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Warland J, Pollock D, Collier A, Horey D, Boyle F. Parents' descriptions of labouring with an antepartum fetal death: Findings from the Birthing in Grief study. Aust N Z J Obstet Gynaecol 2024; 64:133-140. [PMID: 37833833 DOI: 10.1111/ajo.13759] [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: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Evidence to guide intrapartum care when an unborn baby has died is limited. AIMS To explore parents' experiences of care during labour of an antepartum stillbirth. MATERIALS AND METHODS Semi-structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. FINDINGS Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub-themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub-themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. CONCLUSIONS This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available.
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Affiliation(s)
- Jane Warland
- UniSA Clinical and Health Sciences, UniSA, Adelaide, South Australia, Australia
| | - Danielle Pollock
- Evidence-Based Healthcare Research Division, JBI, Adelaide, South Australia, Australia
| | | | - Dell Horey
- Faculty of Science Agriculture Business and Law, University of New England, Armidale, New South Wales, Australia
| | - Frances Boyle
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
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Kolossváry M, deFilippi C, Lu M, Zanni M, Fulda E, Foldyna B, Ribaudo H, Mayrhofer T, Collier A, Bloomfield G, Fichtenbaum C, Overton E, Aberg J, Currier J, Fitch K, Douglas P, Grinspoon S. 463 Proteomic Signature Of Early Coronary Artery Disease In People With Hiv: Analysis Of The Reprieve Mechanistic Substudy. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Collier A, Liu A, Torkelson J, Pattison J, Gaddam S, Patel T, McCarthy K, Zhen H, Oro A. 598 Gibbin toggles CTCF binding and DNA methylation to drive epithelial development. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Balmer DG, Frey R, Gott M, Collier A, Boyd M. A Place to Live and to Die: A Qualitative Exploration of the Social Practices and Rituals of Death in Residential Aged Care. Omega (Westport) 2020; 85:38-58. [PMID: 32576125 DOI: 10.1177/0030222820935217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many countries, an increasing proportion of deaths occur in residential aged care (RAC) (nursing homes) meaning that these have become both a place to live - a home- and a place to die. This paper reports on death practices and rituals in 49 RAC facilities in Aotearoa/New Zealand narrated in semi-structured interviews with staff. Themes coalesced around 'good death'. Dying alone was not seen as a good death and the demands of trying to prevent this caused tension for staff. Meeting family wishes, post death decision-making, after death practices and rituals, including communicating and remembrance of the death, were explored as part of good death. Overall, death rituals in RAC were limited. Balancing the needs of the living, the dying and the dead created tension. The rituals and practices facilities are currently enacting in death/post-death require attention, since more people will die in RAC with increasingly diverse needs.
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Affiliation(s)
- D G Balmer
- School of Nursing, University of Auckland, New Zealand
| | - R Frey
- School of Nursing, University of Auckland, New Zealand
| | - M Gott
- School of Nursing, University of Auckland, New Zealand
| | - A Collier
- School of Nursing, University of Auckland, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, New Zealand
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Watson C, Kamalyan L, Hussain M, Tang B, Collier A, Clifford D, Gelman B, Sacktor N, Morgello S, McCutchan JA, Ellis R, Grant I, Heaton R, Marquine M. A-03 Ethnic/Racial Differences in Longitudinal Neurocognitive Change among People Living with HIV. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
HIV disproportionately affects Black and Latino people in the United States, but data on longitudinal neurocognitive patterns for these groups are scarce. This study evaluated the incidence and predictors of neurocognitive decline by ethnicity/race in a cohort of Black, Latino, and White people living with HIV (PLWH). Participants included 499 PLWH (43.5% White, 42.7% Black, 13.8% Latino; mean age at baseline = 43.5) from the six-site CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study. Participants completed comprehensive neurocognitive and neuromedical evaluations over 3-7 study visits for an average of 2.8 years (SD = 1.1). Interpertation of neurocognitive change was based on published methods using regression-based norms that correct for baseline performance and practice effects. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and predictors of neurocognitive decline. In follow-up, 108 participants (21.6%) declined, 311 (62.3%) remained stable, and 80 (16.0%) improved. In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latinos compared to Whites (HR = 2.19, 95%CI = 1.32-3.63, p = .002) and Blacks (HR = 1.87, 95%CI = 1.14-3.04, p = .01). Including significant covariates (baseline nadir CD4, hepatitis C Virus, and VACS Index: a composite marker of physical health among PLWH)did not significantly decrease the elevated risk for decline among Latinos. We found that Latino PLWH appear to have higher risk of neurocognitive decline compared to White and Black PLWH. Traditional markers of HIV disease and physical health at baseline did not explain this elevated risk of neurocognitive decline. Future research examining economic, socio-environmental, and culturally-relevant biomedical factors may help to explain this observed ethnic/racial disparity in longitudinal neurocognitive function in HIV.
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Paing AC, McMillan KA, Kirk AF, Collier A, Hewitt A, Chastin SFM. Dose-response between frequency of interruption of sedentary time and fasting glucose, the dawn phenomenon and night-time glucose in Type 2 diabetes. Diabet Med 2019; 36:376-382. [PMID: 30264906 DOI: 10.1111/dme.13829] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 01/05/2023]
Abstract
AIM To explore the dose-response between frequency of interruption of sedentary time and basal glucose (fasting glucose, the dawn phenomenon and night-time glucose) in Type 2 diabetes. METHODS In a randomized three-treatment, two-period balanced incomplete block trial, 12 people with Type 2 diabetes (age, 60.0 ± 3.2 years; BMI, 30.2 ± 1.4 kg/m2 ) completed two of three conditions: sitting for 7 h interrupted every 60 min (Condition 1), 30 min (Condition 2), and 15 min (Condition 3) by 3-min light-intensity walking breaks. The activPAL3 and FreeStyle Libre were used to assess physical activity/sedentary behaviour and continuous glucose profile. Standardized meals were provided, and changes in basal glucose of the nights and early mornings before and after treatment conditions were calculated (mean ± SE). RESULTS After treatment conditions, fasting glucose and duration of the dawn phenomenon were lower for Condition 3 (-1.0 ± 0.2 mmol/l, P < 0.02; -3.1 ± 1.3 h, P = 0.004) compared with Condition 1 (-0.1 ± 0.2 mmol/l; 1.9 ± 1.2 h). The magnitude of the dawn phenomenon was reduced in Condition 3 (-0.6 ± 0.4 mmol/l, P = 0.041) compared with Condition 2 (0.6 ± 0.3 mmol/l). Night-time glycaemic variability (coefficient of variation) was reduced in Condition 3 (-9.7 ± 3.9%) relative to Condition 2 (6.1 ± 4.8%, P < 0.03) and Condition 1 (2.5 ± 1.8%, P = 0.02). There was no change in night-time mean glucose. CONCLUSIONS Frequent interruptions of prolonged sitting with 3 min of light-intensity walking breaks every 15 min improves fasting glucose, the dawn phenomenon and night-time glycaemic variability, and this might be a simple therapeutic intervention to improve glucose control. Clinicaltrials.gov Identifier: NCT02738996.
