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Gatfield ER, Harvey C, Hayler M, Archer S, Chapman J, Chantler H, Ajithkumar T. The Benefits of a Rapid Access Pathway for Patients Requiring Single Fraction Radiotherapy Treatment: The Cambridge Experience. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00147-X. [PMID: 38702242 DOI: 10.1016/j.clon.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024]
Affiliation(s)
- E R Gatfield
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Harvey
- Department of Radiotherapy, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Hayler
- Department of Radiotherapy, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Archer
- Department of Radiotherapy, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Chapman
- Department of Radiotherapy, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - H Chantler
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T Ajithkumar
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Harvey C. Joint extension speed dictates bio-inspired morphing trajectories for optimal longitudinal flight dynamics. J R Soc Interface 2024; 21:20230734. [PMID: 38654630 PMCID: PMC11040252 DOI: 10.1098/rsif.2023.0734] [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: 12/11/2023] [Revised: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
Avian wing morphing allows dynamic, active control of complex flight manoeuvres. Previous linear time-invariant (LTI) models have quantified the effect of varying fixed wing configurations but the time-dependent effects of morphing between different configurations is not well understood. To fill this gap, I implemented a linear parameter-varying (LPV) model for morphing wing gull flight. This approach models the wing joint angles as scheduled parameters and accounts for nonlinear kinematic and gravitational effects while interpolating between LTI models at discrete trim points. With the resulting model, I investigated the longitudinal response associated with various joint extension trajectories. By optimizing the extension trajectory for four independent objectives (speed and pitch angle overshoot, speed rise time and pitch angle settling time), I found that the extension trajectory inherent to the gull wing does not guarantee an optimal response but may provide a sufficient response with a simpler mechanical implementation. Furthermore, the results indicated that gulls likely require extension speed feedback. This morphing LPV model provides insights into underlying control mechanisms, which may allow for avian-like flight in future highly manoeuvrable uncrewed aerial vehicles.
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Affiliation(s)
- C. Harvey
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA95616, USA
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Magaña G, Harvey C, Taggart CC, Rodgers AM. Bacterial Outer Membrane Vesicles: Role in Pathogenesis and Host-Cell Interactions. Antibiotics (Basel) 2023; 13:32. [PMID: 38247591 PMCID: PMC10812699 DOI: 10.3390/antibiotics13010032] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Outer membrane vesicles (OMVs) are small, spherical structures released from the outer membranes of Gram-negative bacteria into the surrounding environment. Investigations into OMVs range from their biogenesis and cargo composition to their ability to transfer virulence factors and modulate host immune responses. This emerging understanding of OMVs has unveiled their pivotal role in the pathogenicity of infectious diseases, shedding light on their interactions with host cells, their contributions to inflammation, their potential involvement in antimicrobial resistance, and their promising use for the development of novel treatments and therapies. Numerous studies have associated the OMVs of pathogenic bacteria with the exacerbation of inflammatory diseases, underlining the significance of understanding the mechanisms associated with these vesicles to find alternatives for combating these conditions. Additionally, OMVs possess the ability to act as decoys, absorbing and neutralizing antibiotics, which significantly diminishes the efficacy of a broad spectrum of antimicrobial agents. Another subtopic of interest is OMVs produced by commensal microbiota. These vesicles are increasingly acknowledged for their mutualistic functions, significantly influencing their host's physiology and immune responses. Consequently, OMVs play a crucial role in maintaining a balanced gut microbiota by fostering symbiotic relationships that significantly contribute to the overall health and well-being of the host. This comprehensive review aims to provide an up-to-date review of OMVs derived from Gram-negative bacteria, summarizing current research findings, and elucidating the multifaceted role of these vesicles in diverse biological contexts.
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Affiliation(s)
| | | | | | - Aoife M. Rodgers
- Wellcome Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast BT9 7AE, UK; (G.M.); (C.H.); (C.C.T.)
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Abstract
The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2), and the disease it causes (COVID-19), have had a profound impact on global human society and threaten to continue to have such an impact with newly emerging variants. Because of the widespread effects of SARS-CoV-2, understanding how lifestyle choices impact the severity of disease is imperative. This review summarizes evidence for an involvement of chronic, non-resolving inflammation, gut microbiome disruption (dysbiosis with loss of beneficial microorganisms), and impaired viral defenses, all of which are associated with an imbalanced lifestyle, in severe disease manifestations and post-acute sequelae of SARS-CoV-2 (PASC). Humans' physiological propensity for uncontrolled inflammation and severe COVID-19 are briefly contrasted with bats' low propensity for inflammation and their resistance to viral disease. This insight is used to identify positive lifestyle factors with the potential to act in synergy for restoring balance to the immune response and gut microbiome, and thereby protect individuals against severe COVID-19 and PASC. It is proposed that clinicians should consider recommending lifestyle factors, such as stress management, balanced nutrition and physical activity, as preventative measures against severe viral disease and PASC.
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Affiliation(s)
- Elizabeth Enichen
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, CO, USA (EE, CH, BDA)
| | - Caitlyn Harvey
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, CO, USA (EE, CH, BDA)
| | - Barbara Demmig-Adams
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, CO, USA (EE, CH, BDA)
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Harvey C, Baliga VB, Wong JCM, Altshuler DL, Inman DJ. Birds can transition between stable and unstable states via wing morphing. Nature 2022; 603:648-653. [PMID: 35264798 PMCID: PMC8942853 DOI: 10.1038/s41586-022-04477-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/26/2022] [Indexed: 11/12/2022]
Abstract
Birds morph their wing shape to accomplish extraordinary manoeuvres1–4, which are governed by avian-specific equations of motion. Solving these equations requires information about a bird’s aerodynamic and inertial characteristics5. Avian flight research to date has focused on resolving aerodynamic features, whereas inertial properties including centre of gravity and moment of inertia are seldom addressed. Here we use an analytical method to determine the inertial characteristics of 22 species across the full range of elbow and wrist flexion and extension. We find that wing morphing allows birds to substantially change their roll and yaw inertia but has a minimal effect on the position of the centre of gravity. With the addition of inertial characteristics, we derived a novel metric of pitch agility and estimated the static pitch stability, revealing that the agility and static margin ranges are reduced as body mass increases. These results provide quantitative evidence that evolution selects for both stable and unstable flight, in contrast to the prevailing narrative that birds are evolving away from stability6. This comprehensive analysis of avian inertial characteristics provides the key features required to establish a theoretical model of avian manoeuvrability. Analysis of inertial characteristics across 22 bird species shows that evolution has selected for avian manoeuvrability using both stable and unstable flight dynamics.
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Affiliation(s)
- C Harvey
- Department of Aerospace Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - V B Baliga
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - J C M Wong
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - D L Altshuler
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - D J Inman
- Department of Aerospace Engineering, University of Michigan, Ann Arbor, MI, USA
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Harvey C, Baliga VB, Goates CD, Hunsaker DF, Inman DJ. Correction to 'Gull-inspired joint-driven wing morphing allows adaptive longitudinal flight control'. J R Soc Interface 2021; 18:20210635. [PMID: 34465212 DOI: 10.1098/rsif.2021.0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Harvey C, Baliga VB, Goates CD, Hunsaker DF, Inman DJ. Gull-inspired joint-driven wing morphing allows adaptive longitudinal flight control. J R Soc Interface 2021; 18:20210132. [PMID: 34102085 PMCID: PMC8187025 DOI: 10.1098/rsif.2021.0132] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
Birds dynamically adapt to disparate flight behaviours and unpredictable environments by actively manipulating their skeletal joints to change their wing shape. This in-flight adaptability has inspired many unmanned aerial vehicle (UAV) wings, which predominately morph within a single geometric plane. By contrast, avian joint-driven wing morphing produces a diverse set of non-planar wing shapes. Here, we investigated if joint-driven wing morphing is desirable for UAVs by quantifying the longitudinal aerodynamic characteristics of gull-inspired wing-body configurations. We used a numerical lifting-line algorithm (MachUpX) to determine the aerodynamic loads across the range of motion of the elbow and wrist, which was validated with wind tunnel tests using three-dimensional printed wing-body models. We found that joint-driven wing morphing effectively controls lift, pitching moment and static margin, but other mechanisms are required to trim. Within the range of wing extension capability, specific paths of joint motion (trajectories) permit distinct longitudinal flight control strategies. We identified two unique trajectories that decoupled stability from lift and pitching moment generation. Further, extension along the trajectory inherent to the musculoskeletal linkage system produced the largest changes to the investigated aerodynamic properties. Collectively, our results show that gull-inspired joint-driven wing morphing allows adaptive longitudinal flight control and could promote multifunctional UAV designs.
