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Toriola E, Biviano L, Lau C, Hooke N, Donnelly A, Dickins E, Pengilly S, Ging J, Shaw N, Singh J. Advancing Pediatric Care: The virtualKIDS Experience in Nursing-Led Audio-Visual Clinical Services. Creat Nurs 2024; 30:118-124. [PMID: 38600876 DOI: 10.1177/10784535241245667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
During the COVID-19 pandemic, the escalating trend of pediatric patients, particularly non-urgent cases, going to the emergency departments (EDs) in New South Wales, Australia, prompted the establishment of virtualKIDS, a nursing-led telehealth service. This service, initiated in June 2021, operates 24/7 and provides comprehensive care through audio-visual consultations emphasizing a patient-centered approach. Three elements-COVID-19 Outpatient Response Team (CORT), virtualKIDS Acute Review (vKAR), and Virtual Urgent Care (VUC)-addressed specific needs during and beyond the pandemic, showcasing the adaptability and impact of virtual care. vKAR focuses on post-discharge support, allowing families access to telehealth for up to three days. Preliminary data indicates a 44% reduction in ED visits within 48 h. VUC employs nursing-led triaging paired with audiovisual assessment, demonstrating a 69% hospitalization avoidance rate. Hybrid ambulatory models such as a sleep study at home project, day-only tonsillectomies, and arthroscopic knee surgeries showcase innovative approaches to reducing hospital admissions and enhancing patient outcomes. This paper presents the evolution and diverse models of care implemented by the virtualKIDS service, offering insights into its potential as a nursing-led alternative to ED visits in acute-care pediatrics.
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Affiliation(s)
- Eunice Toriola
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Lyn Biviano
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Christine Lau
- Integrated Care Service, Sydney Children's Hospital Network
| | - Natalie Hooke
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Amie Donnelly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Emma Dickins
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Sandra Pengilly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Joanne Ging
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Nadine Shaw
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Jagdev Singh
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Gilbert Y, Shrapnel J, Lau C, Dalby-Payne J. Duration of monitoring after cessation of oxygen therapy in infants with bronchiolitis. J Paediatr Child Health 2023; 59:1223-1229. [PMID: 37654081 DOI: 10.1111/jpc.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/07/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
AIM There is no evidence for how long bronchiolitis patients should be observed after coming off oxygen therapy and wide practice variation exists. We aimed to investigate whether it is safe to discharge bronchiolitis patients 4 h after cessation of oxygen therapy. METHODS A retrospective single-centre cohort study of 884 infants (n = 462 in 2018 vs. n = 422 in 2019) aged 0-24 months admitted with bronchiolitis in 2018 and 2019 was conducted after implementation of a bronchiolitis protocol recommending discharge home 4 h post-cessation of oxygen therapy in 2019. We compared the rate of readmissions and Clinical Reviews/Rapid Responses in the pre- and post-exposure cohorts. RESULTS There was a significant reduction in median (interquartile range (IQR)) time to discharge post oxygen cessation by 87 min (510 (370-1033) min versus 423 (273-904) min; P < 0.001) and in median (IQR) length of stay by 6.7 h (2.11 (1.54-2.97) days vs. 1.83 (1.17-2.71) days; P < 0.001). There was no significant difference between readmissions in 2018 compared to 2019 (0.6% vs. 1.4%; P = 0.317). In 2018, there were two Clinical Reviews and in 2019 there were two Rapid Responses post-cessation of oxygen. There were 89 patients discharged within 4 h of cessation of oxygen therapy (n = 18 in 2018 vs. n = 71 in 2019; P < 0.001) with no readmissions, Clinical Reviews or Rapid Responses in the 2019 cohort. CONCLUSIONS This study demonstrates that patients can be discharged 4 h after cessation of supplemental oxygen without increased risk of adverse events.