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Affiliation(s)
- A C Paing
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - K A McMillan
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - A F Kirk
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - A Collier
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - A Hewitt
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - S F M Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Science, Ghent University, Ghent, Belgium
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Abstract
AIMS Research regarding the determinants of concordance with gestational diabetes mellitus (GDM) treatment is limited. Here, we test whether the psychosocial changes outlined in the teachable moments model, as proposed by McBride et al. (McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003; 18: 156-170) are associated with following GDM treatment recommendations. METHODS Fifty-nine women completed a baseline questionnaire (1 week after GDM diagnosis) in which they reported risk perception, social support, emotional response, the importance of their maternal identity and self-efficacy. One month later, participants reported their concordance with instructions regarding glucose monitoring, diet and, if applicable, medication. We used regression analysis to test for associations between the psychosocial factors measured at baseline and concordance at 1-month follow-up. RESULTS Those who perceived their risk as higher or felt supported by family or friends were more likely to report a high level of concordance with GDM treatment. Emotional response, identity salience and self-efficacy were not related to concordance. CONCLUSIONS Future interventions designed to increase concordance could benefit from a focus on risk perception and social support, as these factors appear to be most strongly associated with following GDM treatment recommendations.
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Affiliation(s)
- J Okely
- Psychology Division, University of Stirling, Stirling
| | - C Mason
- Psychology Division, University of Stirling, Stirling
| | | | | | - V Swanson
- Psychology Division, University of Stirling, Stirling
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Smyth J, Mullen CC, Jack L, Collier A, Bal AM. Diabetes, malignancy and age as predictors of Candida glabrata bloodstream infection: A re-evaluation of the risk factors. J Mycol Med 2018; 28:547-550. [PMID: 29803698 DOI: 10.1016/j.mycmed.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Echinocandins and azoles are widely used in the treatment of candidaemia. Guidelines of the Infectious Diseases Society of America recommend commencing treatment with an echinocandin in candidaemic patients with risk factors for Candida glabrata i.e. patients who are elderly, or who have diabetes or malignancy, or those with recent prescription of azoles. We attempted to validate whether age, diabetes and malignancy are associated with C. glabrata candidaemia. PATIENTS, MATERIALS AND METHODS Information in relation to demographics, patient associated risk factors, and laboratory parameters were collected from the casenotes and the laboratory information system. We then analysed the distribution of the risk factors (age, diabetes, and malignancy) in candidaemic patients with C. glabrata and patients with species other than C. glabrata (excluding Candida krusei). RESULTS Over a 42-month period (April 2011-September 2017), 124 patients had candidaemia. We analysed data for 119 patients of whom 33 (27.7%) had C. glabrata and the remaining 86 (72.2%) were infected with other species. Sixty-five patients were elderly (age≥65), 40 had some form of malignancy, 34 had diabetes, and 4 patients were prescribed azoles in the 30 days prior to candidaemia (many patients had multiple risk factors). Comparing patients with C. glabrata to patients infected with other species, we found no association with diabetes (39.3% vs. 24.4%, P=0.1), malignancy (36.3 vs. 32.5%, P=0.69), and age (54.5% vs. 54.6%, P=0.99). CONCLUSIONS Diabetes, malignancy and age are not reliable predictors of candidaemia due to C. glabrata.
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Affiliation(s)
- J Smyth
- Department of Medicine, University Hospital Ayr, NHS Ayrshire and Arran, Lister street, KA2 0BE Kilmarnock, United Kingdom
| | - C C Mullen
- Department of Medicine, University Hospital Ayr, NHS Ayrshire and Arran, Lister street, KA2 0BE Kilmarnock, United Kingdom
| | - L Jack
- Department of Anaesthesia, University Hospital Crosshouse, NHS Ayrshire and Arran, Lister street, KA2 0BE Kilmarnock, United Kingdom
| | - A Collier
- Department of Medicine, University Hospital Ayr, NHS Ayrshire and Arran, Lister street, KA2 0BE Kilmarnock, United Kingdom
| | - A M Bal
- Department of Microbiology, University Hospital Crosshouse, NHS Ayrshire and Arran, Lister street, KA2 0BE Kilmarnock, United Kingdom.