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Affiliation(s)
- C. Harvey
- Department of Aerospace Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - V. B. Baliga
- Department of Zoology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - C. D. Goates
- Department of Mechanical and Aerospace Engineering, Utah State University, Logan, UT 84322, USA
| | - D. F. Hunsaker
- Department of Mechanical and Aerospace Engineering, Utah State University, Logan, UT 84322, USA
| | - D. J. Inman
- Department of Aerospace Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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Zipfel S, Biancari F, Mariscalco G, Dalén M, Settembre N, Welp H, Perrotti A, Wiebe K, Leo E, Loforte A, Chocron S, Pacini D, Juvonen T, Broman LM, Di Perna D, Yusuff H, Harvey C, Mongardon N, Maureira JP, Levy B, Falk L, Ruggieri VG, Kluge S, Reichenspurner H, Folliguet T, Fiore A. Extracorporeal Membrane Oxygenation for Patients with Severe COVID-19-Related ARDS: A European Multicenter Analysis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Camenzuli C, DiMarco AN, Isaacs KE, Grant Y, Jackson J, Alsafi A, Harvey C, Barwick TD, Tolley N, Palazzo FF. The changing face of reoperative parathyroidectomy: a single-centre comparison of 147 parathyroid reoperations. Ann R Coll Surg Engl 2020; 103:29-34. [PMID: 32829647 DOI: 10.1308/rcsann.2020.0185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Reoperative parathyroidectomy for persistent and recurrent primary hyperparathyroidism is dependent on radiology. This study aimed to compare outcomes in reoperative parathyroidectomy at a single centre using a combination of traditional and newer imaging studies. MATERIALS AND METHODS Retrospective case note review of all reoperative parathyroidectomies for persistent and recurrent primary hyperparathyroidism over five years (June 2014 to June 2019; group A). Imaging modalities used and their positive predictive value, complications and cure rates were compared with a published dataset spanning the preceding nine years (group B). RESULTS From over 2000 parathyroidectomies, 147 were reoperations (101 in group A and 46 in group B). Age and sex ratios were similar (56 vs 62 years; 77% vs 72% female). Ultrasound use remains high and shows better positive predictive value (76% vs 57 %). 99mTc-sestamibi use has declined (79% vs 91%) but the positive predictive value has improved (74% vs 53%). 4DCT use has almost doubled (61% vs 37%) with better positive predictive value (88% vs 75%). 18F-fluorocholine positron emission tomography-computed tomography and ultrasound-guided fine-needle aspiration for parathyroid hormone are novel modalities only available for group A. Both carried a positive predictive value of 100%. Venous sampling with or without angiography use has decreased (35% vs 39%) but maintains a high positive predictive value (86% vs 91%). Cure rates were similar (96% vs 100%). Group A had 5% permanent hypoparathyroidism, 1% permanent vocal cord palsy and 1% haematoma requiring reoperation. No complications for group B. CONCLUSION Optimal imaging is key to good cure rates in reoperative parathyroidectomy. High-quality, non-interventional imaging techniques have produced a shift in the preoperative algorithm without compromising outcomes.
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Affiliation(s)
- C Camenzuli
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A N DiMarco
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - K E Isaacs
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Y Grant
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - J Jackson
- Department of Endocrine and Thyroid Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Alsafi
- Department of Endocrine and Thyroid Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C Harvey
- Department of Endocrine and Thyroid Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T D Barwick
- Department of Endocrine and Thyroid Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - N Tolley
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - F F Palazzo
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Harvey C, Ratcliffe P, Gulliford MC. Well-being, physical activity and long-term conditions: cross-sectional analysis of Health Survey for England 2016. Public Health 2020; 185:368-374. [PMID: 32739777 DOI: 10.1016/j.puhe.2020.06.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/20/2020] [Accepted: 06/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated whether physical activity is associated with greater well-being in people with multiple long-term conditions or limiting long-term illness (LLI). STUDY DESIGN Cross-sectional analysis of data from the Health Survey for England 2016. METHODS The Warwick-Edinburgh mental well-being score (WEMWBS) was evaluated according to number of days per week with >30 min moderate or vigorous activity. LLI and number of long-term conditions were evaluated as effect modifiers, adjusting for age, sex, smoking, body mass index and education. Marginal effects were estimated for female non-smokers, aged 45-54 years. RESULTS Data were analyzed for 5952 adults (female, 3275; male, 2677) including 1104 (19%) with non-limiting long-term illness and 1486 (25%) with LLI. There were 2065 (35%) with 1-2 long-term conditions, 461 (8%) with 3-4 and 58 (1%) with 5-6 long-term conditions. Participants with LLI were less likely to engage in physical activity on 5 or more days per week (LLI, 24%; No LLI, 47%) and more likely to be inactive (LLI, 41%; No LLI 13%). The adjusted marginal mean WEMWBS for inactive participants with no long-term illness was 49.0 (95% confidence interval 48.1 to 50.0), compared with 51.1 (50.4-51.8) if active on 5+ days per week. In LLI, the adjusted marginal mean WEMWBS was 41.6 (40.7-42.5) if inactive but 47.6 (46.6-48.6) if active on 5+ days per week. Similar associations were observed for the number of long-term conditions. CONCLUSIONS Physical activity may be associated with greater increments in well-being among people with multiple long-term conditions or LLI than those without.
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Affiliation(s)
- C Harvey
- King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London SE1 1UL, UK
| | - P Ratcliffe
- King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London SE1 1UL, UK
| | - M C Gulliford
- King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London SE1 1UL, UK.
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11
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Abstract
A gliding bird's ability to stabilize its flight path is as critical as its ability to produce sufficient lift. In flight, birds often morph the shape of their wings, but the consequences of avian wing morphing on flight stability are not well understood. Here, we investigate how morphing the gull elbow joint in gliding flight affects their static pitch stability. First, we combined observations of freely gliding gulls and measurements from gull wing cadavers to identify the wing configurations used during gliding flight. These measurements revealed that, as wind speed and gusts increased, gulls flexed their elbows to adopt wing shapes characterized by increased spanwise camber. To determine the static pitch stability characteristics of these wing shapes, we prepared gull wings over the anatomical elbow range and measured the developed pitching moments in a wind tunnel. Wings prepared with extended elbow angles had low spanwise camber and high passive stability, meaning that mild perturbations could be negated without active control. Wings with flexed elbow angles had increased spanwise camber and reduced static pitch stability. Collectively, these results demonstrate that gliding gulls can transition across a broad range of static pitch stability characteristics using the motion of a single joint angle.
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Affiliation(s)
- C Harvey
- 1 Department of Zoology, University of British Columbia , Vancouver, British Colombia , Canada V6T 1Z4
| | - V B Baliga
- 1 Department of Zoology, University of British Columbia , Vancouver, British Colombia , Canada V6T 1Z4
| | - P Lavoie
- 2 Institute for Aerospace Studies, University of Toronto , Toronto, Ontario , Canada M3H 5T6
| | - D L Altshuler
- 1 Department of Zoology, University of British Columbia , Vancouver, British Colombia , Canada V6T 1Z4
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Doukakis E, Debattista K, Bashford-Rogers T, Dhokia A, Asadipour A, Chalmers A, Harvey C. Audio-Visual-Olfactory Resource Allocation for Tri-modal Virtual Environments. IEEE Trans Vis Comput Graph 2019; 25:1865-1875. [PMID: 30762561 DOI: 10.1109/tvcg.2019.2898823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Virtual Environments (VEs) provide the opportunity to simulate a wide range of applications, from training to entertainment, in a safe and controlled manner. For applications which require realistic representations of real world environments, the VEs need to provide multiple, physically accurate sensory stimuli. However, simulating all the senses that comprise the human sensory system (HSS) is a task that requires significant computational resources. Since it is intractable to deliver all senses at the highest quality, we propose a resource distribution scheme in order to achieve an optimal perceptual experience within the given computational budgets. This paper investigates resource balancing for multi-modal scenarios composed of aural, visual and olfactory stimuli. Three experimental studies were conducted. The first experiment identified perceptual boundaries for olfactory computation. In the second experiment, participants ( N=25) were asked, across a fixed number of budgets ( M=5), to identify what they perceived to be the best visual, acoustic and olfactory stimulus quality for a given computational budget. Results demonstrate that participants tend to prioritize visual quality compared to other sensory stimuli. However, as the budget size is increased, users prefer a balanced distribution of resources with an increased preference for having smell impulses in the VE. Based on the collected data, a quality prediction model is proposed and its accuracy is validated against previously unused budgets and an untested scenario in a third and final experiment.
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Meadows C, Toolan M, Slack A, Newman S, Ostermann M, Camporota L, Gardiner D, Webb S, Barker J, Vuylsteke A, Harvey C, Ledot S, Scott I, Barrett NA. Diagnosis of death using neurological criteria in adult patients on extracorporeal membrane oxygenation: Development of UK guidance. J Intensive Care Soc 2019; 21:28-32. [PMID: 32284715 DOI: 10.1177/1751143719832170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/17/2022] Open
Abstract
The diagnosis of death using neurological criteria is an important legal method of establishing death in the UK. The safety of the diagnosis lies in the exclusion of conditions which may mask the diagnosis and the testing of the fundamental reflexes of the brainstem including the apnoea reflex. Extracorporeal membrane oxygenation for cardiac or respiratory support can impact upon these tests, both through drug sequestration in the circuit and also through the ability to undertake the apnoea test. Until recently, there has been no nationally accepted guidance regarding the conduct of the tests to undertake the diagnosis of death using neurological criteria for a patient on extracorporeal membrane oxygenation. This article considers both the background to and the process of guideline development.