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Affiliation(s)
- Yasmin Gilbert
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jane Shrapnel
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christine Lau
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jacqueline Dalby-Payne
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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3
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Mohiuddin MM, Singh AK, Scobie L, Goerlich CE, Grazioli A, Saharia K, Crossan C, Burke A, Drachenberg C, Oguz C, Zhang T, Lewis B, Hershfeld A, Sentz F, Tatarov I, Mudd S, Braileanu G, Rice K, Paolini JF, Bondensgaard K, Vaught T, Kuravi K, Sorrells L, Dandro A, Ayares D, Lau C, Griffith BP. Graft dysfunction in compassionate use of genetically engineered pig-to-human cardiac xenotransplantation: a case report. Lancet 2023; 402:397-410. [PMID: 37393920 PMCID: PMC10552929 DOI: 10.1016/s0140-6736(23)00775-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND A genetically engineered pig cardiac xenotransplantation was done on Jan 7, 2022, in a non-ambulatory male patient, aged 57 years, with end-stage heart failure, and on veno-arterial extracorporeal membrane oxygenation support, who was ineligible for an allograft. This report details our current understanding of factors important to the xenotransplantation outcome. METHODS Physiological and biochemical parameters critical for the care of all heart transplant recipients were collected in extensive clinical monitoring in an intensive care unit. To ascertain the cause of xenograft dysfunction, we did extensive immunological and histopathological studies, including electron microscopy and quantification of porcine cytomegalovirus or porcine roseolovirus (PCMV/PRV) in the xenograft, recipient cells, and tissue by DNA PCR and RNA transcription. We performed intravenous immunoglobulin (IVIG) binding to donor cells and single-cell RNA sequencing of peripheral blood mononuclear cells. FINDINGS After successful xenotransplantation, the graft functioned well on echocardiography and sustained cardiovascular and other organ systems functions until postoperative day 47 when diastolic heart failure occurred. At postoperative day 50, the endomyocardial biopsy revealed damaged capillaries with interstitial oedema, red cell extravasation, rare thrombotic microangiopathy, and complement deposition. Increased anti-pig xenoantibodies, mainly IgG, were detected after IVIG administration for hypogammaglobulinaemia and during the first plasma exchange. Endomyocardial biopsy on postoperative day 56 showed fibrotic changes consistent with progressive myocardial stiffness. Microbial cell-free DNA testing indicated increasing titres of PCMV/PRV cell-free DNA. Post-mortem single-cell RNA sequencing showed overlapping causes. INTERPRETATION Hyperacute rejection was avoided. We identified potential mediators of the observed endothelial injury. First, widespread endothelial injury indicates antibody-mediated rejection. Second, IVIG bound strongly to donor endothelium, possibly causing immune activation. Finally, reactivation and replication of latent PCMV/PRV in the xenograft possibly initiated a damaging inflammatory response. The findings point to specific measures to improve xenotransplant outcomes in the future. FUNDING The University of Maryland School of Medicine, and the University of Maryland Medical Center.
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Affiliation(s)
- Muhammad M Mohiuddin
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Avneesh K Singh
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Linda Scobie
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Corbin E Goerlich
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alison Grazioli
- Cardiac Surgery Intensive Care Unit, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kapil Saharia
- Institute of Human Virology, Division of Infectious Disease, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Claire Crossan
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Allen Burke
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Cinthia Drachenberg
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Cihan Oguz
- Integrated Data Sciences Section, Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tianshu Zhang
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Billeta Lewis
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alena Hershfeld
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Faith Sentz
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ivan Tatarov
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Mudd
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gheorghe Braileanu
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathryn Rice
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Christine Lau
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bartley P Griffith
- Program in Cardiac Xenotransplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Chowdhury S, Crocker NA, Peebles WA, Rhodes TL, Zeng L, Lantsov R, Van Compernolle B, Brookman M, Pinsker RI, Lau C. A novel Doppler backscattering (DBS) system to simultaneously measure radio frequency plasma fluctuations and low frequency turbulence. Rev Sci Instrum 2023; 94:073504. [PMID: 37493501 DOI: 10.1063/5.0149654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/12/2023] [Indexed: 07/27/2023]
Abstract
A novel quadrature Doppler Backscattering (DBS) system has been developed and optimized for the E-band (60-90 GHz) frequency range using either O-mode or X-mode polarization in DIII-D plasmas. In general, DBS measures the amplitude of density fluctuations and their velocity in the lab frame. The system can simultaneously monitor both low-frequency turbulence (f < 10 MHz) and radiofrequency plasma density fluctuations over a selectable frequency range (20-500 MHz). Detection of high-frequency fluctuations has been demonstrated for low harmonics of the ion cyclotron frequency (e.g., 2fci ∼ 23 MHz) and externally driven high-frequency helicon waves (f = 476 MHz) using an adjustable frequency down conversion system. Importantly, this extends the application of DBS to a high-frequency spectral domain while maintaining important turbulence and flow measurement capabilities. This unique system has low phase noise, good temporal resolution (sub-millisecond), and excellent wavenumber coverage (kθ ∼ 1-20 cm-1 and kr ≲ 30 cm-1). As a demonstration, localized internal DIII-D plasma measurements are presented from turbulence (f ≤ 5 MHz), Alfvenic waves (f ∼ 6.5 MHz), ion cyclotron waves (f ≥ 20 MHz), as well as fluctuations around 476 MHz driven by an external high-power 476 MHz helicon wave antenna. In the future, helicon measurements will be used to validate GENRAY and AORSA modeling tools for prediction of helicon wave propagation, absorption, and current drive location for the newly installed helicon current drive system on DIII-D.