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Abdel-Razek O, Collier A, Predham S, Curtis F, Bullen A, Benteau T, Stuckless S, Young T, Connors S, Hodgkinson K. SEX-INFLUENCED MORTALITY IN THREE WELL-ASCERTAINED FAMILIES WITH CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA CAUSED BY A RYR2 P.R420W MUTATION: THE POWER OF EXTENDED FAMILY HISTORY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Telfer S, Woodburn J, Collier A, Cavanagh P. Virtually optimized insoles for offloading the diabetic foot: A randomized crossover study. J Biomech 2017; 60:157-161. [DOI: 10.1016/j.jbiomech.2017.06.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 11/17/2022]
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Collier A, Wek R, Spandau D. 576 Translational control through eIF2α is required for cell cycle arrest following UVB irradiation. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Spandau D, Collier A, Wek R. 355 Preferential protein translation is required for keratinocyte differentiation. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Collier A, Ghosh S, Hair M, Waugh N. Gender differences and patterns of cardiovascular risk factors in Type 1 and Type 2 diabetes: a population-based analysis from a Scottish region. Diabet Med 2015; 32:42-6. [PMID: 25156218 DOI: 10.1111/dme.12569] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 12/21/2022]
Abstract
AIM To explore the gender differences, along with the relationships between BMI, glycaemic control, cardiovascular risk factors and the prevalence of diabetes complications, in a representative population-based group of people with Type 1 and Type 2 diabetes. METHODS Data were obtained from general practices in Ayrshire and Arran, Scotland for 15 351 patients. RESULTS In the cohort with Type 1 diabetes, after adjustment for age, men had a significantly lower BMI (P = 0.007) and significantly lower total cholesterol (P = 0.005), HDL-cholesterol (P = 2.5*10(-17)) and HbA1c levels (P = 0.003) than women. By contrast, men had higher blood pressure, both systolic (P = 0.034) and diastolic (P = 0.0003), and higher non-fasting triglyceride levels (P = 0.001). Men with Type 1 diabetes had a higher prevalence of neuropathy (P = 0.021). Among people with Type 2 diabetes, men had a significantly lower BMI (P = 4.26*10(-37)), and significantly lower total cholesterol (P = 2.96*10(-62)) and HDL-cholesterol levels (P = 8.25*10(-141)) but higher non-fasting triglyceride levels (P = 0.0002). In Type 2 diabetes, men had a higher prevalence of ischaemic heart disease (P = 1.66*10(-25)), stroke (P = 0.002) and peripheral vascular disease (P = 1.68*10(-12)), while women were older (P = 4.83*10(-23)), heavier and had a higher prevalence of hypertension (P = 5.32*10(-12)). More people with Type 2 diabetes were on lipid-lowering treatment (84.7 vs 52.4%; P = 5.51*10(-8)) than were those with Type 1 diabetes. The prevalence of retinopathy was higher among non-smokers thank smokers in people with both Type 1 and Type 2 diabetes (Type 1, P = 0.016; Type 2, P = 0.001). CONCLUSIONS The study shows gender differences between Type 1 and 2 diabetes that are of clinical significance and require further investigation. Follow-up of the patients included in the present study should give us much greater understanding of the importance of gender in the development of metabolic abnormalities and diabetes complications.
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Affiliation(s)
- A Collier
- Department of General Medicine, Ayr Hospital, Ayr, UK
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Collier A, Ghosh S, Hair M, Waugh N. Impact of socioeconomic status and gender on glycaemic control, cardiovascular risk factors and diabetes complications in type 1 and 2 diabetes: a population based analysis from a Scottish region. Diabetes Metab 2014; 41:145-51. [PMID: 25454092 DOI: 10.1016/j.diabet.2014.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Abstract
AIMS In this cross-sectional study, the aims were to investigate the association of the socioeconomic status and gender on the prevalence of type 1 and 2 diabetes, glycaemic control, cardiovascular risk factors plus the complications of diabetes in a population-based analysis in the county of Ayrshire and Arran, Scotland. METHODS Quality Outcome Framework data was obtained from General Practices in Ayrshire and Arran, Scotland (n=15,351 patients). RESULTS In type 1 diabetes, there was an increasing linear trend in HbA1c across deprivation levels (P<0.01). In type 1 diabetes, obesity in women (P<0.01) and increased non-fasting triglyceride levels in both men and women were associated with deprivation (P<0.05). In type 2 diabetes, there was a significant prevalence trend with deprivation for women (P<0.01) but not with glycaemic control (P=0.12). Smoking, ischaemic heart disease and neuropathy (P<0.01) were all associated with increasing deprivation with gender differences. In type 2 diabetes, reduced HDL cholesterol (P<0.01 both genders), and percentage of people on lipid lowering therapy (men P<0.05; women P<0.01) were associated with deprivation. Smoking, ischaemic heart disease, peripheral vascular disease and neuropathy plus foot ulcers (P<0.05) were all associated with increasing deprivation with gender differences. CONCLUSIONS Socioeconomic status and gender are associated with changes in glycaemic control and cardiovascular risk factors plus complication development in both type 1 and 2 diabetes. The mechanisms are unclear but follow-up of these patients should allow greater understanding.
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Affiliation(s)
- A Collier
- Department of General Medicine, The Ayr Hospital, NHS Ayrshire & Arran, KA6 6DX, United Kingdom.
| | - S Ghosh
- AMRI Institute of Diabetes and Hormonal Disorders, 38/1A Gariahat Road, 700029 Kolkata, India
| | - M Hair
- Statistics Consultant, NHS Ayrshire & Arran, KA6 6DX, United Kingdom
| | - N Waugh
- Health Sciences, Division of Health Sciences, Warwick Medical School, Coventry CV4 7AL, United Kingdom
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Collier A, Blackman A, Foster G, Zammit G, Rosenberg R, Wadden T, Aronne L, Claudius B, Jensen T, Mignot E. S28 Liraglutide 3.0 Mg Reduces Severity Of Obstructive Sleep Apnoea And Body Weight In Obese Individuals With Moderate Or Severe Disease: Scale Sleep Apnoea Trial. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Collier A, McLaren J, Godwin J, Bal A. Is Clostridium difficile associated with the '4C' antibiotics? A retrospective observational study in diabetic foot ulcer patients. Int J Clin Pract 2014; 68:628-32. [PMID: 24499256 PMCID: PMC4238420 DOI: 10.1111/ijcp.12347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Clostridium difficile is an anaerobic cytotoxin-producing bacterium that can cause infectious diarrhoea, pseudomembranous colitis and toxic megacolon. The major risk factors for developing C. difficile infection include recent or current antimicrobial use, diabetes, age over 65, proton pump inhibitor use, immunosuppression and previous infection with C. difficile. Most diabetic foot ulcers are polymicrobial. METHODS As a result guidelines advise treatment with broad spectrum antibiotics which include the '4C's' (clindamycin, cephalosporins, co-amoxiclav and ciprofloxacin) which are associated with a higher risk of C. difficile infection. Retrospective observational data (June 2008 to January 2012) for the diabetes foot ulcers were gathered from the Diabetes/Podiatry Clinic database in NHS Ayrshire and Arran and cross-matched with the NHS Ayrshire and Arran Microbiology database. There were 111 patients with mean age 59 years (range 24-94 years), 33 type 1 patients, 78 type 2 patients, mean duration of diabetes 16 years (6 months-37 years) and mean HbA1c 67 mmol/mol (54-108 mmol/mol) [8.3% (7.1-12%)]. RESULTS The total number of days antimicrobials prescribed for all patients was 7938 (mean number of antimicrobial days per patient = 71.5 days). There was one case of C. difficile infection of 111 patients giving an incidence of 1.25 cases per 10,000 patient-days of antibiotics/1 case per 209 foot ulcers. CONCLUSIONS Large doses, numbers and greater duration of antibiotic therapy all result in a greater degree of normal gut flora depletion. It is possible that the alterations in gut flora in diabetic foot ulcer patients protect them from antibiotic-induced C. difficile overgrowth.