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Affiliation(s)
- Cis Meadows
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Toolan
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Slack
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Newman
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,NHS Blood and Transplant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Ostermann
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Camporota
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Gardiner
- NHS Blood and Transplant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Webb
- Department of Critical Care Medicine, Royal Papworth NHS Foundation Trust, Cambridge, UK.,Joint Standards Committee of the Intensive Care Society & Faculty of Intensive Care Medicine, London, UK
| | - J Barker
- Department of Critical Care Medicine, Manchester University Hospitals, Manchester, UK
| | - A Vuylsteke
- Department of Critical Care Medicine, Royal Papworth NHS Foundation Trust, Cambridge, UK
| | - C Harvey
- Department of Critical Care Medicine, University Hospital of Leicester, Leicester, UK
| | - S Ledot
- Department of Critical Care Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - I Scott
- Department of Critical Care Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
| | - N A Barrett
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Abraham JE, Vallier AL, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Provenzano E, Pinilla K, Roylance R, Copson E, Armstrong A, McMurtry E, Tischkowitz M, Earl HM. Abstract OT3-01-02: PARTNERING / PARTNER : Phase II sub-study to establish if the addition of combinations of new agents (olaparib, cell cycle and immune checkpoint inhibitors) can improve the rate of pathological complete response (pCR) and minimal residual disease (MRD) in triple negative breast cancer (TNBC) and / or germline BRCA mutated (gBRCAm) patients with evidence of residual disease after PARTNER therapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-01-02] [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: 11/16/2022]
Abstract
Abstract
Background:
In patients with TNBC, following standard neoadjuvant chemotherapy, residual disease (RD) is correlated with poor prognosis and 50% relapse within 5 years [1]. PARTNER is a neoadjuvant clinical trial which randomises TNBC and gBRCAm patients to carboplatin and paclitaxel +/- olaparib followed by anthracycline-based chemotherapy. Patients with RD after neoadjuvant treatment in this trial also face poorer survival outcomes, due to the paucity of treatment options. PARTNERING, develops a new strategy using novel agent combinations as an alternative pathway for patients with RD within the PARTNER trial.
Methods: PARTNERING is a phase II open label, sub-study with a two-stage Simon design with biomarker guided treatment cohorts open only to patients in the PARTNER trial. A maximum of 15 patients will be included in each cohort. Patients with RD > 10% tumour cellularity (TC) on biopsy after neoadjuvant therapy will be eligible. Patients who have no tumour cells or < 10% TC, and those with progressive disease will be excluded. Allocation of patients into the cohorts will be based on tumour infiltrating lymphocytes (TILs) expression either on diagnostic or post treatment biopsy. Patients with tumours with TILs score ≤20% are considered “non-immunogenic” They will be stratified according to HRD status and allocated to receive a cell cycle checkpoint inhibitor + olaparib. Patients with a TILs score >20% are considered “immunogenic” and will be allocated to receive an immune checkpoint inhibitor with olaparib or a cell cycle checkpoint inhibitor.
Primary outcome measure is pCR / MRD rate at surgery after the administration of 2 cycles / 8 weeks of a combination of new agents. The rate of conversion to pCR/MRD will be correlated with TC, TILs, BRCA and homologous recombination deficiency (HRD) status, Ki67% and previous olaparib treatment.
Progress: The PARTNERING pathway in the PARTNER trial will be open late 2018.
Citation Format: Abraham JE, Vallier A-L, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Provenzano E, Pinilla K, Roylance R, Copson E, Armstrong A, McMurtry E, Tischkowitz M, Earl HM. PARTNERING / PARTNER : Phase II sub-study to establish if the addition of combinations of new agents (olaparib, cell cycle and immune checkpoint inhibitors) can improve the rate of pathological complete response (pCR) and minimal residual disease (MRD) in triple negative breast cancer (TNBC) and / or germline BRCA mutated (gBRCAm) patients with evidence of residual disease after PARTNER therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-01-02.
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Affiliation(s)
- JE Abraham
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A-L Vallier
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - W Qian
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Machin
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Grybowicz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - S Thomas
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Weiss
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - C Harvey
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K McAdam
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Hughes-Davies
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Roberts
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Provenzano
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K Pinilla
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - R Roylance
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Copson
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Armstrong
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E McMurtry
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Tischkowitz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - HM Earl
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
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Abraham J, Vallier AL, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Roylance R, Copson E, Pinilla K, Armstrong A, Provenzano E, Tischkowitz M, McMurty E, Earl H. Abstract OT3-03-03: PARTNER: Randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-03-03] [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: 11/16/2022]
Abstract
Abstract
Background: No specific targeted therapies are available for Triple Negative Breast Cancers (TNBC), an aggressive and diverse subgroup. The basal TNBC sub-group share some phenotypic and molecular similarities with germline BRCA (gBRCA) tumours. In gBRCA patients, and potentially other homologous recombination deficiencies, these already compromised pathways may allow drugs called PARP inhibitors (Olaparib) to work more effectively. Aims: To establish if the addition of olaparib to neoadjuvant platinum based chemotherapy for basal TNBC and/or gBRCA breast cancer is safe and improves efficacy (pathological complete response (pCR)).
Methods: Trial design: 3-stage open label randomised phase II/III trial of neoadjuvant paclitaxel and carboplatin +/- olaparib, followed by clinicians' choice of anthracycline regimen. Stage 1 and 2: Randomisation (1:1:1) to either control (3 weekly carboplatin AUC5/weekly paclitaxel 80mg/m2 for 4 cycles) or one of two research arms with the same chemotherapy regimen but with two different schedules of olaparib 150mg BD for 12 days. Stage 3: Patients are randomised (1:1) to either control arm or to the research arm selected in stage 2. End-points: Stage 1: Safety; Stage 2: Schedule selection using pCR rate and completion rate of olaparib using a “pick-the-winner” design. Stage 3: pCR rate. Enrichment design is applied with an overall significance level 0.05(α) and 80% power. A total of 527 patients will be included to detect an absolute improvement of 15% (all patients) and 20% (gBRCA patients) by adding olaparib to platinum based chemotherapy.
Trial Progress: PARTNER has been recruiting in UK since 27th May 2016. IDSMC recommended to continue the trial without change after reviewing the Stage 1 safety data. The recruitment of stage 2 was completed in April 2018 and results to be reviewed by the IDSMC in early 2019. The trial is open and enrolling patients to national and international sites.
Citation Format: Abraham J, Vallier A-L, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Roylance R, Copson E, Pinilla K, Armstrong A, Provenzano E, Tischkowitz M, McMurty E, Earl H. PARTNER: Randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-03-03.
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Affiliation(s)
- J Abraham
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A-L Vallier
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - W Qian
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Machin
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Grybowicz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - S Thomas
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Weiss
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - C Harvey
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K McAdam
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Hughes-Davies
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Roberts
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - R Roylance
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Copson
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K Pinilla
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Armstrong
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Provenzano
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Tischkowitz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E McMurty
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - H Earl
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
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Behm KT, Cole JM, Joglekar AS, Gerstmayr E, Wood JC, Baird CD, Blackburn TG, Duff M, Harvey C, Ilderton A, Kuschel S, Mangles SPD, Marklund M, McKenna P, Murphy CD, Najmudin Z, Poder K, Ridgers CP, Sarri G, Samarin GM, Symes D, Warwick J, Zepf M, Krushelnick K, Thomas AGR. A spectrometer for ultrashort gamma-ray pulses with photon energies greater than 10 MeV. Rev Sci Instrum 2018; 89:113303. [PMID: 30501337 DOI: 10.1063/1.5056248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 06/09/2023]
Abstract
We present a design for a pixelated scintillator based gamma-ray spectrometer for non-linear inverse Compton scattering experiments. By colliding a laser wakefield accelerated electron beam with a tightly focused, intense laser pulse, gamma-ray photons up to 100 MeV energies and with few femtosecond duration may be produced. To measure the energy spectrum and angular distribution, a 33 × 47 array of cesium-iodide crystals was oriented such that the 47 crystal length axis was parallel to the gamma-ray beam and the 33 crystal length axis was oriented in the vertical direction. Using an iterative deconvolution method similar to the YOGI code, modeling of the scintillator response using GEANT4 and fitting to a quantum Monte Carlo calculated photon spectrum, we are able to extract the gamma ray spectra generated by the inverse Compton interaction.