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Affiliation(s)
- S Chowdhury
- Physics and Astronomy Department, University of California Los Angeles, Los Angeles, California 90098, USA
| | - N A Crocker
- Physics and Astronomy Department, University of California Los Angeles, Los Angeles, California 90098, USA
| | - W A Peebles
- Physics and Astronomy Department, University of California Los Angeles, Los Angeles, California 90098, USA
| | - T L Rhodes
- Physics and Astronomy Department, University of California Los Angeles, Los Angeles, California 90098, USA
| | - L Zeng
- Physics and Astronomy Department, University of California Los Angeles, Los Angeles, California 90098, USA
| | - R Lantsov
- Physics and Astronomy Department, University of California Los Angeles, Los Angeles, California 90098, USA
| | - B Van Compernolle
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
| | - M Brookman
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
| | - R I Pinsker
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
| | - C Lau
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
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Leppink E, Lau C, Lin Y, Wukitch SJ. Evaluation of the Abel inversion integral in O-mode plasma reflectometry using Chebyshev-Gauss quadrature. Rev Sci Instrum 2023; 94:063506. [PMID: 37862546 DOI: 10.1063/5.0132246] [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] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/15/2023] [Indexed: 10/22/2023]
Abstract
The Abel transform is often used to reconstruct plasma density profiles from O-Mode polarized reflectometry diagnostics. However, standard numerical trapezoidal evaluation of the Abel inversion integral can be computationally expensive for a large number of evaluation points, and an endpoint singularity exists on the upper-bound of the integral, which can result in an increased error. In this work, Chebyshev-Gauss quadrature is introduced as a new method to evaluate the Abel inversion integral for the problem of O-Mode plasma reflectometry. The method does not require numerical evaluation of an integral singularity and is shown to have similar accuracy compared to existing methods while being computationally efficient.
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Affiliation(s)
- E Leppink
- MIT Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - C Lau
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - Y Lin
- MIT Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - S J Wukitch
- MIT Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
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Cerrato C, Margaret M, Autorino R, Simone G, Yang B, Uzzo R, Kutikov A, Porpiglia F, Capitanio U, Montorsi F, Porter J, Beksac A, Nguyen M, Hakimi K, Pandolfo S, Minervini A, Lau C, Monish A, Eun D, Mottrie A, Mir C, Sundaram C, Antonelli A, Kaouk J, Derweesh I. Partial versus radical nephrectomy for complex renal mass: Multicenter comparative analysis of functional outcomes (ROSULA Collaborative Group). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01057-6] [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: 02/12/2023]
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7
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Cerrato C, Autorino R, Simone G, Yang B, Uzzo R, Porpiglia F, Capitanio U, Montorsi F, Porter J, Beksac A, Minervini A, Lau C, Akbar A, Eun D, Mottrie A, Mir C, Meagher M, Nguyen M, Pandolfo S, Kutikov A, Cerruto M, Antonelli A, Sundaram C, Kaouk J, Derweesh I. Partial or radical nephrectomy for complex renal mass: A comparative analysis of oncological outcomes and complications from the rosula (robotic surgery for large renal mass) collaborative group. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00891-6] [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: 02/12/2023]
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8
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Zhang Y, Lau C, Gabriel B, Ifeoluwa J, Yap T. Venous thromboembolism risk in testosterone treated men with and without Klinefelter syndrome. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Passarello L, Lau C, McCahon E, Popat H. A neonatal case of central conducting lymphatic anomaly successfully treated with sirolimus. Pediatr Blood Cancer 2022; 69:e29752. [PMID: 35652569 DOI: 10.1002/pbc.29752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Larissa Passarello
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Christine Lau
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Sydney, Australia
| | - Emma McCahon
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The University of Sydney, Camperdown, Sydney, Australia
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10
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Hodgins M, van Leeuwen D, Braithwaite J, Hanefeld J, Wolfe I, Lau C, Dickins E, McSweeney J, McCaskill M, Lingam R. The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic. Int J Health Policy Manag 2022; 11:2155-2165. [PMID: 34814662 PMCID: PMC9808299 DOI: 10.34172/ijhpm.2021.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children's Hospitals Network (SCHN), the largest provider of children's health services in the Southern hemisphere. METHODS We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN's response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. RESULTS The CSSF captured SCHN's complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN's response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN's resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. CONCLUSION Using the CSSF, we found that SCHN's ability to innovate was key to ensuring its resilience during the pandemic.
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Affiliation(s)
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna Hanefeld
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ingrid Wolfe
- Institute for Women and Children's Health, King's College London, London, UK
| | - Christine Lau
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Emma Dickins
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Joeanne McSweeney
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Mary McCaskill
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Raghu Lingam
- University of New South Wales, Sydney, NSW, Australia
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11
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Williams P, Koirala A, Saravanos GL, Lopez LK, Glover C, Sharma K, Williams T, Carey E, Shaw N, Dickens E, Sitaram N, Ging J, Bray P, Crawford NW, McMullan B, Macartney K, Wood N, Fulton EL, Lau C, Britton PN. COVID