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Agar M, Draper B, Phillips PA, Phillips J, Collier A, Harlum J, Currow D. Making decisions about delirium: a qualitative comparison of decision making between nurses working in palliative care, aged care, aged care psychiatry, and oncology. Palliat Med 2012; 26:887-96. [PMID: 21908522 DOI: 10.1177/0269216311419884] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Delirium has a significant impact on nursing practice from diagnosis and management, with under-detection and variable management of delirium being international problems. This study aimed to explore nurses' assessment and management of delirium when caring for people with cancer, the elderly or older people requiring psychiatric care in the inpatient setting. METHODS Participants in this qualitative study were nurses working in Australian public hospital inpatient dedicated units in palliative care, aged care (geriatrics), aged care (geriatric) psychiatry and oncology. Semi-structured interviews were used to explore nurses' views about specific areas of delirium assessment and management. Purposive sampling was used and interviews conducted until thematic saturation reached. A thematic content analysis was performed from a grounded theory perspective. RESULTS A total of 40 participants were included in the study. The analysis revealed four broad analytical themes: (1) superficial recognition and understanding of the operational definition of delirium or recognition of delirium as a syndrome; (2) nursing assessment: investigative versus a problem solving approach; (3) management: maintaining dignity and minimizing chaos; and (4) distress and the effect on others. DISCUSSION Nurses have limited knowledge of the features of delirium regardless of their specialty discipline. Delirium was uniformly identified as a highly distressing experience for patients, families and staff alike. The majority of nurses had a superficial understanding of delirium management, and adopted a task-orientated approach aimed at addressing the more noticeable problems. These findings have implications for both education and knowledge translation. Innovative approaches are needed to align health professional behaviours with best evidence delirium care.
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Affiliation(s)
- M Agar
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, Australia.
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Kunwar P, Hawkins NR, Yu X, Liu Y, Collier A, Gabriel EE, Hertz T, Horton H. Breadth or conservation score (CS): which is more important for HIV-1 T cell based vaccine immunogen design? Retrovirology 2012. [PMCID: PMC3441473 DOI: 10.1186/1742-4690-9-s2-p260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Brixey SN, Kopp BC, Schlotthauer AE, Collier A, Corden TE. Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting. Inj Prev 2011; 17 Suppl 1:i23-7. [DOI: 10.1136/ip.2010.027037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Collier A, Ghosh S, Dowie A, Walsh K, O'Leary C. HIV testing in dementia: clinical, ethical and patient safety implications. Br J Hosp Med (Lond) 2008; 69:500-3. [PMID: 18819295 DOI: 10.12968/hmed.2008.69.9.31044] [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: 11/11/2022]
Abstract
This article presents patient safety issues along with the professional and ethical challenges in relation to UK guidelines on HIV testing in patients who are incapacitated as a result of dementia. Current protocols are designed to protect the patient, but may have undesirable consequences for patients, carers and doctors.
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Affiliation(s)
- A Collier
- Department of General Medicine, The Ayr Hospital, Ayr KA6 6DX
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Alderson L, Montgomery J, Ryan D, Ghosh S, Collier A. Day case surgery and obesity: a changing perspective. Br J Anaesth 2008; 100:140; author reply 140. [DOI: 10.1093/bja/aem357] [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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Collier A, Heilig L, Schilling L, Williams H, Dellavalle RP. Cochrane Skin Group systematic reviews are more methodologically rigorous than other systematic reviews in dermatology. Br J Dermatol 2007; 155:1230-5. [PMID: 17107394 DOI: 10.1111/j.1365-2133.2006.07496.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Cochrane collaboration aims to produce high-quality systematic reviews. It is not known whether the methods used in producing Cochrane Skin Group (CSG) reviews result in higher quality reviews than other systematic reviews in dermatology. OBJECTIVES To determine how the methodological quality of dermatological CSG reviews published in The Cochrane Library and in peer-reviewed journals compare with non-Cochrane systematic reviews. METHODS Two blinded investigators independently assessed review quality using the 10-item Oxman and Guyatt scale. RESULTS Thirty-eight systematic reviews (17 Cochrane reviews published in The Cochrane Library, 11 Cochrane reviews published in peer-reviewed journals and 10 non-Cochrane reviews published in peer-reviewed journals) were examined. The Cochrane Library reviews included quality of life (11/17 vs. 1/10, P = 0.014) and adverse outcomes (14/17 vs. 2/10, P = 0.003) more often than non-Cochrane reviews published in peer-reviewed journals. Cochrane reviews published in both peer-reviewed journals and The Cochrane Library were more likely to include comprehensive search strategies (11/11 and 17/17 vs. 6/10, P-values = 0.04 and 0.01), take steps to minimize selection bias (11/11 and 16/17 vs. 3/10, P-values = 0.003 and 0.001) and appropriately assess the validity of all included trials (10/11 and 16/17 vs. 4/10, P-values = 0.04 and 0.007) than non-Cochrane reviews. Overall, Cochrane reviews published both in peer-reviewed journals and in The Cochrane Library were assigned higher quality scores by reviewers than non-Cochrane reviews (median = 6.0 and 6.5 vs. 4.5, P-values = 0.01 and 0.002). CONCLUSIONS The Cochrane Library systematic review methodology leads to higher quality reviews on dermatological topics.
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Affiliation(s)
- A Collier
- Department of Dermatology, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA
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Halbert C, Kessler L, Collier A, Paul Wileyto E, Brewster K, Weathers B. Psychological functioning in African American women at an increased risk of hereditary breast and ovarian cancer. Clin Genet 2005; 68:222-7. [PMID: 16098010 DOI: 10.1111/j.1399-0004.2005.00483.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite attention to psychological issues during genetic counselling and testing for hereditary breast and ovarian cancer risk, limited information is available on cancer-specific distress among African American women being targeted for participation in counselling and testing. Therefore, the purpose of this study is to examine cancer-specific distress in African American women at an increased risk of hereditary breast and ovarian cancer and to identify factors having significant associations with distress in this population. Respondents were 141 African American women identified for participation in genetic counselling and testing for BRCA1/2 mutations. Overall, respondents reported moderate levels of cancer-specific distress. Younger age (coefficient=6.0, p=0.001), being unemployed (coefficient=-5.0, p=0.01), and having a personal history of cancer (coefficient=5.0, p=0.02) had significant associations with intrusion. Younger age was also associated significantly with greater avoidance (r=6.0, p=0.02). These results suggest that African American women aged 50 and younger, those who are unemployed and women with a personal history of breast or ovarian cancer may be the most vulnerable to experiencing elevated levels of distress during genetic counselling and testing. Greater attention to psychological issues, including concerns about cancer and cancer risks, may be needed during genetic counselling and testing for BRCA1/2 mutations with these women.
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Affiliation(s)
- Ch Halbert
- University of Pennsylvania, Philadelphia, PA 19104, USA.
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Deeks SG, Barditch-Crovo P, Collier A, Smith A, Miller M, McGowan I, Coakley DF. Hydroxyurea does not enhance the anti-HIV activity of low-dose tenofovir disoproxil fumarate. J Acquir Immune Defic Syndr 2001; 28:336-9. [PMID: 11707669 DOI: 10.1097/00126334-200112010-00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tenofovir disoproxil fumarate (DF) is an adenosine analogue with significant activity against HIV-1. Hydroxyurea decreases the intracellular concentrations of deoxyadenosine triphosphate, the active metabolite of adenosine. We therefore tested the hypothesis that hydroxyurea could enhance the anti-HIV activity of low-dose tenofovir in vivo. Eight patients received tenofovir DF, 75 mg, plus hydroxyurea, 500 mg bid, for 28 days. Changes in plasma HIV RNA levels were compared with a previously studied cohort of patients treated with tenofovir DF, 75 mg once daily ( n = 8), or tenofovir placebo ( n = 12). The median change in HIV RNA levels after 28 days of continuous treatment was -0.01 log(10) copies/ml for tenofovir placebo, -0.33 log(10) copies/ml for tenofovir 75 mg once daily, and -0.22 log(10) copies RNA/ml for tenofovir plus hydroxyurea. The difference between placebo and tenofovir-treated groups was significant ( p <.05); however, the difference between the tenofovir and tenofovir plus hydroxyurea groups was not significant ( p =.90). We conclude that hydroxyurea does not significantly enhance the antiviral activity of low-dose tenofovir.
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Affiliation(s)
- S G Deeks
- San Francisco General Hospital AIDS Program, University of California, San Francisco, California 94110, USA.
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Barditch-Crovo P, Deeks SG, Collier A, Safrin S, Coakley DF, Miller M, Kearney BP, Coleman RL, Lamy PD, Kahn JO, McGowan I, Lietman PS. Phase i/ii trial of the pharmacokinetics, safety, and antiretroviral activity of tenofovir disoproxil fumarate in human immunodeficiency virus-infected adults. Antimicrob Agents Chemother 2001; 45:2733-9. [PMID: 11557462 PMCID: PMC90724 DOI: 10.1128/aac.45.10.2733-2739.2001] [Citation(s) in RCA: 269] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tenofovir DF is an antiviral nucleotide with activity against human immunodeficiency virus type 1 (HIV-1). The pharmacokinetics, safety, and activity of oral tenofovir DF in HIV-1-infected adults were evaluated in a randomized, double-blind, placebo-controlled, escalating-dose study of four doses (75, 150, 300, and 600 mg given once daily). Subjects received a single dose of tenofovir DF or a placebo, followed by a 7-day washout period. Thereafter, subjects received their assigned study drug once daily for 28 days. Pharmacokinetic parameters were dose proportional and demonstrated no change with repeated dosing. Reductions in plasma HIV-1 RNA were dose related at tenofovir DF doses of 75 to 300 mg, but there was no increase in virus suppression between the 300- and 600-mg dose cohorts, despite dose-proportional increases in drug exposure. Grade III or IV adverse events were limited to laboratory abnormalities, including elevated creatine phosphokinase and liver function tests, which resolved with or without drug discontinuation and without sequelae. No patients developed detectable sequence changes in the reverse transcriptase gene.
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Affiliation(s)
- P Barditch-Crovo
- The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA.
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Gray-Donald K, Robinson E, Collier A, David K, Renaud L, Rodrigues S. Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. CMAJ 2000; 163:1247-51. [PMID: 11107459 PMCID: PMC80308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay, Quebec. To address this problem, a diet and activity intervention during pregnancy, which was based on social learning theory, was initiated in 4 Cree communities. METHODS A prospective intervention compared dietary, weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy. A control period in 4 communities (July 1995-March 1996) was followed by an intervention period (April 1996-January 1997) when subjects were offered regular, individual diet counselling, physical activity sessions and other activities related to nutrition. RESULTS The intervention and control groups did not differ at baseline regarding their mean age (24.3 years [SD 6.29] v. 23.8 years [SD 5.86]), mean prepregnancy weight (81.0 kg [SD 19.46] v. 78.9 kg [SD 17.54]) and mean gestational age at recruitment (17.1 weeks [SD 7.06] v. 18.5 weeks [SD 6.92]). The intervention did not result in differences in diet measured at 24-30 weeks' gestation, rate of weight gain over the second half of pregnancy (0.53 kg per week [SD 0.32] v. 0.53 kg per week [SD 0.27]) or plasma glucose level (50 g oral glucose screen) between 24 and 30 weeks (7.21 mmol/L [SD 2.09] v. 7.43 mmol/L [SD 2.10]). Mean birth weights were similar (3741 g [SD 523] v. 3686 g [SD 686]), as was maternal weight at 6 weeks post partum (88.1 kg [SD 16.8] v. 86.4 kg [SD 19.0]). The only changes in dietary intake were a reduction in caffeine (pregnancy) and an increase in folate (post partum). INTERPRETATION This intervention had only a minor impact on diet; finding ways of encouraging appropriate body weight and activity levels remains a challenge.
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Affiliation(s)
- K Gray-Donald
- School of Dietetics and Human Nutrition, McGill University, Montreal, Que.
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Schooley RT, Spino C, Kuritzkes D, Walker BD, Valentine FA, Hirsch MS, Cooney E, Friedland G, Kundu S, Merigan TC, McElrath MJ, Collier A, Plaeger S, Mitsuyasu R, Kahn J, Haslett P, Uherova P, deGruttola V, Chiu S, Zhang B, Jones G, Bell D, Ketter N, Twadell T, Chernoff D, Rosandich M. Two double-blinded, randomized, comparative trials of 4 human immunodeficiency virus type 1 (HIV-1) envelope vaccines in HIV-1-infected individuals across a spectrum of disease severity: AIDS Clinical Trials Groups 209 and 214. J Infect Dis 2000; 182:1357-64. [PMID: 11023459 DOI: 10.1086/315860] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2000] [Revised: 06/20/2000] [Indexed: 11/03/2022] Open
Abstract
The potential role of human immunodeficiency virus type 1 (HIV-1)-specific immune responses in controlling viral replication in vivo has stimulated interest in enhancing virus-specific immunity by vaccinating infected individuals with HIV-1 or its components. These studies were undertaken to define patient populations most likely to respond to vaccination, with the induction of novel HIV-1-specific cellular immune responses, and to compare the safety and immunogenicity of several candidate recombinant HIV-1 envelope vaccines and adjuvants. New lymphoproliferative responses (LPRs) developed in <30% of vaccine recipients. LPRs were elicited primarily in study participants with a CD4 cell count >350 cells/mm(3) and were usually strain restricted. Responders tended to be more likely than nonresponders to have an undetectable level of HIV-1 RNA at baseline (P=.067). Induction of new cellular immune responses by HIV-1 envelope vaccines is a function of the immunologic stage of disease and baseline plasma HIV-1 RNA level and exhibits considerable vaccine strain specificity.
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Affiliation(s)
- R T Schooley
- University of Colorado Health Sciences Center, Denver, CO, USA.
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Klinck R, Westhof E, Walker S, Afshar M, Collier A, Aboul-Ela F. A potential RNA drug target in the hepatitis C virus internal ribosomal entry site. RNA 2000; 6:1423-31. [PMID: 11073218 PMCID: PMC1370013 DOI: 10.1017/s1355838200000935] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Subdomain IlId from the hepatitis C virus (HCV) internal ribosome entry site (IRES) has been shown to be essential for cap-independent translation. We have conducted a structural study of a 27-nt fragment, identical in sequence to IlId, to explore the structural features of this subdomain. The proposed secondary structure of IlId is comprised of two 3 bp helical regions separated by an internal loop and closed at one end by a 6-nt terminal loop. NMR and molecular modeling were used interactively to formulate a validated model of the three-dimensional structure of IlId. We found that this fragment contains several noncanonical structural motifs and non-Watson-Crick base pairs, some of which are common to other RNAs. In particular, a motif characteristic of the rRNA alpha-sarcin/ricin loop was located in the internal loop. The terminal loop, 5'-UUGGGU, was found to fold to form a trinucleotide loop closed by a trans-wobble U.G base pair. The sixth nucleotide was bulged out to allow stacking of this U.G pair on the adjacent helical region. In vivo mutational analysis in the context of the full IRES confirmed the importance of each structural motif within IIId for IRES function. These findings may provide clues as to host cellular proteins that play a role in IRES-directed translation and, in particular, the mechanism through which host ribosomes are sequestered for viral function.
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Affiliation(s)
- R Klinck
- RiboTargets Ltd., Abington, Cambridge, United Kingdom
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Abstract
This is a case report of a spinal epidural abscess, caused by Staphylococcus aureus, in a 3-year-old girl. The child presented with fever and hip pain, but without any neurologic deficit. After normal plain films and a normal bone scan were obtained, the diagnosis was made via magnetic resonance imaging (MRI). The neurosurgery and pediatric infectious disease teams evaluated the patient, and the decision was made to forego surgical drainage and to treat medically with appropriate intravenous and then oral antibiotics. Several months later, the child was doing well without any signs of neurologic sequelae. Because of the rarity of this disease in children, the treatment guidelines are controversial. Many suggest that a spinal epidural abscess must be drained surgically. Our experience adds to the literature a case of a child successfully treated with antibiotics alone. We believe that this success is related to the fact that the child was diagnosed by MRI early in the course of the disease and that she never displayed any neurologic deficits.
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Affiliation(s)
- M H Bair-Merritt
- University of North Carolina School of Medicine, University of North Carolina Children's Hospital, Chapel Hill, North Carolina 27599-7220, USA
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Affiliation(s)
- R Denays
- Centre Hospitalier Etterbeek-Ixelles, Service de Neurologie, Bruxelles, Belgium
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Abstract
The General Dental Council's recommendations on dental education places a new emphasis on the importance of ethics and law in the dental curriculum, stating that students should have an awareness of moral and ethical responsibilities involved in the provision of care to individual patients and to populations. The duties of care to protect a patient's life and health at all times, to respect their autonomy to make informed choices about what happens to them, and to do this fairly and without prejudice, are widely accepted as the fundamental ethical principles governing all health care. The specifics of these duties of care are detailed in Maintaining Standards: guidance to dentists on professional and personal conduct, published by the GDC.
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Akridge R, Hladik F, Markee J, Alef C, Kelley H, Collier A, Collier A, McElrath MJ. Cellular immunity and target cell susceptibility in persons with repeated HIV-1 exposure. Immunol Lett 1999; 66:15-9. [PMID: 10203029 DOI: 10.1016/s0165-2478(98)00180-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We prospectively studied 37 HIV-1 uninfected persons engaging in repeated high risk sexual activity with an HIV-1 infected partner, as well as 18 of their infected partners. Only one subject (3%) demonstrated the homozygous 32-bp deletion delta32delta32 of the HIV-1 co-receptor CCR5. CD4+ cells from all high risk subjects except the delta32delta32 CCR5 homozygote were susceptible in vitro to both CCR5-dependent and CXCR4-dependent HIV-1 strains. Median HIV-1 plasma RNA levels of the infected partners were not significantly different from levels of matched infected controls. Thirteen subjects demonstrated HIV-1 specific CTL at one or more visits, and these activities were more commonly observed in persons with the wild type CCR5 genotype. These results indicate that cellular immunity rather than inheritance of the delta32 CCR5 mutation accounts more often for persistently HIV-1-resistant cases.
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Affiliation(s)
- R Akridge
- The Department of Laboratory Medicine, the University of Washington School of Medicine, Seattle, USA
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Goh WC, Markee J, Akridge RE, Meldorf M, Musey L, Karchmer T, Krone M, Collier A, Corey L, Emerman M, McElrath MJ. Protection against human immunodeficiency virus type 1 infection in persons with repeated exposure: evidence for T cell immunity in the absence of inherited CCR5 coreceptor defects. J Infect Dis 1999; 179:548-57. [PMID: 9952360 DOI: 10.1086/314632] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
It has been hypothesized that protection against human immunodeficiency virus (HIV)-1 infection may result from either acquired host immunity, inheritance of a dysfunctional CCR5 HIV-1 coreceptor, or a low or attenuated virus inoculum. Thirty-seven HIV-1-uninfected persons engaging in repeated high-risk sexual activity with an HIV-1-infected partner were prospectively studied to determine the contribution of these factors in protecting against HIV-1 transmission. More than one-third (13/36) demonstrated HIV-1-specific cytotoxicity, and this activity significantly correlated with the wild type CCR5 genotype (P=.03). Only 1 subject (3%) demonstrated the homozygous CCR5 32-bp deletion (Delta32/Delta32). Median plasma HIV-1 RNA levels from 18 HIV-1-infected sex partners were not statistically different from those of matched infected control patients. These results indicate that inheritance of the Delta32 CCR5 mutation does not account for the majority of persistently HIV-1-resistant cases, and the presence of cellular immunity in these persons suggests either undetected infection or protective immunity.
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Affiliation(s)
- W C Goh
- Division of Molecular Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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McCarlie J, Alexander G, Sommerville J, McGettrick P, MacPherson N, Collier A. Use of collaborative audit to assist local implementation of the SIGN guideline for prevention of visual impairment in diabetes. Health Bull (Edinb) 1999; 57:29-34. [PMID: 12811862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES To use audit to inform the local implementation of a national clinical guideline for the prevention of visual impairment in diabetes. DESIGN Computer and patient record search in hospital and general practice to determine levels of morbidity and follow-up. Questionnaire to each practice to determine models and techniques of eye screening. SETTING Ayrshire and Arran Health Board area, Scotland. SUBJECTS All known diabetic patients. MAIN MEASURES Proportion of diabetic patients who have had diabetic eye review and monitoring of risk factors within one year. Proportion of diabetic patients who have risk factors recorded within target level. Proportion of eye screening centres with recommended mechanisms in place. RESULTS Both district general hospitals, and 59 of the 63 general practices, in the area took part in the audit. A total of 6,217 diabetic patients were included; the prevalence of diabetes in this population was 1.65%. Twenty-seven per cent were insulin treated. Seventy-two per cent of diabetics who were not registered blind had a record of having had fundoscopy performed through dilated pupils within one year. Sixty-nine per cent of those who were not registered blind had had corrected visual acuity measured within one year. Eighty-five per cent of diabetics had HbA1C recorded within one year and of these 65% had a level of 8% or less. Eighty-eight per cent had a blood pressure recording within twelve months and 52% of recorded pressures were 140/90 mmHg or less. Smoking status was recorded for 89% of patients and 75% of patients with a record were non-smokers. Representatives of 57 practices returned a completed questionnaire. All these practices had a Snellen chart, but only 83% had near vision testing equipment and only 54% had a pinhole occluder. CONCLUSIONS An area wide collaborative audit provided local data to inform the process of guideline implementation and baseline data from which to evaluate this process. Wide stakeholder involvement increased interest, motivation and support for the process. The audit highlighted specific areas for change and provided the local stimulus for change.
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Affiliation(s)
- J McCarlie
- Ayrshire Central Hospital, Irvine KA12 8SS
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Collier A, King D. Computer generated odontoid peg "fracture", a cause for concern? Injury 1998; 29:719-23. [PMID: 10211206 DOI: 10.1016/s0020-1383(98)00154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ehongo A, Cordonnier M, Van Nechel C, Thibaut S, Collier A, Brucher JM, Monseu G. [Internuclear bilateral pseudo-ophthalmoplegia and dermatomyositis]. Bull Soc Belge Ophtalmol 1997; 263:43-51. [PMID: 9410406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 60 year-old woman complaining of diplopia presents an ocular motility disturbance mimicking internuclear ophthalmoplegia. Idiopathic dermatomyositis is diagnosed by the help of clinical, biological, electrophysiological and histological data. The outcome is favorable under corticotherapy. Ocular muscle involvement is rare in dermatomyositis. An overlap syndrome with another auto-immune disorder like myasthenia should be excluded in this kind of manifestation.