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Affiliation(s)
- K T Behm
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - J M Cole
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - A S Joglekar
- Physics and Astronomy, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - E Gerstmayr
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - J C Wood
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - C D Baird
- York Plasma Institute, Department of Physics, University of York, York YO10 5DD, United Kingdom
| | - T G Blackburn
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - M Duff
- SUPA Department of Physics, University of Strathclyde, Glasgow G4 0NG, United Kingdom
| | - C Harvey
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - A Ilderton
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - S Kuschel
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität, 07743 Jena, Germany
| | - S P D Mangles
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - M Marklund
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - P McKenna
- SUPA Department of Physics, University of Strathclyde, Glasgow G4 0NG, United Kingdom
| | - C D Murphy
- York Plasma Institute, Department of Physics, University of York, York YO10 5DD, United Kingdom
| | - Z Najmudin
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - K Poder
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - C P Ridgers
- York Plasma Institute, Department of Physics, University of York, York YO10 5DD, United Kingdom
| | - G Sarri
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - G M Samarin
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - D Symes
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - J Warwick
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - M Zepf
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität, 07743 Jena, Germany
| | - K Krushelnick
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - A G R Thomas
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
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17
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Abraham J, Vallier AL, Qian W, Grybowicz L, Thomas S, Machin A, Harvey C, Chiu E, McAdam K, Hughes-Davies L, Roylance R, Copson E, Armstrong A, Provenzano E, Tischkowitz M, McMurtry E, Earl H. Abstract OT3-04-03: PARTNER randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-04-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: No specific targeted therapies are available for Triple Negative Breast Cancers (TNBC), an aggressive and diverse subgroup. The basal TNBC subgroup show some phenotypic and molecular similarities with germline BRCA (gBRCA). In gBRCA patients, and potentially other homologous recombination deficiencies, these already compromised pathways may allow drugs called PARP inhibitors (olaparib) to work more effectively.
Aims: To establish if the addition of olaparib to neoadjuvant platinum based chemotherapy for basal TNBC and/or gBRCA breast cancer is safe and improves efficacy (pathological complete response (pCR)).
Trial design: 3 stage open label randomised phase II/III trial of neoadjuvant paclitaxel and carboplatin +/olaparib, followed by clinicians' choice of anthracycline regimen.
Stage 1 and 2: Patients are randomised (1:1:1) to either control (3 weekly carboplatin AUC5/weekly paclitaxel 80mg/m2 for 4 cycles) or one of two research arms with the same chemotherapy regimen but with two different schedules of olaparib 150mg BD for 12 days.
Stage 3: Patients are randomised (1:1) to either control arm or to the research arm selected in stage 2.
Methods:
Stage 1 Safety: both research arms combined.
Stage 2 Schedule selection criteria: pCR rate and completion rate of olaparib protocol treatment. It is a “pickthewinner” design with 53 patients in each research arm. This allows a 90% power, 5% onesided significance level to test null hypothesis of pCR ≤35% versus an alternative hypothesis of pCR ≥55% in each of the research arms.
Stage 3 Efficacy:anticipated pCR ˜55-60% for all trial patients and ˜60-65% for gBRCA patients. The trial is powered to detect an absolute improvement of 15% (all patients) and 20% (gBRCA patients) by adding olaparib to chemotherapy (enriched design). TNBC patient recruitment will be capped, to ensure required gBRCA patients are enrolled. Enrichment design is applied with overall significance level 0.05(α) = 0.025(αall)+ 0.025(αgBRCA) and 80% power.
Target accrual: 527 [gBRCA 220] Current accrual: 56 Sites activated: 15 [expected number of sites 30-50].
Citation Format: Abraham J, Vallier A-L, Qian W, Grybowicz L, Thomas S, Machin A, Harvey C, Chiu E, McAdam K, Hughes-Davies L, Roylance R, Copson E, Armstrong A, Provenzano E, Tischkowitz M, McMurtry E, Earl H. PARTNER randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-04-03.
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Affiliation(s)
- J Abraham
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - A-L Vallier
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - W Qian
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - L Grybowicz
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - S Thomas
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - A Machin
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - C Harvey
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E Chiu
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - K McAdam
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - L Hughes-Davies
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - R Roylance
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E Copson
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - A Armstrong
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E Provenzano
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - M Tischkowitz
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E McMurtry
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - H Earl
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
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Abstract
The sequencing of exons 2-7 of a likely new HLA-C*05 allele identified the second example of HLA-C*05:142, in a male UK European, within a few months of the first example being found in Germany. C*05:142 differs from C*05:01:01:01 by a single base (395G>C) in exon 3 resulting in an amino acid substitution of R108P. Comprehensive serological HLA-Cw5 typing, using 19 antisera, indicated that C*05:142 encodes a "normal" Cw5 specificity. Failure to identify the involvement of position 108 in published HLA-C epitopes supported this assertion. The likely HLA class I C*05:142-bearing haplotype is A*02:01~C*05:142~B*44:02. This new allele has a maximum frequency of 0.00001, in 34,743 sequenced-based typed subjects, contrasting with that of C*05:01 (allele frequency 0.10441), in our local, largely UK European, blood donors.
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Affiliation(s)
- J Rowlands
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Wales, UK
| | - T Climer
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Wales, UK
| | - C Harvey
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Wales, UK
| | - L Williams
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Wales, UK
| | - C Darke
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Wales, UK
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19
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Sharman R, Illingworth G, Harvey C, Jowett A, Foster R, Espie C. 0057 A PRELIMINARY EVALUATION OF ADOLESCENT SLEEP IN THE UK - BASELINE SLEEPING PATTERNS FROM THE OXFORD TEENSLEEP COHORT. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.056] [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: 11/13/2022] Open
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20
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Rowlands J, Climer T, Harvey C, Williams L, Darke C. HLA-A*24:374-A novel allele encoding the HLA-A2403 specificity. HLA 2017; 89:239-240. [PMID: 28297415 DOI: 10.1111/tan.12989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/30/2022]
Abstract
HLA-A*24:374 differs from A*24:03:01:01 by 2 exon 3 bases resulting in a substitution of T163E.
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Affiliation(s)
- J Rowlands
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, Wales, UK
| | - T Climer
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, Wales, UK
| | - C Harvey
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, Wales, UK
| | - L Williams
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, Wales, UK
| | - C Darke
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, Wales, UK
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21
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Street J, Williams L, Climer T, Harvey C, Darke C. Three new HLA alleles-B*49:43,C*03:321andDQB1*02:72. HLA 2017; 89:245-246. [DOI: 10.1111/tan.12981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J. Street
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - L. Williams
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - T. Climer
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - C. Harvey
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - C. Darke
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
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22
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Abraham JE, Vallier AL, Qian W, Grybowicz L, Thomas S, Mahmud S, Harvey C, McAdam K, Hughes-Davies L, Roylance R, Copson E, Brown J, Provenzano E, Tischkowitz M, Earl HM. Abstract OT2-01-15: PARTNER - Randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-15] [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: 11/16/2022]
Abstract
Abstract
Background: Triple Negative Breast Cancers (TNBC) are a biologically diverse and aggressive sub-group. Early effective treatment can lead to cure. Current standard treatment is systemic chemotherapy either pre-/post-definitive surgery. No specific targeted therapies are available for TNBC. There are phenotypic and molecular similarities between germline BRCA (gBRCA) breast cancer and TNBC. In TNBC 10%-20% harbour gBRCA mutations. In gBRCA patients, and potentially other homologous recombination deficiencies, these already compromised pathways allow drugs called PARP inhibitors (olaparib) to work particularly effectively.
Aims: To establish if the addition of olaparib to neoadjuvant platinum-based chemotherapy for TNBC and/or gBRCA breast cancer is safe and improves efficacy.
Trial design: 3-stage open label randomised phase II/III trial of neoadjuvant olaparib +/- platinum containing chemotherapy followed by clinicians' choice of anthracycline regimen. Stage 1 and 2, patients are randomised (1:1:1) to either control (3 weekly carboplatin AUC5/weekly paclitaxel 80mg/m2 chemotherapy - 4 cycles) or one of two research arms which uses the same chemotherapy regimen but with two different schedules of olaparib 150mg BD). Stage 3: patients are randomised (1:1) to either control arm or to the research arm selected in stage 2.
Primary outcome measures:
Stage 1: safety of the addition of olaparib to chemotherapy. Prophylactic G-CSF is mandatory.
Stage 2: pathological complete response (pCR) in each of the two research arms. At the end of stage 2, one of the research arms will be dropped.
Stage 3: pCR at surgery after neoadjuvant treatment. pCR - defined as no residual invasive carcinoma within the breast (ductal carcinoma in situ permitted) AND no evidence of metastatic disease within the lymph nodes.
Eligibility:
•Aged 16 to 70.
•Written informed consent.
•Histologically confirmed invasive breast cancer.
•Clinical stage T1-4 N0-2 (tumour or metastatic node diameter>10mm)
•Confirmed ER-negative and HER2-negative or gBRCA mutation positive, irrespective of hormone status.
•Performance Status 0-1
Statistical Methods: Stage 1, Safety: both research arms combined. Stage 2, Schedule selection criteria: pCR rate and completion rate of olaparib protocol treatment. It is a “pick-the winner” design with 53 patients in each research arm. This allows a 90% power, 5% one-sided significance level to test null hypothesis of pCR ≤35% versus an alternative hypothesis of pCR ≥55% in each of the research arms.