‐19 in New South Wales children during 2021: severity and clinical spectrum. Med J Aust 2022; 217:303-310. [PMID: 35851698 PMCID: PMC9349636 DOI: 10.5694/mja2.51661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/04/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/23/2022]
Abstract
Objectives: To describe the severity and clinical spectrum of coronavirus disease 2019 (COVID‐19) in children during the 2021 New South Wales outbreak of the Delta variant of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Design, setting: Prospective cohort study in three metropolitan Sydney local health districts, 1 June – 31 October 2021. Participants: Children under 16 years of age with positive SARS‐CoV‐2 nucleic acid test results admitted to hospital or managed by the Sydney Children’s Hospital Network (SCHN) virtual care team. Main outcome measures: Age‐specific SARS‐CoV‐2 infection frequency, overall and separately for SCHN virtual and hospital patients; rates of medical and social reason admissions, intensive care admissions, and paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 per 100 SARS‐CoV‐2 infections; demographic and clinical factors that influenced likelihood of hospital admission. Results: A total of 17 474 SARS‐CoV‐2 infections in children under 16 were recorded in NSW, of whom 11 985 (68.6%) received SCHN‐coordinated care, including 459 admitted to SCHN hospitals: 165 for medical reasons (1.38 [95% CI, 1.17–1.59] per 100 infections), including 15 admitted to intensive care, and 294 (under 18 years of age) for social reasons (2.45 [95% CI, 2.18–2.73] per 100 infections). In an analysis that included all children admitted to hospital and a random sample of those managed by the virtual team, having another medical condition (adjusted odds ratio [aOR], 7.42; 95% CI, 3.08–19.3) was associated with increased likelihood of medical admission; in univariate analyses, non‐asthmatic chronic respiratory disease was associated with greater (OR, 9.21; 95% CI, 1.61–174) and asthma/viral induced wheeze with lower likelihood of admission (OR, 0.38; 95% CI, 0.18–0.78). The likelihood of admission for medical reasons declined from infancy to 5–11 years, but rose again for those aged 12–15 years. Sex and Indigenous status did not influence the likelihood of admission. Conclusion: Most SARS‐CoV‐2 infections (Delta variant) in children were asymptomatic or associated with mild disease. Hospitalisation was relatively infrequent, and most common for infants, adolescents, and children with other medical conditions. More children were hospitalised for social than for medical reasons. The known: Information regarding disease severity and reasons for hospital admissions of children with COVID‐19 in Australia is very limited. The new: In 2021, more NSW children with SARS‐CoV‐2 infections were hospitalised for social or welfare reasons (294, 64%; 2.45 per 100 infections) than for medical treatment (165, 36%; 1.38 per 100 infections). Children under six months of age, aged 12–15 years, or with another medical condition were more likely to be hospitalised than other children. The implications: As acute COVID‐19 is typically mild in children, measures that protect them from SARS‐CoV‐2 but harm their overall wellbeing may be disproportionate. Community support for children with special care needs could reduce the number of hospitalisations.
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Affiliation(s)
- Phoebe Williams
- The Children's Hospital at Westmead Sydney NSW
- Sydney Children's Hospital at Randwick Sydney NSW
| | - Archana Koirala
- The University of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | | | - Laura K Lopez
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Catherine Glover
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Ketaki Sharma
- The University of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Tracey Williams
- The Children's Hospital at Westmead Sydney NSW
- Home in the Hospital service, the Sydney Children's Hospitals Network Sydney NSW
| | - Emma Carey
- Kids Research, the Sydney Children's Hospitals Network Sydney NSW
| | - Nadine Shaw
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Emma Dickens
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Neela Sitaram
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Joanne Ging
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Paula Bray
- Kids Research, the Sydney Children's Hospitals Network Sydney NSW
- Home in the Hospital service, the Sydney Children's Hospitals Network Sydney NSW
| | - Nigel W Crawford
- Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Children’s Research Institute Melbourne VIC
- Royal Children's Hospital Melbourne Melbourne VIC
| | - Brendan McMullan
- Royal Children's Hospital Melbourne Melbourne VIC
- The University of New South Wales Sydney NSW
| | - Kristine Macartney
- The University of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Nicholas Wood
- The Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
| | - Elizabeth L Fulton
- The Children's Hospital at Westmead Sydney NSW
- Home in the Hospital service, the Sydney Children's Hospitals Network Sydney NSW
| | - Christine Lau
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Philip N Britton
- The Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
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Guo Y, Mei Z, Li D, Banerjee A, Khalil MA, Burke A, Ritter J, Lau C, Kreisel D, Gelman AE, Jacobsen E, Luzina IG, Atamas SP, Krupnick AS. Ischemia reperfusion injury facilitates lung allograft acceptance through IL-33-mediated activation of donor-derived IL-5 producing group 2 innate lymphoid cells. Am J Transplant 2022; 22:1963-1975. [PMID: 35510760 PMCID: PMC9357103 DOI: 10.1111/ajt.17084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 01/25/2023]
Abstract
Pathways regulating lung alloimmune responses differ from most other solid organs and remain poorly explored. Based on our recent work identifying the unique role of eosinophils in downregulating lung alloimmunity, we sought to define pathways contributing to eosinophil migration and homeostasis. Using a murine lung transplant model, we have uncovered that immunosuppression increases eosinophil infiltration into the allograft in an IL-5-dependent manner. IL-5 production depends on immunosuppression-mediated preservation of donor-derived group 2 innate lymphoid cells (ILC2). We further describe that ischemia reperfusion injury upregulates the expression of IL-33, which functions as the dominant and nonredundant mediator of IL-5 production by graft-resident ILC2. Our work thus identifies unique cellular mechanisms that contribute to lung allograft acceptance. Notably, ischemia reperfusion injury, widely considered to be solely deleterious to allograft survival, can also downregulate alloimmune responses by initiating unique pathways that promote IL-33/IL-5/eosinophil-mediated tolerance.