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Affiliation(s)
- A Ehongo
- Service de Neuro-Ophtalmologie, Hôpital Erasme, U.L.B
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Deeks SG, Collier A, Lalezari J, Pavia A, Rodrigue D, Drew WL, Toole J, Jaffe HS, Mulato AS, Lamy PD, Li W, Cherrington JM, Hellmann N, Kahn J. The safety and efficacy of adefovir dipivoxil, a novel anti-human immunodeficiency virus (HIV) therapy, in HIV-infected adults: a randomized, double-blind, placebo-controlled trial. J Infect Dis 1997; 176:1517-23. [PMID: 9395363 DOI: 10.1086/514150] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Adefovir dipivoxil is a novel nucleotide analogue with several promising in vitro anti-human immunodeficiency virus (HIV) characteristics. To evaluate the safety and efficacy of adefovir dipivoxil monotherapy, a randomized, double-blind, placebo-controlled study was initiated involving 72 subjects with moderately advanced HIV disease. Subjects were randomly assigned in a 2:1 ratio to receive adefovir dipivoxil or placebo as a once-daily oral dose for 6 weeks, followed by 6 weeks of open-label adefovir dipivoxil. Two dose levels were studied (125 mg and 250 mg). Adefovir dipivoxil was determined to be safe and well-tolerated when administered for 12 weeks. At week 6, changes in absolute CD4 T cell levels and HIV-1 RNA levels were significantly greater with adefovir dipivoxil than with placebo. These effects were sustained through 12 weeks of treatment. As determined by standard RNA sequencing techniques, only 1 of the 24 subjects who received adefovir dipivoxil (125 mg/day) developed any genotypic change from baseline.
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Affiliation(s)
- S G Deeks
- University of California, San Francisco, San Francisco General Hospital, 94110, USA
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Rubinstein M, Denays R, Collier A. Evaluation of suspected dementia. N Engl J Med 1996; 335:1997; author reply 1997-8. [PMID: 8975130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Busch MP, Collier A, Gernsheimer T, Carrington JD, Flanigan TP, Kashkari M, Kennedy M, Kumar PN, Lane TA, Mellors JW, Mohandas K, Pollard RB, Viele M, Yomtovian R, Holland PV, McCurdy PR. The Viral Activation Transfusion Study (VATS): rationale, objectives, and design overview. Transfusion 1996; 36:854-9. [PMID: 8863770 DOI: 10.1046/j.1537-2995.1996.361097017169.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M P Busch
- Irwin Memorial Blood Centers, San Francisco, California, USA
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Schooley RT, Campbell TB, Kuritzkes DR, Blaschke T, Stein DS, Rosandich ME, Phair J, Pottage JC, Messari F, Collier A, Kahn J. Phase 1 study of combination therapy with L-697,661 and zidovudine. The ACTG 184 Protocol Team. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 12:363-70. [PMID: 8673545 DOI: 10.1097/00042560-199608010-00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We performed a pilot study that examined the clinical and pharmacokinetic interactions between zidovudine (ZDV) and a pyridinone derivative, L-697-661. The results indicate that the drugs were well tolerated, with no important pharmacokinetic interactions, when administered concomitantly for as long as 8 weeks. Although the number of study participants was small, we noted rapid emergence of resistance to L-697,661 among ZDV-naive study subjects who were administered L-697,661 as monotherapy but did not observe isolates of human immunodeficiency virus type 1 (HIV-1) resistant to L-697,661 among those who were administered concomitant ZDV. These results suggest a potential interaction between development of resistance to L-697,661 and ZDV. Although the clinical development of L-697,661 has been halted, our results support the need for further studies to test whether specific interactions among antiretroviral agents administered in combination and the molecular target can delay the emergence of isolates that exhibit resistance to all drugs in the regimen.
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Affiliation(s)
- R T Schooley
- University of Colorado Health Sciences Center, Denver 80262, USA
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Ingram MC, Wallace AM, Collier A, Fraser R, Connell JM. Sodium status, corticosteroid metabolism and blood pressure in normal human subjects and in a patient with abnormal salt appetite. Clin Exp Pharmacol Physiol 1996; 23:375-8. [PMID: 8713674 DOI: 10.1111/j.1440-1681.1996.tb02744.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
1. A patient with severe hypertension was found to have mildly impaired 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD) activity on the basis of urinary steroid metabolite ratios, low plasma aldosterone, angiotensin II and renin levels and marginally low levels of plasma potassium. 2. The patient also had a compulsively high salt intake. 3. We tested the hypothesis that high salt intake may affect 11 beta-HSD activity. 4. High salt intake in normal subjects did not significantly alter either blood pressure or 11 beta-HSD activity. 5. We suggest that the potentially small hypertensive effect of the partial enzyme deficiency in our patient, also reported in patients with essential hypertension, has been markedly amplified by the very high salt intake.
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Affiliation(s)
- M C Ingram
- MRC Blood Pressure Unit, Western Infirmary, Glasgow, Scotland
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Knudsen S, Saadbye P, Hansen LH, Collier A, Jacobsen BL, Schlundt J, Karlström OH. Development and testing of improved suicide functions for biological containment of bacteria. Appl Environ Microbiol 1995; 61:985-91. [PMID: 7793926 PMCID: PMC167358 DOI: 10.1128/aem.61.3.985-991.1995] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We have developed very efficient suicide functions for biological containment based on the lethal Escherichia coli relF gene. The suicide functions are placed in duplicate within a plasmid and arranged to prevent inactivation by deletion, recombination, and insertional inactivation. The efficiency of this concept was tested in a plasmid containment system that prevents transfer of plasmids to wild-type bacteria. Protection against plasmid transfer was assayed in test tubes and in rat intestine. Protection was efficient and refractory to inactivation by mutation and transposons. The efficiency of the suicide system was also tested in soil and seawater. We show that unprecedented suicide efficiency can be achieved in soil and seawater after suicide induction by IPTG (isopropyl-beta-D-thiogalactopyranoside). More than 7 orders of magnitude reduction in suicide bacteria was achieved.
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Affiliation(s)
- S Knudsen
- Center for Environmental Diagnostics and Bioremediation, University of West Florida 32561
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