Stage 3, Efficacy: anticipated pCR ∼45-55% for all trial patients and ∼50-60% for gBRCA patients. The trial is powered to detect an absolute improvement of 15% (all patients) and 20% (gBRCA patients) by adding olaparib to chemotherapy (enriched design). TNBC patient recruitment will be capped, to ensure the required number of gBRCA patients are enrolled. Enrichment design is applied with the overall significance level 0.05(α)=0.025(αall)+ 0.025(αgBRCA) and 80% power.
Present accrual: 1 [Trial opened: 23rd May 2016]
Target accrual: 527 (TNBC 307; gBRCA 220)
Contact information: Dr. Jean Abraham; Email: ja344@medschl.cam.ac.uk.
Citation Format: Abraham JE, Vallier A-L, Qian W, Grybowicz L, Thomas S, Mahmud S, Harvey C, McAdam K, Hughes-Davies L, Roylance R, Copson E, Brown J, Provenzano E, Tischkowitz M, Earl HM. PARTNER - Randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-15.
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Affiliation(s)
- JE Abraham
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - A-L Vallier
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - W Qian
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - L Grybowicz
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - S Thomas
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - S Mahmud
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - C Harvey
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - K McAdam
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - L Hughes-Davies
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - R Roylance
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - E Copson
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - J Brown
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - E Provenzano
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - M Tischkowitz
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - HM Earl
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; Royal Marsden Hospital, London, United Kingdom
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23
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Shaw SD, Berger L, Harvey C, Alley MR, Bishop PJ, Speare R. Adenomatous hyperplasia of the mucous glands in captive Archey's frogs (Leiopelma archeyi). N Z Vet J 2016; 65:140-146. [PMID: 27855564 DOI: 10.1080/00480169.2016.1255158] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To describe the gross and light microscopic characteristics of skin lesions observed on the ventral skin of captive Archey's frogs (Leiopelma archeyi) between 2000 and 2012, and to investigate their occurrence, possible aetiology and association with survival. METHODS Postmortem skin samples were obtained for histological evaluation from 37 frogs, with and without skin lesions, that died while in captivity at Auckland Zoo between 2000 and 2012. Four frogs with skin lesions were biopsied under general anaesthesia and samples used for both light and transmission electron microscopy. The records of 94 frogs held at the University of Otago and Auckland Zoo between 2000-2012 were reviewed, which included some frogs recently collected from the wild. Information about the occurrence of skin lesions, and mortality associated with skin lesions was collated. RESULTS Grossly the skin lesions varied in appearance; most were circular, pale grey papules, which measured from <0.5-1.5 mm in diameter with no umbilication. The overlying epidermis was not fragile and there was no associated inflammation. Contents often appeared clear or semi-transparent. Lesions were located predominantly on ventral surfaces including trunk, thighs, lower legs and forearms, and gular region, but not on digits. The number ranged from single to multiple, often confluent lesions covering the entire ventral surface of the frog. Histologically the lesions consisted of enlarged proliferating mucous glands that expanded the dermis and elevated the epidermis. They were semi-organised, solid or occasionally cavitated acinar structures with central lumina which sometimes contained mucus. Nuclei showed moderate anisokaryosis and mitotic figures were uncommon. Transmission electron microscopy did not show any infectious agents. Between 2000 and 2012, skin lesions were recorded in 35/94 (37%) frogs. The size and location of skin lesions varied over time, with some resolving and sometimes reappearing. Skin lesions were not associated with an increased risk of death. CONCLUSIONS The skin lesions had the gross and microscopic characteristics of adenomatous hyperplasia of the dermal mucous glands. CLINICAL RELEVANCE The aetiology of this adenomatous hyperplasia is unknown, but factors associated with the captive environment are the most likely cause. This is the first description of adenomatous hyperplasia of the cutaneous mucous glands in amphibians.
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Affiliation(s)
- S D Shaw
- a New Zealand Centre for Conservation Medicine , Auckland Zoological Park, Auckland , New Zealand.,b One Health Research Group, College of Public Health, Medical and Veterinary Sciences , James Cook University , Townsville , Queensland , Australia
| | - L Berger
- b One Health Research Group, College of Public Health, Medical and Veterinary Sciences , James Cook University , Townsville , Queensland , Australia
| | - C Harvey
- c Gribbles Veterinary Laboratories , Auckland , New Zealand
| | - M R Alley
- d Wildbase Pathology, Institute of Veterinary, Animal and Biomedical Sciences , Massey University , Palmerston North , New Zealand
| | - P J Bishop
- e Department of Zoology , University of Otago , Dunedin , New Zealand
| | - R Speare
- b One Health Research Group, College of Public Health, Medical and Veterinary Sciences , James Cook University , Townsville , Queensland , Australia
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24
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Street J, Davies E, Harvey C, Darke C. Two new HLA class I alleles - A*11:241 and C*08:132. HLA 2016; 88:196-7. [PMID: 27593541 DOI: 10.1111/tan.12880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
HLA-A*11:241 differs from A*11:01:01:01 (215G > A, exon 2, R48Q); HLA-C*08:132 from C*08:02:01:01 (587 T > A exon 3, L172Q).
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Affiliation(s)
- J Street
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, UK
| | - E Davies
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, UK
| | - C Harvey
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, UK
| | - C Darke
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, UK.
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25
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Street J, Harvey C, Johnson J, Darke C. A further HLA-DRB1*15 family allele -DRB1*15:112. HLA 2016; 88:209-10. [DOI: 10.1111/tan.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J. Street
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
| | - C. Harvey
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
| | - J. Johnson
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
| | - C. Darke
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
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26
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Vaja R, Sharkey A, Joshi V, Harvey C. O-143SHOULD NEONATES WITH SEVERE CONGENITAL DIAPHRAGMATIC HERNIA BE GIVEN THE OPTION OF EXTRACORPOREAL MEMBRANE OXYGENATION? DO OR DO NOT, THERE IS NO TRY. OR IS THERE? Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.141] [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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27
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Masters NJ, Alexander S, Jackson B, Sigler L, Chatterton J, Harvey C, Gibson R, Humphrey S, Rawdon TG, Spence RP, Ha HJ, McInnes K, Jakob-Hoff R. Dermatomycosis caused by Paranannizziopsis australasiensis in five tuatara (Sphenodon punctatus) and a coastal bearded dragon (Pogona barbata) in a zoological collection in New Zealand. N Z Vet J 2016; 64:301-7. [DOI: 10.1080/00480169.2016.1177473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- NJ Masters
- Zoological Society of London, London NW1 4RY, United Kingdom
| | - S Alexander
- New Zealand Centre for Conservation Medicine, Auckland Zoo, Western Springs 1022, New Zealand
| | - B Jackson
- New Zealand Centre for Conservation Medicine, Auckland Zoo, Western Springs 1022, New Zealand
| | - L Sigler
- University of Alberta Microfungus Collection and Herbarium, Devonian Botanic Garden, Edmonton, Alberta, T6G 2E1, Canada
| | - J Chatterton
- New Zealand Centre for Conservation Medicine, Auckland Zoo, Western Springs 1022, New Zealand
| | - C Harvey
- New Zealand Veterinary Pathology, Western Springs 1022, New Zealand
| | - R Gibson
- New Zealand Centre for Conservation Medicine, Auckland Zoo, Western Springs 1022, New Zealand
| | - S Humphrey
- Ministry for Primary Industries, PO Box 40742, Upper Hutt 5140, New Zealand
| | - TG Rawdon
- Ministry for Primary Industries, PO Box 40742, Upper Hutt 5140, New Zealand
| | - RP Spence
- Ministry for Primary Industries, PO Box 40742, Upper Hutt 5140, New Zealand
| | - HJ Ha
- Ministry for Primary Industries, PO Box 40742, Upper Hutt 5140, New Zealand
| | - K McInnes
- Department of Conservation, PO Box 10420, Wellington 6143, New Zealand
| | - R Jakob-Hoff
- New Zealand Centre for Conservation Medicine, Auckland Zoo, Western Springs 1022, New Zealand
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28
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Street J, Johnson J, Lemin AJ, Harvey C, Darke C. Immunogenetics of three novel HLA-Class II alleles: DRB1*03:112, DQB1*03:02:16 and DQB1*03:139. Int J Immunogenet 2015; 43:40-4. [DOI: 10.1111/iji.12244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/18/2015] [Indexed: 12/01/2022]
Affiliation(s)
- J. Street
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - J. Johnson
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - A. J. Lemin
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - C. Harvey
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - C. Darke
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
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29
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Vaja R, Joshi V, Chauhan I, Porter R, Hickey M, Faulkner G, Harvey C. P-1855-YEAR EXPERIENCE WITH MOBILE ADULT EXTRACORPOREAL MEMBRANE OXYGENATION IN A TERTIARY REFERRAL CENTRE. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Ng BJL, Hutyra LR, Nguyen H, Cobb AR, Kai FM, Harvey C, Gandois L. Carbon fluxes from an urban tropical grassland. Environ Pollut 2015; 203:227-234. [PMID: 24998996 DOI: 10.1016/j.envpol.2014.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
Turfgrass covers a large fraction of the urbanized landscape, but the carbon exchange of urban lawns is poorly understood. We used eddy covariance and flux chambers in a grassland field manipulative experiment to quantify the carbon mass balance in a Singapore tropical turfgrass. We also assessed how management and variations in environmental factors influenced CO2 respiration. Standing aboveground turfgrass biomass was 80 gC m(-2), with a mean ecosystem respiration of 7.9 ± 1.1 μmol m(-2) s(-1). The contribution of autotrophic respiration was 49-76% of total ecosystem respiration. Both chamber and eddy covariance measurements suggest the system was in approximate carbon balance. While we did not observe a significant relationship between the respiration rates and soil temperature or moisture, daytime fluxes increased during the rainy interval, indicating strong overall moisture sensitivity. Turfgrass biomass is small, but given its abundance across the urban landscape, it significantly influences diurnal CO2 concentrations.