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Affiliation(s)
- Yizhan Guo
- Department of Surgery, University of Maryland, Baltimore Maryland
| | - Zhongcheng Mei
- Department of Surgery, University of Maryland, Baltimore Maryland
| | - Dongge Li
- Department of Surgery, University of Maryland, Baltimore Maryland
| | - Anirban Banerjee
- Department of Surgery, University of Maryland, Baltimore Maryland
| | - May A. Khalil
- Department of Surgery, University of Maryland, Baltimore Maryland
| | - Allen Burke
- Department of Pathology, University of Maryland, Baltimore Maryland
| | - Jon Ritter
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis Missouri
| | - Christine Lau
- Department of Surgery, University of Maryland, Baltimore Maryland
| | - Daniel Kreisel
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis Missouri
- Department of Surgery, Washington University in St. Louis, St. Louis Missouri
| | - Andrew E. Gelman
- Department of Pathology & Immunology, Washington University in St. Louis, St. Louis Missouri
- Department of Surgery, Washington University in St. Louis, St. Louis Missouri
| | - Elizabeth Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
| | - Irina G. Luzina
- Department of Medicine, University of Maryland, Baltimore Maryland
| | - Sergei P. Atamas
- Department of Surgery, University of Maryland, Baltimore Maryland
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13
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Banerjee A, Li D, Guo Y, Mei Z, Lau C, Chen K, Westwick J, Klauda JB, Schrum A, Lazear ER, Krupnick AS. A reengineered common chain cytokine augments CD8+ T cell–dependent immunotherapy. JCI Insight 2022; 7:158889. [PMID: 35603788 PMCID: PMC9220948 DOI: 10.1172/jci.insight.158889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Cytokine therapy is limited by undesirable off-target side effects as well as terminal differentiation and exhaustion of chronically stimulated T cells. Here, we describe the signaling properties of a potentially unique cytokine by design, where T cell surface binding and signaling are separated between 2 different families of receptors. This fusion protein cytokine, called OMCPmutIL-2, bound with high affinity to the cytotoxic lymphocyte-defining immunoreceptor NKG2D but signaled through the common γ chain cytokine receptor. In addition to precise activation of cytotoxic T cells due to redirected binding, OMCPmutIL-2 resulted in superior activation of both human and murine CD8+ T cells by improving their survival and memory cell generation and decreasing exhaustion. This functional improvement was the direct result of altered signal transduction based on the reorganization of surface membrane lipid rafts that led to Janus kinase-3–mediated phosphorylation of the T cell receptor rather than STAT/AKT signaling intermediates. This potentially novel signaling pathway increased CD8+ T cell response to low-affinity antigens, activated nuclear factor of activated T cells transcription factors, and promoted mitochondrial biogenesis. OMCPmutIL-2 thus outperformed other common γ chain cytokines as a catalyst for in vitro CD8+ T cell expansion and in vivo CD8+ T cell–based immunotherapy.
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Affiliation(s)
- Anirban Banerjee
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Dongge Li
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Yizhan Guo
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Zhongcheng Mei
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Christine Lau
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Kelly Chen
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | | | - Jeffery B. Klauda
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland, USA
| | - Adam Schrum
- Departments of Molecular Microbiology and Immunology, Surgery, and Biomedical, Biological and Chemical Engineering, University of Missouri, Columbia, Missouri, USA
| | - Eric R. Lazear
- Courier Therapeutics, Houston, Texas, USA
- Valo Health, Boston, Massachusetts, USA
| | - Alexander S. Krupnick
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
- Courier Therapeutics, Houston, Texas, USA
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14
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Hata A, Guo Y, Miller AE, Hata M, Mei Z, Manafi A, Li D, Banerjee A, Lazear E, Lau C, Gelman AE, Kreisel D, Yoshino I, Wilkes D, Barker TH, Krupnick AS. Loss of Stromal Cell Thy-1 Plays a Critical Role in Lipopolysaccharide Induced Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2022; 41:1044-1054. [DOI: 10.1016/j.healun.2022.05.009] [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] [Received: 05/17/2021] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
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15
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Pasrija C, Shah A, Holmes S, Bittle G, Reed R, Patel V, Lau C, Krupnick A. Safety of Single Lung Transplantation Post Donation Service Area-Specific Organ Distribution. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Narahari AK, Mehaffey JH, Chandrabhatla AS, Hawkins RB, Charles EJ, Roeser ME, Lau C, Ailawadi G. Longitudinal analysis of National Institutes of Health funding for academic thoracic surgeons. J Thorac Cardiovasc Surg 2022; 163:872-879.e2. [PMID: 33676759 PMCID: PMC8329128 DOI: 10.1016/j.jtcvs.2021.01.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/22/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE National Institutes of Health (NIH) funding for academic (noncardiac) thoracic surgeons at the top-140 NIH-funded institutes in the United States was assessed. We hypothesized that thoracic surgeons have difficulty in obtaining NIH funding in a difficult funding climate. METHODS The top-140 NIH-funded institutes' faculty pages were searched for noncardiac thoracic surgeons. Surgeon data, including gender, academic rank, and postfellowship training were recorded. These surgeons were then queried in NIH Research Portfolio Online Reporting Tools Expenditures and Results for their funding history. Analysis of the resulting grants (1980-2019) included grant type, funding amount, project start/end dates, publications, and a citation-based Grant Impact Metric to evaluate productivity. RESULTS A total of 395 general thoracic surgeons were evaluated with 63 (16%) receiving NIH funding. These 63 surgeons received 136 grants totaling $228 million, resulting in 1772 publications, and generating more than 50,000 citations. Thoracic surgeons have obtained NIH funding at an increasing rate (1980-2019); however, they have a low percentage of R01 renewal (17.3%). NIH-funded thoracic surgeons were more likely to have a higher professorship level. Thoracic surgeons perform similarly to other physician-scientists in converting K-Awards into R01 funding. CONCLUSIONS Contrary to our hypothesis, thoracic surgeons have received more NIH funding over time. Thoracic surgeons are able to fill the roles of modern surgeon-scientists by obtaining NIH funding during an era of increasing clinical demands. The NIH should continue to support this mission.
