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O'Connell LJ, Connor T, Healy B. Author response to: "Robust epidemiological investigations in hospital-based COVID-19 outbreaks cannot be overlooked - even in the era of WGS". J Hosp Infect 2023; 141:1-2. [PMID: 37678436 DOI: 10.1016/j.jhin.2023.08.016] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Affiliation(s)
- L J O'Connell
- Infectious Diseases Department, Morriston Hospital, Swansea, UK. lorcan.o'
| | - T Connor
- Cardiff University, Public Health Wales NHS Trust, Cardiff, UK
| | - B Healy
- NHS Wales Swansea Bay University Health Board, Swansea, UK
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2
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O'Connell L, Asad H, Hall G, Jones T, Walters J, Manchipp-Taylor L, Barry J, Keighan D, Jones H, Williams C, Cronin M, Hughes H, Morgan M, Connor TR, Healy B. Detailed analysis of in-hospital transmission of SARS-CoV-2 using whole genome sequencing. J Hosp Infect 2023; 131:23-33. [PMID: 36240955 PMCID: PMC9554319 DOI: 10.1016/j.jhin.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Affiliation(s)
- L O'Connell
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK. lorcan.o'
| | - H Asad
- Health Protection Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Swansea, UK
| | - G Hall
- Swansea Bay University Health Board, Swansea, UK
| | - T Jones
- Swansea Bay University Health Board, Swansea, UK
| | - J Walters
- Quality Improvement Infection Prevention & Control, Infection Prevention & Control Team, Swansea Bay University Health Board, Swansea, UK
| | | | - J Barry
- Swansea Bay University Health Board, Swansea, UK
| | - D Keighan
- Estates, Swansea Bay University Health Board, Swansea, UK
| | - H Jones
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - C Williams
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - M Cronin
- Health Protection CDSC, Public Health Wales, Cardiff, UK
| | - H Hughes
- Public Health Wales and Cardiff University Health Board, Cardiff, UK
| | - M Morgan
- Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme, Public Health Wales, Cardiff, UK
| | - T R Connor
- Public Health Wales and Cardiff University, Cardiff, UK
| | - B Healy
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK
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Rijken J, Towns S, Healy B. The need to update NCRP 151 data for 10 MV linear accelerator bunker shielding based on new measurements and Monte Carlo simulations. J Radiol Prot 2021; 41:842-852. [PMID: 34624879 DOI: 10.1088/1361-6498/ac2e0b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Linear accelerator bunker shielding protocols such as NCRP 151 have previously been tested against a large sample of measured data from real bunkers and machines but differences in per-energy concrete penetration (TVLs) for 10 MV has not yet been resolved. These differences are likely due to historical beam data and can potentially result in over-exposure of radiation workers and the public. This study examines a cohort of clinical linac bunker survey measurements and compares them to popular shielding protocols. Differences were investigated using contemporary beam data for both Monte Carlo simulation and in analytical equations. For primary barriers, NCRP 151 underestimates the dose rate through concrete by on average a factor of 2 with secondary barriers and maze entrance doses having much better agreement. Use of contemporary beam data in Monte Carlo simulation and an analytical equation yielded TVL values much closer to the measured values compared to NCRP 151. The TVL data in NCRP 151 is outdated and needs to be updated based upon the energy spectra of modern linear accelerators. Until then, physicists should use the TVL values shown in this study instead.
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Affiliation(s)
- J Rijken
- Icon Cancer Centre, Windsor Gardens, SA, Australia
| | - S Towns
- Icon Cancer Centre, Moreland, VIC, Australia
| | - B Healy
- Icon Cancer Centre, South Brisbane, QLD, Australia
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Lim JY, Jessop ZM, Gibson JAG, Jovic TH, Combellack E, Dobbs TD, Healy B, Humphreys IR, Eccles R, Hutchings HA, Whitaker IS. 1524 Design and Implementation Of ICE-COVID, A Double-Blind Randomised Placebo-Controlled Trial on The Efficacy of Iota-Carrageenan Nasal and Throat Spray for Covid-19 Prophylaxis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.508] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
The severity of Covid-19 infection is associated with viral load. For infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus to attach to the host cell surface receptors. Iota-carrageenan (I-C), a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a range of viruses in clinical trials, through prevention of viral entry into respiratory host cells and in-vitro activity against SARS-CoV-2. Our aim, as an academic surgical department, was to design and implement a clinical trial to investigate whether I-C nasal and throat sprays are effective in reducing the rate and severity of Covid-19 infection.
Method
The study is a single centre, double-blinded randomised controlled trial. Recruitment of 480 participants aged ≥18 years without previous Covid-19 infection and who have not yet been vaccinated, commenced in December 2020. Participants are randomised to either the treatment (0.12% I-C in 0.5% saline spray) or placebo (0.5% saline spray) arm and will prophylactically apply the spray to their nose and throat while completing a daily symptom tracker for a total of 10 weeks. The primary outcome is the acquisition of Covid-19 infection. Secondary outcomes include symptom type, severity and duration, subsequent familial/household Covid-19 infection and infection with non-Covid-19 upper respiratory tract infections.
Discussion
Our hypothesis is that I-C sprays will reduce SARS-CoV-2 attachment to the naso- and oropharyngeal mucosal epithelial cells thus reducing the effective viral infective dose. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population.