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Affiliation(s)
- B J L Ng
- Department of Geography, National University of Singapore, Singapore
| | - L R Hutyra
- Boston University, Department of Earth and Environment, Boston, MA, USA.
| | - H Nguyen
- Boston University, Department of Earth and Environment, Boston, MA, USA
| | - A R Cobb
- Singapore-MIT Alliance for Research and Technology, Center for Environmental Sensing and Modeling, 1 CREATE Way, Singapore
| | - F M Kai
- Singapore-MIT Alliance for Research and Technology, Center for Environmental Sensing and Modeling, 1 CREATE Way, Singapore
| | - C Harvey
- Singapore-MIT Alliance for Research and Technology, Center for Environmental Sensing and Modeling, 1 CREATE Way, Singapore; Massachusetts Institute of Technology, Department of Civil and Environmental Engineering, Cambridge, MA, USA
| | - L Gandois
- Singapore-MIT Alliance for Research and Technology, Center for Environmental Sensing and Modeling, 1 CREATE Way, Singapore; Université de Toulouse: UPS, INP, EcoLab (Laboratoire Ecologie fonctionnelle et Environnement), ENSAT, Avenue de l'Agrobiopôle, F-31326 Castanet-Tolosan, France; CNRS, EcoLab, F-31326 Castanet-Tolosan, France
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31
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Affiliation(s)
- J. Street
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
| | - C. Harvey
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
| | - E. Cook
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
| | - J. Johnson
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
| | - C. Darke
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Wales UK
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32
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Zunza M, Theron GB, Harvey C. Compliance with infant formula feeding by HIV-positive women one week after delivery in Khayelitsha, South Africa. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2011.11441467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Zunza
- Department of Interdisciplinary Science, Stellenbosch University, South Africa
| | - G B Theron
- Department of Obstetrics and Gynaecology, Stellenbosch University, South Africa
| | - C Harvey
- Centre for Statistical Consultation, Stellenbosch University, South Africa
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33
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Sarri G, Corvan DJ, Schumaker W, Cole JM, Di Piazza A, Ahmed H, Harvey C, Keitel CH, Krushelnick K, Mangles SPD, Najmudin Z, Symes D, Thomas AGR, Yeung M, Zhao Z, Zepf M. Ultrahigh Brilliance Multi-MeV γ-Ray Beams from Nonlinear Relativistic Thomson Scattering. Phys Rev Lett 2014; 113:224801. [PMID: 25494074 DOI: 10.1103/physrevlett.113.224801] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Indexed: 06/04/2023]
Abstract
We report on the generation of a narrow divergence (θ_{γ}<2.5 mrad), multi-MeV (E_{max}≈18 MeV) and ultrahigh peak brilliance (>1.8×10^{20} photons s^{-1} mm^{-2} mrad^{-2} 0.1% BW) γ-ray beam from the scattering of an ultrarelativistic laser-wakefield accelerated electron beam in the field of a relativistically intense laser (dimensionless amplitude a_{0}≈2). The spectrum of the generated γ-ray beam is measured, with MeV resolution, seamlessly from 6 to 18 MeV, giving clear evidence of the onset of nonlinear relativistic Thomson scattering. To the best of our knowledge, this photon source has the highest peak brilliance in the multi-MeV regime ever reported in the literature.
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Affiliation(s)
- G Sarri
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - D J Corvan
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - W Schumaker
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - J M Cole
- The John Adams Institute for Accelerator Science, Imperial College of Science, Technology and Medicine, London SW7 2AZ, United Kingdom
| | - A Di Piazza
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - H Ahmed
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - C Harvey
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - C H Keitel
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - K Krushelnick
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - S P D Mangles
- The John Adams Institute for Accelerator Science, Imperial College of Science, Technology and Medicine, London SW7 2AZ, United Kingdom
| | - Z Najmudin
- The John Adams Institute for Accelerator Science, Imperial College of Science, Technology and Medicine, London SW7 2AZ, United Kingdom
| | - D Symes
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - A G R Thomas
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - M Yeung
- Helmholtz Institute Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - Z Zhao
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - M Zepf
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom and Helmholtz Institute Jena, Fröbelstieg 3, 07743 Jena, Germany
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Gonoskov A, Bashinov A, Gonoskov I, Harvey C, Ilderton A, Kim A, Marklund M, Mourou G, Sergeev A. Anomalous radiative trapping in laser fields of extreme intensity. Phys Rev Lett 2014; 113:014801. [PMID: 25032929 DOI: 10.1103/physrevlett.113.014801] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Indexed: 06/03/2023]
Abstract
We demonstrate that charged particles in a sufficiently intense standing wave are compressed toward, and oscillate synchronously at, the antinodes of the electric field. We call this unusual behavior anomalous radiative trapping (ART). We show using dipole pulses, which offer a path to increased laser intensity, that ART opens up new possibilities for the generation of radiation and particle beams, both of which are high energy, directed, and collimated. ART also provides a mechanism for particle control in high-intensity quantum-electrodynamics experiments.
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Affiliation(s)
- A Gonoskov
- Department of Applied Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden and Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod 603950, Russia and University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia
| | - A Bashinov
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod 603950, Russia and University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia
| | - I Gonoskov
- Department of Physics, Umeå University, SE-90187 Umeå, Sweden
| | - C Harvey
- Centre for Plasma Physics, Queen's University Belfast, Belfast BT7 1NN, United Kingdom
| | - A Ilderton
- Department of Applied Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - A Kim
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod 603950, Russia and University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia
| | - M Marklund
- Department of Applied Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden and Department of Physics, Umeå University, SE-90187 Umeå, Sweden
| | - G Mourou
- University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia and Institut de la Lumière Extrême, UMS 3205 ENSTA, Ecole Polytechnique, CNRS, 91761 Palaiseau, France
| | - A Sergeev
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod 603950, Russia and University of Nizhny Novgorod, Nizhny Novgorod 603950, Russia
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Morgan VA, McGrath JJ, Jablensky A, Badcock JC, Waterreus A, Bush R, Carr V, Castle D, Cohen M, Galletly C, Harvey C, Hocking B, McGorry P, Neil AL, Saw S, Shah S, Stain HJ, Mackinnon A. Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychol Med 2014; 44:2163-2176. [PMID: 24365456 PMCID: PMC4045165 DOI: 10.1017/s0033291713002973] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/05/2013] [Accepted: 11/09/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are insufficient data from nationwide surveys on the prevalence of specific psychotic disorders and associated co-morbidities. METHOD The 2010 Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18-64 years with psychotic disorders in contact with public treatment services from an estimated resident population of 1 464 923 adults. This paper is based on data from 1642 participants with an International Classification of Diseases (ICD)-10 psychotic disorder. Its aim is to present estimates of treated prevalence and lifetime morbid risk of psychosis, and to describe the cognitive, physical health and substance use profiles of participants. RESULTS The 1-month treated prevalence of psychotic disorders was 3.10 cases per 1000 population aged 18-64 years, not accounting for people solely accessing primary care services; lifetime morbid risk was 3.45 per 1000. Mean premorbid intelligence quotient was approximately 0.5 s.d.s below the population mean; current cognitive ability (measured with a digit symbol coding task) was 1.6 s.d.s below the population mean. For both cognitive tests, higher scores were significantly associated with better independent functioning. The prevalence of the metabolic syndrome was high, affecting 60.8% of participants, and pervasive across diagnostic groups. Of the participants, two-thirds (65.9%) were current smokers, 47.4% were obese and 32.4% were sedentary. Of the participants, half (49.8%) had a lifetime history of alcohol abuse/dependence and 50.8% lifetime cannabis abuse/dependence. CONCLUSIONS Our findings highlight the need for comprehensive, integrative models of recovery to maximize the potential for good health and quality of life for people with psychotic illness.
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Affiliation(s)
- V. A. Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - J. J. McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - A. Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - J. C. Badcock
- School of Psychology, The University of Western Australia, Crawley, Western Australia
- Clinical Research Centre, North Metropolitan Health Service-Mental Health, Mount Claremont, WA, Australia
| | - A. Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - R. Bush
- School of Population Health, The University of Queensland, Ipswich, QLD, Australia
| | - V. Carr
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
- Schizophrenia Research Institute, Sydney, NSW, Australia
| | - D. Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- St Vincent's Hospital, Melbourne, VIC, Australia
| | - M. Cohen
- Hunter New England Mental Health, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - C. Galletly
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
- Northern Sector, Adelaide Metro Mental Health Directorate, Adelaide, SA, Australia
| | - C. Harvey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Psychosocial Research Centre, North West Area Mental Health Services, Coburg, VIC, Australia
| | - B. Hocking
- SANE Australia, Melbourne, VIC, Australia
| | - P. McGorry
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Orygen Youth Health Research Centre, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - A. L. Neil
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - S. Saw
- Australian Government Department of Health and Ageing, Canberra, ACT, Australia
| | - S. Shah
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - H. J. Stain
- Centre for Rural and Remote Mental Health, University of Newcastle, Newcastle, NSW, Australia
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - A. Mackinnon
- Orygen Youth Health Research Centre, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Speggiorin S, Robinson SG, Harvey C, Westrope C, Faulkner GM, Kirkland P, Peek GJ. Experience with the Avalon® bicaval double-lumen veno-venous cannula for neonatal respiratory ECMO. Perfusion 2014; 30:250-4. [PMID: 24972812 DOI: 10.1177/0267659114540020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We report a single centre experience of neonatal respiratory ECMO using the Avalon® double-lumen venous cannula and compare it with reports in the literature. RESULTS Between 2008 and 2012, the Avalon® cannula was used in 72 neonates: median age at cannulation was 1.8 days (IQR 1.2-2.8 days) and bodyweight 3.4 Kg (3.0-3.7 Kg). Meconium aspiration syndrome (61.1%), persistent hypertension of the newborn (25%) and congenital diaphragmatic hernia (5.6%) were the most common diagnoses. Complications occurred in 19 patients (26.4%): cannula site bleeding in 6 (8.3%), the cannula perforating the right atrial wall and requiring emergency midline sternotomy in 5 (6.9%) and the cannula needing repositioning in 3 (4.2%). Overall survival at discharge or transfer to the referring hospital was 88.8%. Successful wean off ECMO occurred in 68 patients (94.4%) after a median of 90.5 hours (63.4-136.11). ECMO support was withdrawn in 4 patients (5.6%). CONCLUSIONS The Avalon® dual-lumen veno-venous cannula can be used for respiratory ECMO in the neonatal population. However, as the incidence of right atrial perforation is not negligible, we suspended its used in this group of patients.
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Affiliation(s)
- S Speggiorin
- Heartlink ECMO Centre, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S G Robinson
- Heartlink ECMO Centre, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C Harvey
- Heartlink ECMO Centre, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C Westrope
- Heartlink ECMO Centre, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G M Faulkner
- Heartlink ECMO Centre, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - P Kirkland
- Heartlink ECMO Centre, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G J Peek
- Heartlink ECMO Centre, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
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Jackson B, Harvey C, Galbraith J, Robertson M, Warren K, Holyoake C, Julian L, Varsani A. Clinical beak and feather disease virus infection in wild juvenile eastern rosellas of New Zealand; biosecurity implications for wildlife care facilities. N Z Vet J 2014; 62:297-301. [PMID: 24916448 DOI: 10.1080/00480169.2014.909750] [Citation(s) in RCA: 13] [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: 10/25/2022]
Abstract
CASE HISTORY Four juvenile eastern rosellas (Platycercus eximius) were admitted to two separate wildlife care facilities in the Auckland region by members of the public. They had missing or dystrophic wing and tail feathers that rendered them flightless, suggestive of beak and feather disease virus (BFDV) infection. Two were subject to euthanasia after failing to re-grow their feathers, with samples taken for histopathology and PCR analysis. Blood samples were obtained from the other two birds at the time of examination, however these individuals were lost to follow up. PATHOLOGICAL AND MOLECULAR FINDINGS Basophilic inclusion bodies were observed in histological sections of the feather bulb, typical of BFDV infection, from the two euthanised individuals. Blood from all four birds tested positive by PCR for BFDV, and analysis of the recovered full BFDV genomes identified them as belonging to the BFDV-A strain. DIAGNOSIS Beak and feather disease virus infection. CLINICAL RELEVANCE This report highlights the clinical impacts of BFDV in juvenile eastern rosellas that may result in their admission to wildlife care facilities, creating a biosecurity risk in institutions that may host other native parrots intended for release. The environmental stability of BFDV and resistance to disinfection requires strict quarantine procedures to prevent contamination and spread within a facility. It is recommended that high-risk species such as wild eastern rosella be excluded from facilities that may also house native parrots.
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Affiliation(s)
- B Jackson
- a New Zealand Centre for Conservation Medicine , Auckland Zoological Park, Motions Road, Western Springs, Auckland 1022 , New Zealand
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Street J, Bengtsson M, Johnson J, Harvey C, Darke C. HLA-B*27:05:25 - a further HLA-B*27:05 allele with a synonymous nucleotide substitution. ACTA ACUST UNITED AC 2014; 83:131-2. [PMID: 24372479 DOI: 10.1111/tan.12266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 10/08/2013] [Accepted: 11/15/2013] [Indexed: 12/01/2022]
Abstract
HLA-B*27:05:25 differs from B*27:05:02 by a single synonymous nucleotide substitution (192C>T) at codon 40 in exon 2.
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Affiliation(s)
- J Street
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Pontyclun, Wales, UK
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Bengtsson M, Street J, Johnson J, Harvey C, Corbin S, Darke C. A new HLA-A*03 null allele - A*03:162N caused by an exon 4 insertion and discovered during an external quality assessment exercise. ACTA ACUST UNITED AC 2013; 83:53-4. [PMID: 24215676 DOI: 10.1111/tan.12244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/01/2013] [Accepted: 10/15/2013] [Indexed: 11/26/2022]
Abstract
HLA-A*03:162N differs from A*03:01:01:01 by an exon 4, 664-665insCATG causing E198A and A199X.
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Affiliation(s)
- M Bengtsson
- Department of Immunology, Genetics and Pathology, Uppsala University and University Hospital, Uppsala, Sweden
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Gonoskov A, Gonoskov I, Harvey C, Ilderton A, Kim A, Marklund M, Mourou G, Sergeev A. Probing nonperturbative QED with optimally focused laser pulses. Phys Rev Lett 2013; 111:060404. [PMID: 23971542 DOI: 10.1103/physrevlett.111.060404] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Indexed: 06/02/2023]
Abstract
We study nonperturbative pair production in intense, focused laser fields called e-dipole pulses. We address the conditions required, such as the quality of the vacuum, for reaching high intensities without initiating beam-depleting cascades, the number of pairs which can be created, and experimental detection of the created pairs. We find that e-dipole pulses offer an optimal method of investigating nonperturbative QED.
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Affiliation(s)
- A Gonoskov
- Department of Physics, Umeå University, SE-90187 Umeå, Sweden.
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Joshi V, Harvey C, Nakas A, Waller DA, Peek GJ, Firmin R. The need for thoracic surgery in adult patients receiving extracorporeal membrane oxygenation: a 16-year experience. Perfusion 2013; 28:328-32. [DOI: 10.1177/0267659113480401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives: Patients on extracorporeal membrane oxygenation (ECMO) are at risk from thoracic complications such as bleeding or pneumothorax, which may subsequently necessitate thoracic surgical intervention. We aimed to: 1) analyse the indication and nature of thoracic surgical intervention in these patients and 2) analyse the effect of a change in the ECMO circuit from roller pump to centrifugal pump on transfusion requirements pre and post thoracotomy. Methods: We retrospectively reviewed a prospectively collected database of 569 adults put on ECMO between 1995 and 2011. Patients undergoing thoracotomy were identified and outcomes were statistically analysed. Results: Forty thoracotomies were performed in 18 patients [61% male, median age 31 (14-56) years, one bilateral procedure]. The indications for ECMO included: pneumonia 14/18 (78%), trauma 2/18 (11%) and other 2/18 (11%). Median duration on ECMO was 13 (1–257) days and the time to initial thoracotomy was 10 (1-183) days. The indications for thoracotomy were: excessive bleeding post chest drain insertion (11/19, 58%), uncontrolled air leak (9/19, 47%) and pleural effusion (4/19, 21%). The primary operations were 12/19 (63%) evacuation of haemothorax, 3/19 (16%) lung repair, 2/19 (11%) diagnostic lung biopsy and 2/19 (11%) other. Ten patients needed a further 21 thoracotomies (3 lobectomies); average 2 (1-5) per patient. In total, 30/40 (75%) thoracotomies were performed for bleeding complication. The change from roller to centrifugal pump trended towards a reduction in mean transfusion requirements in these patients following thoracotomy (11.5 versus 4 units, p=0.14). The in-hospital mortality was 7/18 (39%) patients. There were no statistically significant predictors of poor outcome. Conclusions: The need for thoracotomy whilst on ECMO is 3.2% in this large series. Intervention may be complicated, thus, either ECMO specialists should have thoracic training or thoracic surgeons should be on-site. Potential mortality is high and, although not statistically significant, a difference in transfusion requirements was observed following the change of circuit.
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Affiliation(s)
- V Joshi
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
| | - C Harvey
- Department of Extracorporeal Membrane Oxygenation, Glenfield Hospital, Leicester, UK
| | - A Nakas
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
| | - DA Waller
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
| | - GJ Peek
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
- Department of Extracorporeal Membrane Oxygenation, Glenfield Hospital, Leicester, UK
| | - R Firmin
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
- Department of Extracorporeal Membrane Oxygenation, Glenfield Hospital, Leicester, UK
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Mulla H, Peek GJ, Harvey C, Westrope C, Kidy Z, Ramaiah R. Oseltamivir pharmacokinetics in critically ill adults receiving extracorporeal membrane oxygenation support. Anaesth Intensive Care 2013; 41:66-73. [PMID: 23362894 DOI: 10.1177/0310057x1304100112] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is known to affect pharmacokinetics and hence optimum dosing. The aim of this open label, prospective study was to investigate the pharmacokinetics of oseltamivir (prodrug) and oseltamivir carboxylate (active metabolite) during ECMO. Fourteen adult patients with suspected or confirmed H1N1 influenza were enrolled in the study. Oseltamivir 75 mg was enterally administered twice daily and blood samples for pharmacokinetic assessment were taken on day 1 and 5. A multi-compartmental model to describe the pharmacokinetics of oseltamivir and oseltamivir carboxylate was developed using a non-linear mixed effects modelling approach. The median (range) clearance of oseltamivir carboxylate was 15.8 (4.8-36.6) l/hour, lower than the reported mean value of 21.5 l/hour in healthy adults. The median (range) steady state volume of distribution of oseltamivir carboxylate was 179 (61-436) litres, much greater than healthy adults but similar to previous reports in critically ill patients. Substantial 'between subject' variability in systemic exposure to oseltamivir carboxylate was revealed; median (range) area under the curve and Cmax were 4346 (644-13660) ng/hour/ml and 509 (54-1277) ng/ml, respectively. Both area under the curve and Cmax were significantly correlated with serum creatinine (r2=0.37, P=0.02 and r2=0.29, P=0.02, respectively). Systemic exposure to oseltamivir carboxylate following the administration of enteral oseltamivir 75 mg twice daily in adult ECMO patients is comparable to those in ambulatory patients and far in excess of concentrations required to maximally inhibit neuraminidase activity of the H1N1 virus. Dosage adjustment for ECMO, per se, appears not to be necessary; however, doses should be reduced in patients with renal dysfunction.
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Affiliation(s)
- H Mulla
- University Hospitals of Leicester, Glenfield Hospital, Leicester, UK.
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Challapalli A, Jones E, Harvey C, Hellawell GO, Mangar SA. High dose rate prostate brachytherapy: an overview of the rationale, experience and emerging applications in the treatment of prostate cancer. Br J Radiol 2013; 85 Spec No 1:S18-27. [PMID: 23118099 DOI: 10.1259/bjr/15403217] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The technological advances in real-time ultrasound image guidance for high dose rate (HDR) prostate brachytherapy places this treatment modality at the forefront of innovation in radiotherapy. This review article will explore the rationale for HDR brachytherapy as a highly conformal method of dose delivery and safe dose escalation to the prostate, in addition to the particular radiobiological advantages it has over low dose rate and external beam radiotherapy. The encouraging outcome data and favourable toxicity profile will be discussed before looking at emerging applications for the future and how this procedure will feature alongside stereotactic radiosurgery.
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Affiliation(s)
- A Challapalli
- Department of Clinical Oncology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Johnston S, Wroblewski S, Huang Y, Harvey C, Nagi F, Franklin N, Gradishar W. Abstract OT1-1-04: ALTERNATIVE: safety and efficacy of lapatinib (L), trastuzumab (T), or both in combination with an aromatase inhibitor (AI) for the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-ot1-1-04] [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: 11/16/2022]
Abstract
Abstract
Background: Overexpression of the human epidermal growth factor receptor 2 (HER2) gene in breast cancer is associated with an aggressive phenotype, poor prognosis, and resistance to endocrine therapies. Of HER2+ patients, ∼50% are also hormone receptor-positive (HR+). For patients who are both HER2+ and HR+, combining the AI letrozole with the dual tyrosine kinase inhibitor L has been shown to improve outcomes compared with letrozole alone. The combination of L and T, a humanized monoclonal antibody-targeting HER2, has been shown to improve outcomes compared with L alone.
Trial design: The ALTERNATIVE study is a Phase III, randomized, open-label, multicenter trial, which will examine the efficacy of L/T/AI in combination versus T/AI alone. Patients will be randomized to 1 of 3 treatment arms: L 1000 mg po QD plus T (loading dose of 8 mg/kg followed by maintenance with 6 mg/kg IV q3w plus an AI po QD); T plus an AI; or L 1500 mg po QD plus an AI. Choices of AI include letrozole, anastrozole, or exemestane.
Eligibility criteria: Postmenopausal female patients with HER2+/HR+ metastatic breast cancer (MBC) who have received neo/adjuvant T and endocrine therapy, are treatment naïve for MBC, and are not candidates for chemotherapy.
Specific aims: The primary efficacy endpoint is overall survival (OS), defined as the time from randomization until death due to any cause, for L/T/AI compared with T/AI alone. Secondary efficacy objectives include comparisons of OS between T/AI and L/AI as well as between T/L/AI and L/AI in addition to comparisons of progression-free survival, overall response rate, time to response, and duration of response. The safety objective is to evaluate the safety and tolerability for all 3 treatment groups.
A 4-year recruitment is anticipated. More than 200 centers across 37 countries are planned; approximately 110 centers are currently open for enrollment.
Statistical methods: The study is powered to detect a 42% reduction in risk of death (hazard ratio=0.70) in patients who receive L/T/AI (median 28.5 months) versus T/AI (median 20 months) using a 1-sided test for superiority with α=0.025. The required number of total events to achieve a power of 80% is 249. Secondary comparisons are not powered and will be based on the intent-to-treat population.
Present and target accrual: Twenty-six (26) of 525 patients have been randomized. Patients who have participated in previous neo-/adjuvant trials including a T regimen are eligible, provided they meet all other inclusion criteria.
The study is currently recruiting patients, with an anticipated target accrual of 525 patients by March 2016.
Clinical trial registry number: NCT01160211
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT1-1-04.
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Affiliation(s)
- S Johnston
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom; GlaxoSmithKline, Collegeville, PA; GlaxoSmithKline, Stockley Park, United Kingdom; Northwestern University, Chicago, IL
| | - S Wroblewski
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom; GlaxoSmithKline, Collegeville, PA; GlaxoSmithKline, Stockley Park, United Kingdom; Northwestern University, Chicago, IL
| | - Y Huang
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom; GlaxoSmithKline, Collegeville, PA; GlaxoSmithKline, Stockley Park, United Kingdom; Northwestern University, Chicago, IL
| | - C Harvey
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom; GlaxoSmithKline, Collegeville, PA; GlaxoSmithKline, Stockley Park, United Kingdom; Northwestern University, Chicago, IL
| | - F Nagi
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom; GlaxoSmithKline, Collegeville, PA; GlaxoSmithKline, Stockley Park, United Kingdom; Northwestern University, Chicago, IL
| | - N Franklin
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom; GlaxoSmithKline, Collegeville, PA; GlaxoSmithKline, Stockley Park, United Kingdom; Northwestern University, Chicago, IL
| | - W Gradishar
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom; GlaxoSmithKline, Collegeville, PA; GlaxoSmithKline, Stockley Park, United Kingdom; Northwestern University, Chicago, IL
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Sidhu R, Gavini L, Harvey C, Robertson D, Thomas G. Robot Assisted Laparoscopic Hysterectomy vs. Abdominal Hysterectomy. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.019] [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: 11/27/2022]
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Challapalli A, McLauchlan R, Robinson A, Taylor A, Harvey C, Mangar SA. Implementing image-guided prostate radiotherapy: use of the ACCULOC® system to optimise the planning target volume margins and to assess the potential clinical benefit. Clin Oncol (R Coll Radiol) 2012; 24:590-1. [PMID: 22521958 DOI: 10.1016/j.clon.2012.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/28/2012] [Indexed: 11/15/2022]
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Monzon L, Wasan H, Leen E, Ahmed H, Dawson PM, Harvey C, Muhamed A, Hand J, Price P, Abel PD. Transrectal high-intensity focused ultrasonography is feasible as a new therapeutic option for advanced recurrent rectal cancer: report on the first case worldwide. Ann R Coll Surg Engl 2011; 93:e119-21. [PMID: 21929907 DOI: 10.1308/147870811x592458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High-intensity focused ultrasonography is the only completely non-invasive thermal therapy. To date its applications have been limited but clinical indications are expanding with enhanced technological advances that have increased the accuracy of targeting and decreased the duration of treatment times. We report its first use for rectal cancer.
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Affiliation(s)
- L Monzon
- Imperial College London, London, UK
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Harvey C. Are there any consistent environmental risk factors for Parkinson's disease? Occup Environ Med 2011. [DOI: 10.1136/oemed-2011-100382.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- G Taylor
- Department of General Surgery, Mater Hospital Royal Victoria Hospital, Belfast, UK
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