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Affiliation(s)
- Adishesh K. Narahari
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, 22908 USA
| | - J. Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, 22908 USA
| | - Anirudha S. Chandrabhatla
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, 22908 USA
| | - Robert B. Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, 22908 USA
| | - Eric J. Charles
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, 22908 USA
| | - Mark E. Roeser
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, 22908 USA
| | - Christine Lau
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, 21201 USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan School of Medicine, Ann Arbor, Mich.
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17
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Tuderti G, Autorino R, Minervini A, Kaouk J, Lau C, Perdonà S, Porpiglia F, Derweesh I, Saidian A, Nguyen M, Carbonara U, Rha K, Schiavina R, Mastroianni R, Misuraca L, Mari A, Brassetti A, Anceschi U, Bove A, Ferriero M, Mottrie A, Gallucci M, Simone G. On-clamp versus off-clamp robotic partial nephrectomy for totally endophytic deep renal masses: Propensity score-matched comparison of perioperative, oncologic and functional outcomes of a multicenter analysis (ROSULA database). Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Tuderti G, Autorino R, Mastroianni R, Mari A, Carbonara U, Misuraca L, Anceschi U, Brassetti A, Ferriero M, Bove A, Costantini M, Porpiglia F, Kaouk J, Lau C, Derweesh I, Rha K, Schiavina R, Mottrie A, Gallucci M, Simone G. Nephrometry scores predicting value of Trifecta achievement in a multicenter analysis (ROSULA database) of Robotic Partial Nephrectomy for totally endophytic “deep” renal masses. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00146-4] [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: 11/29/2022]
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19
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Timofte I, Diaz-Abad M, Alghanim F, Assadi J, Lau C, Madathil R, Griffith B, Herr D, Iacono A, Hines S. Spirometry testing for extracorporeal membrane oxygenation (ECMO) bridge to transplant patients. Respir Med Case Rep 2022; 36:101577. [PMID: 35036306 PMCID: PMC8749276 DOI: 10.1016/j.rmcr.2021.101577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/30/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE ECMO can provide a bridge to transplantation and improve survival for patients with advanced lung disease. Although pulmonary function testing (PFT) is an important component of the lung allocation score (LAS), it is not always feasible on patients requiring ECMO. While generally safe, PFT testing has contraindications and is not recommended in unstable patients. Currently there are no recommendations regarding the performance of spirometry in ECMO patients. STUDY DESIGN and Methods: We reviewed data on five patients with advanced lung disease requiring ECMO-bridge to transplant. After careful consideration of the theoretical physiologic risks associated with forced expiratory maneuvers, bedside spirometry was performed in order to update the patients' LAS. RESULTS All patients successfully completed three forced expiratory maneuvers in the seated position with a bedside spirometer. Vital signs and ECMO flow were stable during testing and without complication. In 2 patients who had both a LAS pre and post spirometry, the LAS increased by 3-5 points. CONCLUSION Spirometry results are pivotal to organ allocation under current organ sharing protocols. This case series demonstrates that bedside spirometry testing may be performed safely in patients on ECMO awaiting lung transplantation without appreciable side effects, leading to a more accurate LAS score.
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Affiliation(s)
- Irina Timofte
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Montserrat Diaz-Abad
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Fahid Alghanim
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jordan Assadi
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD, 21061, United States
| | - Christine Lau
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, United States
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ronson Madathil
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, United States
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Bartley Griffith
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, United States
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daniel Herr
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Aldo Iacono
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Stella Hines
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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20
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Haywood N, Mehaffey JH, Kilbourne S, Mannem H, Weder M, Lau C, Krupnick AS, Agarwal A. Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers. J Thorac Cardiovasc Surg 2022; 163:339-345. [PMID: 33008575 PMCID: PMC7474916 DOI: 10.1016/j.jtcvs.2020.09.008] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation. METHODS Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras. RESULTS Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001). CONCLUSIONS Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status.
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Affiliation(s)
- Nathan Haywood
- Division of Thoracic & Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Va
| | - J Hunter Mehaffey
- Division of Thoracic & Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Va
| | - Sarah Kilbourne
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Hannah Mannem
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Max Weder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Christine Lau
- Division of Thoracic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Alexander S Krupnick
- Division of Thoracic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Avinash Agarwal
- Division of Transplantation, Department of Surgery, University of Virginia Health System, Charlottesville, Va.
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21
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Bonares M, Mah K, Christiansen D, Granton J, Weiss A, Lau C, Rodin G, Zimmermann C, Wentlandt K. Pulmonary referrals to specialist palliative medicine: a survey. BMJ Support Palliat Care 2021:bmjspcare-2021-003386. [PMID: 34862240 DOI: 10.1136/bmjspcare-2021-003386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with chronic respiratory disease have significant palliative care needs, but low utilisation of specialist palliative care (SPC) services. Decreased access to SPC results in unmet palliative care needs among this patient population. We sought to determine the referral practices to SPC among respirologists in Canada. METHODS Respirologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional and attitudinal factors were analysed using regression analyses. RESULTS The response rate was 64.7% (438/677). Fifty-nine per cent of respondents believed that their patients have negative perceptions of palliative care and 39% were more likely to refer to SPC earlier if it was renamed supportive care. While only 2.7% never referred to SPC, referral was late in 52.6% of referring physicians. Lower frequency of referral was associated with equating palliative care to end-of-life care (p<0.001), male sex of respirologist (p=0.019), not knowing referral criteria of SPC services (p=0.015) and agreement that SPC services prioritise patients with cancer (p=0.025); higher referral frequency was associated with satisfaction with SPC services (p=0.001). Late referral was associated with equating palliative care to end-of-life care (p<0.001) and agreement that SPC services prioritise patients with cancer (p=0.013). CONCLUSIONS Possible barriers to respirologists' timely SPC referral include misperceptions about palliative care, lack of awareness of referral criteria and the belief that SPC services prioritise patients with cancer. Future studies should confirm these barriers and evaluate the effectiveness of strategies to overcome them.
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Affiliation(s)
- Michael Bonares
- Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - David Christiansen
- Section of Respiratory Medicine, St Boniface General Hospital, Winnipeg, Manitoba, Canada
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Granton
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, University Health Network, Toronto, Ontario, Canada
| | - Andrea Weiss
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine Lau
- Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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Lau C, Shabbir A, Rathod KS, Chhetri I, Ono M, Hamers AJP, Amarin JJ, Ibrahim A, Nuredini G, Godec T, Kapil V, Ahluwalia A. Inorganic nitrate attenuates endothelial dysfunction consequent to systemic inflammation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Chronic cardiovascular diseases are characterised by low-grade systemic inflammation and attenuated nitric oxide (NO) bioavailability resulting in endothelial dysfunction. Inorganic nitrate augments NO bioavailability and improves markers of vascular dysfunction in patients with cardiovascular risk factors. However, the exact mechanism of this effect is uncertain.
Purpose
To determine whether inorganic nitrate supplementation alters systemic inflammation-induced endothelial dysfunction.
Methods
62 healthy male volunteers were randomised 1:1 to receive ∼8–10 mmol of dietary inorganic nitrate in beetroot juice or nitrate-free beetroot juice (placebo) once daily for 6 days. Measures of brachial artery flow-mediated dilatation (FMD), brachial blood pressure (BP), pulse wave analysis and carotid-femoral pulse wave velocity (PWV) by Vicorder were taken prior to and at 8 hours after a typhoid vaccine (to induce mild systemic inflammation). Plasma, urine and saliva samples were also collected. Clinicaltrials.gov: NCT02715635.
Results
Baseline characteristics were similar between the two groups. Inorganic nitrate significantly elevated plasma nitrite (placebo = Δ0.02±0.5 μM, inorganic nitrate = Δ0.63±1.2 μM; p=0.01) and nitrate levels (p<0.0001) compared to placebo. There were significant increases in urine nitrite (p<0.0001) and nitrate (p<0.0001) in addition to salivary nitrite (p<0.0001) and nitrate (p<0.0001) compared to placebo. After 8 hours, typhoid vaccine induced an increase in circulating white cells (placebo = Δ3.34±3.37x109/L, inorganic nitrate = Δ2.9±2.78x109/L; p=0.58) that was similar in in both arms. However, there was a significant reduction in the FMD response in the placebo group at 8-hours post vaccine; an effect that was absent in volunteers treated with inorganic nitrate (placebo = Δ−1.33±1.53%, inorganic nitrate = Δ−0.07±1.84%, p=0.005). Importantly, there were no statistically significant differences in baseline vessel diameter (p=0.78), time to peak diameter in response to flow (p=0.87) and peak shear rate (p=0.57) between the groups. When comparing change from baseline to 8 hours after the vaccine, there were no significant differences in brachial systolic BP (p=0.12), central systolic BP (p=0.12) and PWV (p=0.60) between groups, but a significant reduction in brachial diastolic BP in the inorganic nitrate group (p=0.048).
Conclusions
Inflammation-induced endothelial dysfunction was prevented in those receiving dietary inorganic nitrate suggesting that elevating circulating nitrite and delivering NO to the blood vessel wall, through dietary approaches may offer potential therapeutic benefit in those cardiovascular diseases which typically exhibit low grade inflammation and deficiencies in bioavailable NO.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation
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Affiliation(s)
- C Lau
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A Shabbir
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - K S Rathod
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - I Chhetri
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - M Ono
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A J P Hamers
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - J J Amarin
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A Ibrahim
- University of Southampton, Southampton, United Kingdom
| | - G Nuredini
- Barts Health NHS Trust, London, United Kingdom
| | - T Godec
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - V Kapil
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - A Ahluwalia
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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23
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Shabbir A, Lau C, Rathod KS, Chhetri I, Haque A, Godec T, Khambata RS, Kapil V, Ahluwalia A. Inorganic nitrate attenuates the systemic inflammatory response in typhoid vaccine-induced endothelial dysfunction in healthy volunteers. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Inflammatory responses underlie the development of endothelial dysfunction in CVD, however, therapeutics that might target this pathway have not been forthcoming. A key pathogenic mechanism mediating endothelial dysfunction is a reduction in bioavailable (eNOS-derived) nitric oxide (NO). Activation of the non-canonical pathway for in-vivo NO generation might offer an approach to improve NO levels and recover vascular function in pre-clinical models of CVD. Whether this might occur in humans is unknown.
Purpose
We hypothesize that consumption of inorganic nitrate will lead to increases in bioavailable NO and thus attenuate the inflammatory pathways leading to typhoid vaccine-induced endothelial dysfunction in healthy volunteers.
Methods
Healthy male volunteers were recruited (n=78) and randomized to receive either beetroot juice containing 8–10mmol nitrate or placebo (nitrate-deplete) juice once daily for 6 days. Participants underwent serial measurements of BP, FMD and GTN-induced brachial artery dilatation, and haematology and biochemistry, before and after typhoid vaccination. Blood, urine and saliva nitrite and nitrate were quantified using ozone chemiluminescence, and leukocyte flow cytometry analysis was conducted.
Results
8-hours post-vaccine endothelial function was depressed in placebo-treated volunteers, however this was prevented in nitrate-treated volunteers. This dysfunction was due to impaired endothelial function since responses to GTN were unaffected either by vaccination or dietary intervention (p=0.981). Dietary nitrate resulted in an increase in plasma (p<0.0001), urine (p=0.0006) and saliva (p<0.0001) nitrate, and urine (p=0.0354) and saliva (p<0.0001) nitrite levels. There was a reduction in the proportions of CD14++/CD16+intermediate monocytes in nitrate-treated participants after vaccine (p=0.016, change from baseline between groups). In the nitrate-treated group, less CD14++/CD16+ intermediate monocyte CD62L expression was identified post-vaccine (p=0.0122), compared to placebo, with no difference in soluble plasma CD62L between groups (p=0.875). CD11b median fluorescence intensity was increased in CD3+/CD4+ T-lymphocytes in nitrate-treated volunteers (p=0.0095).
Conclusions
Dietary nitrate reduced BP, as previously shown, indicating efficacy of the intervention. Importantly, we also now show for the first time that inorganic nitrate suppresses the systemic inflammatory response, specifically by reducing the numbers and activation state of CD14++/CD16+ intermediate monocytes. Furthermore, an increased expression of CD3+/CD4+ T-cell CD11b and preserved FMD in healthy volunteers treated with nitrate, suggests an anti-inflammatory phenotype, induced by the intervention, leading to improved endothelial function. Inorganic dietary nitrate modulates endothelial function through the attenuation of inflammatory responses and may be of potential therapeutic benefit in patients with established CAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Shabbir
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - C Lau
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - K S Rathod
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - I Chhetri
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - A Haque
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - T Godec
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - R S Khambata
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - V Kapil
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - A Ahluwalia
- St Bartholomews and Queen Mary University, London, United Kingdom
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Misuraca L, Tuderti G, Autorino R, Carbonara U, Mari A, Amparore D, Mastroianni R, Bove A, Anceschi U, Ferriero M, Brassetti A, Perdonà S, Lau C, Koon H, Leonardo C, Schiavina R, Derweesh I, Porpiglia F, Mottrie A, Kaouk J, Minervini A, Simone G. Nephrometry scores predicting value of trifecta achievement in a multicenter analysis (ROSULA database) of robotic partial nephrectomy for totally endophytic “deep” renal masses. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Tuderti G, Autorino R, Carbonara U, Mari A, Amparore D, Mastroianni R, Bove A, Anceschi U, Perdonà S, Lau C, Koon H, Leonardo C, Misuraca L, Ferriero M, Brassetti A, Schiavina R, Derweesh I, Porpiglia F, Mottrie A, Kaouk J, Minervini A, Simone G. Renal function deterioration assessment in totally endophytic “deep” renal masses treated with robotic partial nephrectomy: comparison with a whole cohort of cT1-2 renal tumors patients from a multicenter analysis (ROSULA database). EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Misuraca L, Tuderti G, Autorino R, Carbonara U, Mari A, Amparore D, Mastroianni R, Bove A, Anceschi U, Ferriero M, Brassetti A, Perdonà S, Lau C, Koon H, Leonardo C, Schiavina R, Derweesh I, Porpiglia F, Mottrie A, Kaouk J, Minervini A, Simone G. Robotic partial nephrectomy for totally endophytic “deep” renal masses: perioperative, pathologic, oncologic and functional outcomes of a multicenter analysis (ROSULA database). EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00755-2] [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: 10/20/2022] Open
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27
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Tuderti G, