries from 2008 to 2012, were compiled. Data completeness was more than 95%. RESULTS Totally 8806 (48% females) patients with 29 715 person years were included, mean age and diabetes duration were 11 years and 5.1 years, respectively. The overall rate of SH was 6.0 per 100 patient-years, and did not change during the study period. The Swedish population constantly had the lowest SH incidence while it decreased significantly in the Danish population. HbA1c decreased significantly over time (p<0.01), while the number of pump users increased (p<0.01). Stratifying for HbA1c levels showed the lowest risk of SH in patients with HbA1c ≤6.7% (≤50 mmol/mol), but in the statistical models adjusting for possible confounders the difference between the HbA1c groups disappeared. Pump users had the lowest SH risk, also after adjusting for possible confounders. CONCLUSIONS Risk of SH differs between the Nordic countries with the lowest risk in Sweden. Pump therapy was associated with decreased risk of SH. The low HbA1c group had the same or a lower risk of SH compared with the highest HbA1c groups. A target HbA1c ≤6.7% (≤50 mmol/mol) seems achievable without increasing the risk of SH.
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Affiliation(s)
- NH Birkebaek
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - AK Drivvoll
- Norwegian Childhood Diabetes Registry, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - K Aakeson
- Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden
| | - R Bjarnason
- Medical Center, Landspitali University Hospital, Reykjavik, Iceland
- Department of Pediatrics, University of Iceland, Reykjavik, Iceland
| | - A Johansen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - U Samuelsson
- Department of Pediatrics, Linköping University Hospital, Linköping, Sweden
| | - T Skrivarhaug
- Norwegian Childhood Diabetes Registry, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - AV Thorsson
- Medical Center, Landspitali University Hospital, Reykjavik, Iceland
- Department of Pediatrics, University of Iceland, Reykjavik, Iceland
| | - J Svensson
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital, Herlev, Denmark
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Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study. Osteoporos Int 2016; 27:2727-2737. [PMID: 27098537 PMCID: PMC4981619 DOI: 10.1007/s00198-016-3608-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/01/2016] [Indexed: 12/02/2022]
Abstract
UNLABELLED We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients. INTRODUCTION To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors. METHODS We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group. RESULTS Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size. CONCLUSIONS We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission.
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Affiliation(s)
- K Thorne
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Johansen
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
- Trauma Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A Akbari
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - J G Williams
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - S E Roberts
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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Johansen A, Wakeman R, Boulton C. 48EARLY RETURN TO OWN HOME AFTER HIP FRACTURE IS NOT UNSAFE – EVIDENCE FROM THE NATIONAL HIP FRACTURE DATABASE. Age Ageing 2016. [DOI: 10.1093/ageing/afw030.01] [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: 11/12/2022] Open
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White SM, Moppett IK, Griffiths R, Johansen A, Wakeman R, Boulton C, Plant F, Williams A, Pappenheim K, Majeed A, Currie CT, Grocott MPW. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia 2016; 71:506-14. [DOI: 10.1111/anae.13415] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- S. M. White
- Brighton and Sussex University Hospitals NHS Trust; Brighton East Sussex UK
| | - I. K. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; University of Nottingham; Queen's Medical Centre Campus; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - R. Griffiths
- Peterborough and Stamford Hospitals NHS Trust; Peterborough UK
| | - A. Johansen
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - R. Wakeman
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - C. Boulton
- National Hip Fracture Database, Falls and Fragility Fracture Audit Programme; Clinical Effectiveness and Evaluation Unit; Royal College of Physicians; London UK
| | - F. Plant
- The Royal National Orthopaedic Hospital; Stanmore Middlesex UK
| | - A. Williams
- Gloucestershire Royal Hospital; Gloucester Gloucestershire UK
| | - K. Pappenheim
- Association of Anaesthetists of Great Britain and Ireland; London UK
| | - A. Majeed
- King Fahad Medical City; Riyadh Saudi Arabia
| | | | - M. P. W. Grocott
- Anaesthesia and Critical Care Medicine; University of Southampton and Southampton NIHR Respiratory Biomedical Research Unit; Southampton UK
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Johansen A, Schirmer H, Nielsen CS, Stubhaug A. Persistent post-surgical pain and signs of nerve injury: the Tromsø Study. Acta Anaesthesiol Scand 2016; 60:380-92. [PMID: 26537886 DOI: 10.1111/aas.12653] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 06/20/2015] [Accepted: 08/19/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The contribution of nerve lesions and neuropathic pain to persistent post-surgical pain (PPSP) is poorly established. The aim of this study was to assess the association between PPSP and symptoms and signs of possible nerve injury in an unselected surgical sample. METHODS Eighty-one individuals with and without persistent pain after surgical procedures, were recruited from a cross-sectional study. Follow-up examination with questionnaires and quantitative sensory testing was performed 15-32 months later (21-64 months after surgery). RESULTS The median rating of maximum pain intensity among individuals with PPSP decreased from numerical rating scale 4/10 at baseline to 2/10 at follow-up, but considerable changes occurred in both directions. Individuals with PPSP at follow-up were significantly more likely to self-report sensory abnormalities than those without PPSP; however, results from sensory testing did not differ significantly between the groups. Self-report of sensory disturbances at the site of surgery was associated with increased warm detection thresholds and tactile pain thresholds. Among individuals with PPSP, 61% had positive findings on sensory testing, suggesting probable neuropathic pain. CONCLUSION In this study, associations between self-reported symptoms and PPSP were stronger than associations between self-reported symptoms and results of psychophysical tests. Fluctuations in pain intensity together with wide ranges for normal variability in sensory functions, hampers detection of significant group differences. Methodological aspects of quantitative sensory testing applied in a mixed clinical sample are discussed.
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Affiliation(s)
- A. Johansen
- Division of Surgical Medicine and Intensive Care; University Hospital of North Norway; Tromsø Norway
- Department of Community Medicine; The Arctic University of Norway; Tromsø Norway
| | - H. Schirmer
- Division of Cardiothoracic and Respiratory Medicine; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Medicine; The Arctic University of Norway; Tromsø Norway
| | - C. S. Nielsen
- Division of Mental Health; Norwegian Institute of Public Health; Oslo Norway
- Department of Pain Management and Research; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
| | - A. Stubhaug
- Department of Pain Management and Research; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
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Rivers K, Johansen A, Smith F, Hewitt J. Development of an Evidence-Based Checklist to Evaluate Dehydration in Older Patients Admitted to a Bahamian Hospital. ACTA ACUST UNITED AC 2016. [DOI: 10.15761/gimci.1000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dolatowski R, Endsley P, Hiltz C, Johansen A, Maughan E, Minchella L, Trefry S. School Nurse Workload--Staffing for Safe Care: Position Statement. NASN Sch Nurse 2015; 30:290-3. [PMID: 26296829 DOI: 10.1177/1942602x15594143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is the position of the National Association of School Nurses (NASN) that daily access to a registered professional school nurse (hereinafter referred to as a school nurse) can significantly improve students' health, safety, and abilities to learn. To meet the health and safety needs of students, families, and school communities, school nurse workloads should be determined at least annually, using student- and community-specific health data.
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Boulton C, Burgon V, Johansen A, Martin F, Stanley R, Wakeman R, Williams A. 31FALLS AMONG HOSPITAL INPATIENTS USING HIP FRACTURE INCIDENCE TO MONITOR PATIENT SAFETY. Age Ageing 2015. [DOI: 10.1093/ageing/afv106.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Saltvedt I, Sletvold O, Marsh D, Johansen A, Pioli G. S-04: Quality improvement in hip fracture care. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30561-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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