Trial registration number
NCT04590365
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Affiliation(s)
- J Y Lim
- Morriston Hospital, Swansea, United Kingdom
| | - Z M Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - J A G Gibson
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - T H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - E Combellack
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - B Healy
- Public Health Wales Microbiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Ian R Humphreys
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Henry Wellcome Building, Heath Park, Cardiff, United Kingdom
| | - Ronald Eccles
- Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Hayley A Hutchings
- Health Services Research, Patient & Population Health & Informatics Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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Affiliation(s)
- C Johnston
- Department of Microbiology and Infectious Diseases, Public Health Wales Microbiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea, SA6 6NL, United Kingdom
| | - B Healy
- Department of Microbiology and Infectious Diseases, Public Health Wales Microbiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea, SA6 6NL, United Kingdom
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Asad H, Johnston C, Blyth I, Holborow A, Bone A, Porter L, Tidswell P, Healy B. Health Care Workers and Patients as Trojan Horses: a COVID19 ward outbreak. Infect Prev Pract 2020; 2:100073. [PMID: 34316562 PMCID: PMC7334135 DOI: 10.1016/j.infpip.2020.100073] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Transmission in healthcare settings can result in significant infections in healthcare workers and patients. Understanding infection dynamics has important implications for methods employed in hospitals to prevent nosocomial transmission events. Methods In this case series report we describe a cluster of COVID-19 (Coronavirus disease 2019) in a tertiary care university hospital, in the early phases of the epidemic, after hospital visiting had been stopped and when the UK lockdown was in place. Findings A 48 year old patient developed COVID-19 31 days post-admission and four days after admission to a medical ward from ITU. Infection was likely acquired from an asymptomatic or minimally symptomatic healthcare worker (HCW). Subsequent investigation over a 14 day period revealed symptoms in 23 staff members and five linked cases in patients on the same ward. Nine of the 23 affected staff members provided care for and had direct exposure with the index case. Four staff reported caring for the index case without use of personal protective equipment. One was coughed on directly by the patient 24 hours prior to the onset of symptoms. Conclusion SARS CoV2 infection can be introduced to a ward area by asymptomatic and minimally symptomatic healthcare workers. Staff members and patients can act as Trojan horses carrying infection into and around the hospital, setting up unexpected transmission events. Transmission of infection from pre-symptomatic, asymptomatic and minimally symptomatic individuals means that universal use of measures to prevent transmission is required for successful reduction of transmission events in the hospital setting.
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Affiliation(s)
- H Asad
- Public Health Wales Microbiology Department, 8 Eaton Cres, Sketty, Swansea, SA2 8QA, UK
| | - C Johnston
- Public Health Wales Microbiology Department, 8 Eaton Cres, Sketty, Swansea, SA2 8QA, UK
| | - I Blyth
- Public Health Wales Microbiology Department, 8 Eaton Cres, Sketty, Swansea, SA2 8QA, UK
| | - A Holborow
- Public Health Wales Microbiology Department, 8 Eaton Cres, Sketty, Swansea, SA2 8QA, UK
| | - A Bone
- Public Health Wales Microbiology Department, 8 Eaton Cres, Sketty, Swansea, SA2 8QA, UK
| | - L Porter
- Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea, SA2 8QA, UK
| | - P Tidswell
- Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea, SA2 8QA, UK
| | - B Healy
- Public Health Wales Microbiology Department, 8 Eaton Cres, Sketty, Swansea, SA2 8QA, UK
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Avo C, Cawthorne KR, Walters J, Healy B. An observational study to identify types of personal protective equipment breaches on inpatient wards. J Hosp Infect 2020; 106:208-210. [PMID: 32590013 PMCID: PMC7311328 DOI: 10.1016/j.jhin.2020.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022]
Affiliation(s)
- C Avo
- Swansea University Medical School, Institute of Life Science 2, Swansea, UK.
| | - K-R Cawthorne
- Swansea University Medical School, Institute of Life Science 2, Swansea, UK
| | - J Walters
- Infection Prevention and Control, Morriston Hospital, Swansea, UK
| | - B Healy
- Public Health Wales Microbiology, Swansea and Cardiff, UK; Department of Medical Microbiology, Morriston Hospital, Swansea, UK
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Kaplan T, Bove R, Galetta K, Healy B, Chitnis C, Houtchens M. Effect of pregnancy loss on MS disease activity. J Neurol Sci 2019; 397:58-60. [DOI: 10.1016/j.jns.2018.12.028] [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] [Received: 08/23/2018] [Revised: 10/27/2018] [Accepted: 12/19/2018] [Indexed: 11/15/2022]
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9
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Henderson RI, Shea-Budgell M, Healy C, Letendre A, Bill L, Healy B, Bednarczyk RA, Mrklas K, Barnabe C, Guichon J, Bedingfield N, MacDonald S, Colquhoun A, Glaze S, Nash T, Bell C, Kellner J, Richardson R, Dixon T, Starlight J, Runner G, Nelson G. First nations people's perspectives on barriers and supports for enhancing HPV vaccination: Foundations for sustainable, community-driven strategies. Gynecol Oncol 2018; 149:93-100. [PMID: 29605057 DOI: 10.1016/j.ygyno.2017.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/17/2017] [Accepted: 12/19/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities. METHODS Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vaccine. A 2017 community gathering was convened to engage First Nations community members, health directors, and health services researchers in dialogue around unique barriers and supports to HPV vaccination in Alberta. Voices of community Elders, parents, health directors, and cancer survivors (n=24) are presented as qualitative evidence to help inform intervention design. RESULTS Key findings from discussions indicate barriers to HPV vaccination include resource constraints and service infrastructure gaps, historical mistrust in healthcare systems, impacts of changing modes of communication, and community sensitivities regarding sexual health promotion. Supports were identified as strengthened inter-generational relationships in communities. CONCLUSIONS AND FUTURE DIRECTION Ongoing dialogue and co-development of community-based strategies to increase HPV vaccine uptake are required. The identification of possible barriers to HPV vaccination in a Canadian Indigenous population contributes to limited global literature on this subject and may inform researchers and policy makers who work with Indigenous populations in other regions.
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Affiliation(s)
- R I Henderson
- Department of Family Medicine, Cumming School of Medicine, Calgary, AB, Canada.
| | - M Shea-Budgell
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
| | - C Healy
- Alberta First Nations Information Governance Centre, Calgary, AB, Canada
| | - A Letendre
- Alberta Cancer Prevention Legacy Fund, Edmonton, AB, Canada
| | - L Bill
- Alberta First Nations Information Governance Centre, Calgary, AB, Canada
| | - B Healy
- Alberta First Nations Information Governance Centre, Calgary, AB, Canada
| | - R A Bednarczyk
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - K Mrklas
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - C Barnabe
- Department of Medicine, Cumming School of Medicine, Calgary, AB, Canada
| | - J Guichon
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - N Bedingfield
- Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
| | - S MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - A Colquhoun
- Alberta Ministry of Health, Edmonton, AB, Canada
| | - S Glaze
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
| | - T Nash
- Indigenous Mental Health Program, Calgary, AB, Canada
| | - C Bell
- Alberta Ministry of Health, Edmonton, AB, Canada
| | - J Kellner
- Department of Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | - R Richardson
- First Nations and Inuit Health Branch, Alberta Region, Edmonton, AB, Canada
| | - T Dixon
- Elder, Eden Valley Nation, AB, Canada
| | | | - G Runner
- Elder, Tsuut'ina Nation, AB, Canada
| | - G Nelson
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
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Prasad R, Zubizarreta E, Healy B, Hopkins K, Wahab MA. Radiotherapy in South Asia: Infrastructure, Human Resource Capacity, and Future Needs. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Delis H, Christaki K, Healy B, Loreti G, Poli G, Toroi P, Meghzifene A. Moving beyond quality control in diagnostic radiology and the role of the clinically qualified medical physicist. Phys Med 2017; 41:104-108. [DOI: 10.1016/j.ejmp.2017.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/02/2017] [Accepted: 04/08/2017] [Indexed: 11/26/2022] Open
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12
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Cheng L, Ali E, Healy B. Facial soft tissue course for trainees in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.1231] [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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13
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Delis H, Poli G, Healy B, Christaki K, Loreti G, Meghzifene A. Raising awareness of medical physics: The view of international atomic energy agency (IAEA). Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.287] [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: 10/21/2022] Open
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14
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Jones GR, Cumming DVE, Honeywell G, Ball R, Sanderson F, Seaton RA, Healy B, Hedderwick S, Gilchrist M, Dryden M, Gilchrist M, Seaton A, Chapman A, Laundy M, Patel S, Jones G, Cumming D, Sanderson F, Jefferies L, Hanlon SO, Owen K, Snape S, Hills T. How is income generated by outpatient parenteral antibiotic treatment (OPAT) in the UK? Analysis of payment tariffs for cellulitis. J Antimicrob Chemother 2015; 70:1236-40. [DOI: 10.1093/jac/dku541] [Citation(s) in RCA: 9] [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: 11/14/2022] Open
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15
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Zubizarreta EH, Fidarova E, Healy B, Rosenblatt E. Need for radiotherapy in low and middle income countries – the silent crisis continues. Clin Oncol (R Coll Radiol) 2014; 27:107-14. [PMID: 25455407 DOI: 10.1016/j.clon.2014.10.006] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/17/2014] [Indexed: 12/11/2022]
Abstract
About 57% of the total number of cancer cases occur in low and middle income countries. Radiotherapy is one of the main components of cancer treatment and requires substantial initial investment in infrastructure and training. Many departments continue to have basic facilities and to use simple techniques, while modern technologies have only been installed in big cities in upper-middle income countries. More than 50% of cancer patients requiring radiotherapy in low and middle income countries lack access to treatment. The situation is dramatic in low income countries, where the proportion is higher than 90%. The overall number of additional teletherapy units needed corresponds to about twice the installed capacity in Europe. The figures for different income level groups clearly show the correlation between gross national income per capita and the availability of services. The range of radiotherapy needs currently covered varies from 0% and 3-4% in low income countries in Latin America and Africa up to 59-79% in upper-middle income countries in Europe and Central Asia. The number of additional radiation oncologists, medical physicist, dosimetrists and radiation therapists (RTTs) required to operate additional radiotherapy departments needed is 43 200 professionals. Training and education programmes are not available in every developing country and in many cases the only option is sending trainees abroad, which is not a cost-effective solution. The implementation of adequate local training should be the following step after establishing the first radiotherapy facility in any country. Joint efforts should be made to establish at least one radiotherapy facility in countries where they do not exist, in order to create radiotherapy communities that could be the base for future expansion.
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Affiliation(s)
| | - E Fidarova
- International Atomic Energy Agency, Vienna, Austria
| | - B Healy
- International Atomic Energy Agency, Vienna, Austria
| | - E Rosenblatt
- International Atomic Energy Agency, Vienna, Austria
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Healy B, Frantzis J, Murry R, Martin J, Plank A, Middleton M, Catton C, Kron T. Results from a multicenter prostate IMRT dosimetry intercomparison for an OCOG-TROG clinical trial. Med Phys 2014; 40:071706. [PMID: 23822410 DOI: 10.1118/1.4808151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A multi-institution dosimetry intercomparison has been undertaken of prostate intensity modulated radiation therapy (IMRT) delivery. The dosimetry intercomparison was incorporated into the quality assurance for site credentialing for the Trans-Tasman Radiation Oncology Group Prostate Fractionated Irradiation Trial 08.01 clinical trial. METHODS An anthropomorphic pelvic phantom with realistic anatomy was used along with multiplanar dosimetry tools for the assessment. Nineteen centers across Australia and New Zealand participated in the study. RESULTS In comparing planned versus measured dose to the target at the isocenter within the phantom, all centers were able to achieve a total delivered dose within 3% of planned dose. In multiplanar analysis with radiochromic film using the gamma analysis method to compare delivered and planned dose, pass rates for a 5%/3 mm criterion were better than 90% for a coronal slice through the isocenter. Pass rates for an off-axis coronal slice were also better than 90% except for one instance with 84% pass rate. CONCLUSIONS Strengths of the dosimetry assessment procedure included the true anthropomorphic nature of the phantom used, the involvement of an expert from the reference center in carrying out the assessment at every site, and the ability of the assessment to detect and resolve dosimetry discrepancies.
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Affiliation(s)
- B Healy
- Radiation Oncology Queensland, Toowoomba, Queensland 4350, Australia.
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Hussain-Yusuf H, Islam A, Healy B, Lockhart M, Nguyen C, Sukocheva O, Stenos J, Graves S. An analysis of Q fever patients 6 years after an outbreak in Newport, Wales, UK. QJM 2012; 105:1067-73. [PMID: 22771556 DOI: 10.1093/qjmed/hcs119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A cohort of 211 factory workers was exposed to a point source of Q fever in 2002. A total of 38 cases and 14 controls took part in a follow-up study 6 years after the outbreak. AIM To compare Q fever serology, the presence of viable Coxiella burnetii, its DNA and fatigue between patients and controls. DESIGN Laboratory case study. METHODS Q fever serology was by microimmunofluroescence. Viable C. burnetii was detected by VERO cell culture and SCID mice inoculation with patient blood samples. Coxiella burnetii DNA was detected by qPCR (com1 gene) on patients' PBMC and on VERO cultures after 6 weeks incubation. Fatigue was measured by the Chalder Fatigue Scale. RESULT At 6 years after the outbreak, 7 of the 38 patients had become seronegative and 4 of the 14 of the controls had become seropositive for Q fever. None of the patient/control peripheral blood mononuclear cells (PBMC) contained viable C. burnetii by VERO cell culture or by SCID mouse inoculation (death or splenomegaly) and none contained C. burnetii DNA by qPCR. CONCLUSION Six years after acute Q fever, some patients had become seronegative but none contained viable C. burnetii or its DNA in their PBMC.
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Affiliation(s)
- H Hussain-Yusuf
- Australian Rickettsial Reference Laboratory, Newcastle & Geelong, Australia
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Gholipour T, Egorova S, Sevdalinova V, Healy B, Bakshi R, Guttmann C, Khoury S, Weiner H, Chitnis T. MRI Characteristics of Malignant Multiple Sclerosis (S50.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s50.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bove R, Healy B, Houtchens M, Glanz B, Khoury S, Guttmann C, De Jager P, Chitnis T. Menopause May Not Modulate Disease Course in Multiple Sclerosis (P06.183). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Messina S, Vargas-Lowy D, Gandhi R, Kivisakk P, Healy B, Patti F, Zappia M, Khoury S, Weiner H, Chitnis T. Adipokine Levels in Relapsing and Progressive Forms of Multiple Sclerosis (P02.077). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Arora A, Delloglio E, Ceccarelli A, Glanz B, Healy B, Tauhid S, Jackson J, Saravanan N, Benedict R, Bakshi R, Neema M. Quantification of Global Cerebral Gray Matter Atrophy in Multiple Sclerosis from 3T MRI (P03.056). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Round WH, Ng KH, Healy B, Rodriguez L, Thayalan K, Tang F, Fukuda S, Srivastava R, Krisanachinda A, Shiau AC, Deng X, Han Y. AFOMP Policy Statement No. 3: recommendations for the education and training of medical physicists in AFOMP countries. Australas Phys Eng Sci Med 2011; 34:303-7. [PMID: 21809140 DOI: 10.1007/s13246-011-0091-3] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/24/2011] [Indexed: 11/25/2022]
Abstract
AFOMP recognizes that clinical medical physicists should demonstrate that they are competent to practice their profession by obtaining appropriate education, training and supervised experience in the specialties of medical physics in which they practice, as well as having a basic knowledge of other specialties. To help its member countries to achieve this, AFOMP has developed this policy to provide guidance when developing medical physicist education and training programs. The policy is compatible with the standards being promoted by the International Organization for Medical Physics and the International Medical Physics Certification Board.
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Affiliation(s)
- W H Round
- School of Engineering, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand.
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Gholipour T, Healy B, Baruch NF, Weiner HL, Chitnis T. Demographic and clinical characteristics of malignant multiple sclerosis. Neurology 2011; 76:1996-2001. [DOI: 10.1212/wnl.0b013e31821e559d] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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24
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Healy B, Frantzis J, Murry R, Martin J, Middleton M, Catton C, Kron T. Development of a dosimetry inter-comparison for IMRT as part of site credentialing for a TROG multi-centre clinical trial for prostate cancer. Australas Phys Eng Sci Med 2011; 34:195-202. [DOI: 10.1007/s13246-011-0063-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 03/03/2011] [Indexed: 12/25/2022]
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Abstract
OBJECTIVE This observational cohort study investigated the seasonal prevalence of multiple sclerosis (MS) disease activity (likelihood and intensity), as reflected by new lesions from serial T2-weighted MRI, a sensitive marker of subclinical disease activity. METHODS Disease activity was assessed from the appearance of new T2 lesions on 939 separate brain MRI examinations in 44 untreated patients with MS. Likelihood functions for MS disease activity were derived, accounting for the temporal uncertainty of new lesion occurrence, individual levels of disease activity, and uneven examination intervals. Both likelihood and intensity of disease activity were compared with the time of year (season) and regional climate data (temperature, solar radiation, precipitation) and among relapsing and progressive disease phenotypes. Contrast-enhancing lesions and attack counts were also compared for seasonal effects. RESULTS Unlike contrast enhancement or attacks, new T2 activity revealed a likelihood 2-3 times higher in March-August than during the rest of the year, and correlated strongly with regional climate data, in particular solar radiation. In addition to the likelihood or prevalence, disease intensity was also elevated during the summer season. The elevated risk season appears to lessen for progressive MS and occur about 2 months earlier. CONCLUSION This study documents evidence of a strong seasonal pattern in subclinical MS activity based on noncontrast brain MRI. The observed seasonality in MS disease activity has implications for trial design and therapy assessment. The observed activity pattern is suggestive of a modulating role of seasonally changing environmental factors or season-dependent metabolic activity.
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Affiliation(s)
- D S Meier
- Center for Neurological Imaging, Brigham & Women's Hospital, 221 Longwood Avenue, RF396, Boston, MA 02115, USA.
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Abstract
We report an audit of 208 patients with a mean age of 39 years (16 to 65) attending the Orthopaedic Assessment Unit at the Wellington Hospital between January 2006 and December 2007 with an injury of the tendo Achillis requiring immobilisation in a cast. Information on assessment of venous thromboembolism (VTE) risk, prophylactic measures and VTE events for all patients was obtained from the medical records. A VTE risk factor was documented in the records of three (1%) patients. One of the 208 patients received aspirin prophylaxis; none received low molecular weight heparin. In all, 13 patients (6.3%, 95% confidence interval 3.4 to 10.5) developed symptomatic VTE during immobilisation in a cast, including six with a distal deep-vein thrombosis (DVT), four with a proximal DVT, and three with a confirmed pulmonary embolus. This incidence of symptomatic VTE is similar to that reported following elective hip replacement. We propose that consideration is given to VTE prophylaxis during prolonged immobilisation of the lower limbs in a cast, to ensure that the same level of protection is provided as for patients undergoing elective hip replacement.
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Affiliation(s)
- B Healy
- Medical Research Institute of New Zealand, P. O. Box 10055, Wellington 6143, New Zealand.
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Bibby S, Healy B, Steele R, Kumareswaran K, Nelson H, Beasley R. Association between leukotriene receptor antagonist therapy and Churg-Strauss syndrome: an analysis of the FDA AERS database. Thorax 2010; 65:132-8. [PMID: 20147592 DOI: 10.1136/thx.2009.120972] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The possible role of leukotriene receptor antagonist (LTRA) therapy in the pathogenesis of Churg-Strauss syndrome (CSS) is uncertain. The aim was to examine the association between LTRA therapy and CSS in cases registered in the FDA Adverse Event Reporting System (AERS) database. METHODS All cases of suspected drug-induced CSS reported to the AERS database between November 1997 and April 2003 were reviewed. Subjects in whom LTRAs were the suspected medication and sufficient documentation existed to confirm the diagnosis of CSS were sequentially categorised into one of the following groups: (A) CSS before treatment initiation; (B) oral or inhaled corticosteroids reduced or stopped within 6 months of CSS onset; (C) possible prodromal phase of CSS at treatment initiation; (D) unstable asthma at treatment initiation; (E) stable asthma at treatment initiation. RESULTS There were 181 case reports of suspected drug-induced CSS with sufficient documentation to confirm a diagnosis of CSS; in 163 (90%) an LTRA was a suspect medication. In 140 of these 163 cases there was sufficient documentation to sequentially categorize the case into groups, with 13 (9%) in A, 27 (19%) in B, 11 (8%) in C, 28 (20%) in D and 61 (44%) in E. CONCLUSION LTRA therapy was a suspect medication in most confirmed cases of CSS reported in the AERS database. In the majority of cases treated with an LTRA, CSS could not be explained by either corticosteroid withdrawal or pre-existing CSS. These findings are informative in considering the potential associations between LTRA therapy and CSS.
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Affiliation(s)
- S Bibby
- Medical Research Institute of New Zealand, P O Box 10055, Wellington 6143, New Zealand
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Wijesinghe M, Perrin K, Healy B, Hart K, Clay J, Weatherall M, Beasley R. Pre-hospital oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Intern Med J 2010; 41:618-22. [PMID: 20214690 DOI: 10.1111/j.1445-5994.2010.02207.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND High concentration oxygen is commonly administered during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The aim of this study was to determine the association between oxygen, severity markers and poor outcomes in AECOPD. METHODS In an audit of patients with AECOPD arriving by ambulance to the Emergency Department of Wellington Hospital, details of oxygen administration, clinical outcomes and severity markers were documented. The main outcome measure was a composite of death, assisted ventilation, or respiratory failure. Associations between oxygen therapy, severity markers and poor clinical outcomes were assessed by logistic regression. RESULTS Of 250 patients 77 (31%) died, required assisted ventilation or were in respiratory failure. Increased oxygen flow was associated with increasing risk of death, assisted ventilation or respiratory failure with an odds ratio (OR) of 1.2 (95% CI 1.0-1.4) per 1 L/min oxygen flow. Increasing PaO(2) was associated with a greater risk of a poor outcome with an OR of 1.1 (95% CI 1.0-1.3) per 10 mmHg higher PaO(2). Home oxygen (OR 2.8, 95% CI 1.5-5.1), previous respiratory failure (OR 2.6, 95% CI 1.5-4.6), previous ventilation (OR 3.2, 95% CI 1.7-5.9) and home nebulizer use (OR 2.4, 95% CI 1.4-4.3) were associated with an increased risk of a poor outcome. CONCLUSION In AECOPD high flow oxygen in the ambulance is associated with poor clinical outcomes. A number of easily identified markers of chronic disease severity indicate an increased risk of a poor clinical outcome.
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Affiliation(s)
- M Wijesinghe
- Medical Research Institute of New Zealand, University of Otago Wellington, New Zealand
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Wijesinghe M, Shirtcliffe P, Perrin K, Healy B, James K, Weatherall M, Beasley R. An audit of the effect of oxygen prescription charts on clinical practice. Postgrad Med J 2010; 86:89-93. [DOI: 10.1136/pgmj.2009.087528] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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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30
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Healy B, Huynh S, Mullane N, O'Brien S, Iversen C, Lehner A, Stephan R, Parker C, Fanning S. Microarray-based comparative genomic indexing of the Cronobacter genus (Enterobacter sakazakii). Int J Food Microbiol 2009; 136:159-64. [DOI: 10.1016/j.ijfoodmicro.2009.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 06/09/2009] [Accepted: 07/03/2009] [Indexed: 10/20/2022]
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31
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Healy B, Valsasina P, Filippi M, Bakshi R. Sample size requirements for treatment effects using gray matter, white matter and whole brain volume in relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80:1218-23. [PMID: 19204021 PMCID: PMC2846617 DOI: 10.1136/jnnp.2008.154732] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the sample size requirements for a neuroprotection trial with change in cerebral gray matter volume (GMV), white matter volume (WMV) or whole brain parenchymal volume (BPV) as outcome measures in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Two datasets with longitudinal MRI measures of untreated patients with RRMS (n = 116 and n = 26) and one dataset of treated patients with RRMS (n = 109) were investigated. In each dataset, normalised GMV, normalised WMV and normalised BPV were analysed using a random intercepts and slopes model to estimate the variance components and per cent change. The required sample size to observe a 33%, 50% and 90% reduction in the per cent change was calculated for each dataset using both a constant per cent change for each measurement and the estimated per cent change for each dataset. RESULTS The per cent change was greatest in GMV but all variance components were smallest in BPV. Using the estimated per cent change, the sample size required in the untreated cohorts was similar for GMV and BPV, and both were lower than WMV. In the treated cohort, the sample size for GMV was the smallest of all measures. Including additional scans reduced the sample size but increasing the length of the trial and clustering scans led to greater reductions. CONCLUSIONS Cerebral GMV may be a viable outcome measure for clinical trials investigating neuroprotection in RRMS patients, especially considering that the treatment effect may be larger on GMV compared with BPV. However, GMV was somewhat limited by increased variability versus BPV.
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Affiliation(s)
- B Healy
- Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School, Boston, Massachusetts, USA
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32
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O’Brien S, Healy B, Negredo C, Anderson W, Fanning S, Iversen C. Prevalence ofCronobacterspecies (Enterobacter sakazakii) in follow-on infant formulae and infant drinks. Lett Appl Microbiol 2009; 48:536-41. [DOI: 10.1111/j.1472-765x.2009.02562.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [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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Chitnis T, Glanz B, Jaffin S, Healy B. Demographics of pediatric-onset multiple sclerosis in an MS center population from the Northeastern United States. Mult Scler 2009; 15:627-31. [PMID: 19299440 DOI: 10.1177/1352458508101933] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The prevalence of pediatric-onset multiple sclerosis (MS) in the United States is unknown. Objective In a large cohort of MS patients, we sought to identify the proportion with first symptom-onset below the age of 18 years, and to compare their demographic and disease characteristics to a typical adult-onset MS population. Methods Patients seen at the Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, Massachusetts, with clinical histories and characteristics of first symptoms recorded in an electronic database, were included in this study. Results We found that 3.06% of patients with a recorded MS history experienced a first attack under the age of 18 years of age compared to 30.83% of patients who experienced first symptoms between the ages of 25–35 years. Gender proportions were similar in both groups, with the exception of a lower female preponderance in pre-pubertal-onset patients. There was a higher proportion of non-Caucasians in the younger cohort. Localization of first symptoms was similar in the two groups. Conclusion About 3% of MS patients experience their first symptom prior to the age of 18 years. Standardized follow-up is required after a first demyelinating attack in childhood, which may lead to earlier diagnosis and treatment of pediatric-onset MS.
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Affiliation(s)
- T Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - B Glanz
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - S Jaffin
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - B Healy
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
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Barnes RA, White PL, Bygrave C, Evans N, Healy B, Kell J. Clinical impact of enhanced diagnosis of invasive fungal disease in high-risk haematology and stem cell transplant patients. J Clin Pathol 2008; 62:64-9. [DOI: 10.1136/jcp.2008.058354] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [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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35
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Mullane N, Healy B, Meade J, Whyte P, Wall PG, Fanning S. Dissemination of Cronobacter spp. (Enterobacter sakazakii) in a powdered milk protein manufacturing facility. Appl Environ Microbiol 2008; 74:5913-7. [PMID: 18641152 PMCID: PMC2565973 DOI: 10.1128/aem.00745-08] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Accepted: 07/07/2008] [Indexed: 11/20/2022] Open
Abstract
The microbial contamination of air filters and possible links to contaminated product in a powdered milk protein-processing facility were investigated. Over a 10-month period, seven air filters, the environment, and powdered product were analyzed for the presence of Cronobacter spp. The effects of air filter installation, maintenance, and subsequent dissemination of Cronobacter were investigated. A total of 30 isolates were characterized by pulsed-field gel electrophoresis (PFGE). PFGE revealed the presence of three clonal populations distributed throughout the manufacturing site. This study highlights the need for proper installation of air filters to limit the dissemination of microorganisms into processing sites.
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Affiliation(s)
- N Mullane
- Centre for Food Safety, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Viglietta V, Bourcier K, Buckle GJ, Healy B, Weiner HL, Hafler DA, Egorova S, Guttmann CRG, Rusche JR, Khoury SJ. CTLA4Ig treatment in patients with multiple sclerosis: an open-label, phase 1 clinical trial. Neurology 2008; 71:917-24. [PMID: 18794494 DOI: 10.1212/01.wnl.0000325915.00112.61] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The modulation of costimulatory pathways represents an original therapeutic approach to regulate T cell-mediated autoimmune diseases by preventing or reducing autoantigen-driven T-cell activation in humans. Autoreactive CD4(+) T cells play a critical role in initiating the immune response leading to the chronic inflammation and demyelination characteristic of multiple sclerosis (MS). METHODS We used IV infusions of CTLA4Ig to block the CD28/B7 T-cell costimulatory pathway in a phase 1 dose-escalation study in MS. Sixteen patients with relapsing-remitting MS received a single CTLA4Ig infusion and were monitored for up to 3 months after treatment. In an extension study, four additional subjects received four doses of CTLA4Ig. RESULTS CTLA4Ig was well tolerated in patients with MS, and most adverse events were rated as mild. Immunologic assessment of the patients showed a reduction in myelin basic protein (MBP) proliferation within 2 months of infusion and decreased interferon-gamma production by MBP-specific lines. CONCLUSIONS Inhibiting costimulatory molecule interactions by using CTLA4Ig seems safe in multiple sclerosis (MS), and the immunologic effects suggest that it may be a promising approach to regulate the inflammatory process associated with MS.
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Affiliation(s)
- V Viglietta
- Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Healy B, Mullane N, Collin V, Mailler S, Iversen C, Chatellier S, Storrs M, Fanning S. Evaluation of an automated repetitive sequence-based PCR system for subtyping Enterobacter sakazakii. J Food Prot 2008; 71:1372-8. [PMID: 18680935 DOI: 10.4315/0362-028x-71.7.1372] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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
Enterobacter sakazakii is regarded as a ubiquitous organism that can be isolated from a wide range of foods and environments. Infection in at-risk infants has been epidemiologically linked to the consumption of contaminated powdered infant formula. Preventing the dissemination of this pathogen in a powdered infant formula manufacturing facility is an important step in ensuring consumer confidence in a given brand together with the protection of the health status of a vulnerable population. In this study we report the application of a repetitive sequence-based PCR typing method to subtype a previously well-characterized collection of E. sakazakii isolates of diverse origin. While both methods successfully discriminated between the collection of isolates, repetitive sequence-based PCR identified 65 types, whereas pulsed-field gel electrophoresis identified 110 types showing > or =95% similarity. The method was quick and easy to perform, and our data demonstrated the utility and value of this approach to monitor in-process contamination, which could potentially contribute to a reduction in the transmission of E. sakazakii.
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Affiliation(s)
- B Healy
- Centre for Food Safety, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Mullane NR, Iversen C, Healy B, Walsh C, Whyte P, Wall PG, Quinn T, Fanning S. Enterobacter sakazakii an emerging bacterial pathogen with implications for infant health. Minerva Pediatr 2007; 59:137-48. [PMID: 17404564] [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: 05/14/2023]
Abstract
Enterobacter sakazakii (E. sakazakii) is an opportunistic pathogen and the aetiological agent in rare but life-threatening cases of meningitis, necrotizing enterocolitis, and sepsis in infants. Among infants, those at greatest risk are neonates (<28 days), particularly those born prematurely or of low birth weight (<2500 g). Consumption of contaminated powdered infant formula (PIF) has been epidemiologically linked with cases of infection. Contamination can occur during the manufacturing process or during postmanufacture reconstitution of formula. Development of rapid, sensitive and specific detection methods will facilitate manufacturers efforts to reduce the occurrence of E. sakazakii in the final powdered product. Furthermore, since PIF is not a sterile product, proper precautions should be taken during handling and reconstitution of formula prior to feeding in order to prevent contamination and proliferation of the bacterium.
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Affiliation(s)
- N R Mullane
- Centre for Food Safety School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland
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Abstract
This report documents a case of sepsis caused by a recently recognized environmental organism and demonstrates the pathogenicity of this bacterium in the clinical setting.
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Affiliation(s)
- A Shetty
- Department of Medical Microbiology/PHL, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN, UK
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Healy B, Llewelyn M, Westmoreland D, Lloyd G, Brown N. The value of follow-up after acute Q fever infection. J Infect 2006; 52:e109-12. [PMID: 16181676 DOI: 10.1016/j.jinf.2005.07.016] [Citation(s) in RCA: 13] [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] [Received: 05/25/2005] [Accepted: 07/23/2005] [Indexed: 11/25/2022]
Abstract
This is a case report of a 53-year-old woman involved in an outbreak of Q fever, in whom Q fever endocarditis was diagnosed 18 months after acute Q fever infection. At the time of diagnosis, she was completely asymptomatic and without screening for chronic Q fever, this severe potentially life-threatening infection would probably not have been recognised until significant valvular destruction had taken place. Early diagnosis enabled prompt, potentially curative medical treatment to start without the need for valvular heart surgery. The authors advocate that serological monitoring should be carried out every 4 months for a period of 2 years after acute Q fever and patients with high phase 1 IgG titres (>800) be investigated further and/or followed more closely depending on the clinical scenario. The case report also discusses the use of complement fixation testing in the diagnosis of Q fever endocarditis. The authors recommend that in cases of culture negative endocarditis, a single negative complement fixation test is not sufficient to exclude the diagnosis of Q fever endocarditis. Micro-immunofluorescence or repeat complement fixation testing is recommended when Q fever endocarditis is suspected clinically.
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Affiliation(s)
- B Healy
- Microbiology Department, NPHS, UHW, Heath Park, Cardiff CF14 4XW, UK.
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Affiliation(s)
- B Healy
- Microbiology Cardiff , NPHS Wales, UHW, Heath Park, Cardiff CF14 4XW, UK.
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Hill R, Healy B, Holloway L, Baldock C. SU-FF-T-181: An Investigation of Surface Dose Changes for Therapeutic Kilovoltage X-Ray Beams with Underlying Lead Shielding. Med Phys 2005. [DOI: 10.1118/1.1997862] [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: 11/07/2022] Open
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Hirt RP, Lal K, Pinxteren J, Warwicker J, Healy B, Coombs GH, Field MC, Embley TM. Biochemical and genetic evidence for a family of heterotrimeric G-proteins in Trichomonas vaginalis. Mol Biochem Parasitol 2003; 129:179-89. [PMID: 12850262 DOI: 10.1016/s0166-6851(03)00122-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have cloned a single copy gene from the human parasite Trichomonas vaginalis that encodes a putative protein of 402 amino acids with approximately 35% sequence identity to known alpha subunits of heterotrimeric G-proteins. It contains the characteristic GTP binding domains G-1 to G-5 with the key residues conserved. The new sequence has an unusual N-terminal extension of approximately 70 residues that cannot be aligned to reference G-proteins and which is characterised by proline-rich repeats. To investigate the expression and cellular localisation of the protein we produced specific antisera against a recombinant fusion protein. The antisera recognised a protein of an apparent molecular mass of 51 kDa in protein extracts from T. vaginalis and immunofluorescent microscopy established that the protein is localised to discrete endomembranes. Using a protocol designed to purify mammalian heterotrimeric G-proteins incorporating a GTPgammaS binding assay, we isolated two proteins from Trichomonas that are recognised by an heterologous GA/1 antisera raised to a peptide of the conserved G-1 domain of G-protein alpha subunits. These two proteins have an apparent molecular mass of 61 and 48 kDa, respectively, larger and smaller than the translation product of the cloned gene. Consistent with these results, the GA/1 antisera did not cross-react with the fusion protein produced from the gene we have cloned. These data suggest T. vaginalis possesses more than one heterotrimeric G-protein alpha subunit. Based on the sequence features of the cloned gene and the biochemical properties of the purified proteins, we suggest that these alpha subunits are likely to be part of classic heterotrimeric G-protein complexes.
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Affiliation(s)
- R P Hirt
- Department of Zoology, The Natural History Museum, Cromwell Rd, London SW7 5BD, UK.
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Ackerly T, Andrews J, Ball D, Guerrieri M, Healy B, Williams I. Discrepancies in volume calculations between different radiotherapy treatment planning systems. Australas Phys Eng Sci Med 2003; 26:91-3. [PMID: 12956193] [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: 03/04/2023]
Abstract
It has been determined that, contrary to expectation, there is a clinically significant variation in the volume calculations of different RTPS (Radiotherapy Treatment Planning System) for identical contours. The situation was investigated prior to a multi-centre trial to determine whether tumour volume is an independent prognostic factor in NSCLC (non-small cell lung cancer) and included four of the commercially available RTPS. The four RTPS tested were, Theraplan Plus V3.0, Cadplan V6.2, Focus V2.6 and ADAC V3.0. Five randomly chosen clinical target related volumes (3 GTVs, one PTV and one CTV) from the trial database originally marked on the Cadplan system were transferred to the other four systems and the resulting volumes were calculated. It was found that Cadplan consistently underestimated the volume relative to the other three systems by 6-12%. This systematic underestimation was found to be caused by different assumptions made by the Cadplan system about the axial outer slice extension of the volume. Cadplan truncates the volume, while the other three systems extrapolate it by half the slice thickness at each end. A short program was written to apply the same method of volume extension to the Cadplan volume that is utilised by the other systems. This produced calculated volumes that were within +/- 1.0% of the average of the volumes calculated by the other three planning systems, and the maximum deviation from the average for any planning system was then reduced to 1.5%. This program was implemented at all participating trial centres utilising Cadplan, thus reducing the intersystem variability to a negligible factor in comparison to the estimates of inter-physician variation. This unexpected finding has significant implications for the validity of multi-centre trials using dose volume histograms, and indeed the adoption of any clinical protocol employing dose volume histogram constraints derived from experience at another centre employing a different RTPS.
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Affiliation(s)
- T Ackerly
- Physical Sciences Department, Peter MacCallum Cancer Centre East Melbourne, Australia.
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Ackerly T, Andrews J, Ball D, Guerrieri M, Healy B, Williams I. Discrepancies in volume calculations between different radiotherapy treatment planning systems. ACTA ACUST UNITED AC 2003. [DOI: 10.1007/bf03178465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- B Healy
- Biomedical Services, American Red Cross, USA
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Siebers R, Healy B, Holt S, Peters S, Crane J, Fitzharris P. Fel d 1 levels in domestic living rooms are not related to cat color or hair length. J Allergy Clin Immunol 2001; 108:652-3. [PMID: 11590399 DOI: 10.1067/mai.2001.118788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baldock C, Harris PJ, Piercy AR, Healy B. Experimental determination of the diffusion coefficient in two-dimensions in ferrous sulphate gels using the finite element method. Australas Phys Eng Sci Med 2001; 24:19-30. [PMID: 11458569 DOI: 10.1007/bf03178282] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A novel two-dimensional finite element method for modelling the diffusion which occurs in Fricke or ferrous sulphate type radiation dosimetry gels is presented. In most of the previous work, the diffusion coefficient has been estimated using simple one-dimensional models. This work presents a two-dimensional model which enables the diffusion coefficient to be determined in a much wider range of experimental situations. The model includes the provision for the determination of a drift parameter. To demonstrate the technique comparative diffusion measurements between ferrous sulphate radiation dosimetry gels, with and without xylenol orange chelating agent and carbohydrate additives have been undertaken. Diffusion coefficients of 9.7 +/- 0.4, 13.3 +/- 0.6 and 9.5 +/- 0.8 10(-3) cm2h-1 were determined for ferrous sulphate radiation dosimetry gels with and without xylenol orange and with xylenol orange and sucrose additives respectively.
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Affiliation(s)
- C Baldock
- Centre for Medical and Health Physics, School of Physical Sciences, Queensland University of Technology, GPO Box 2434, Brisbane Q 4001.
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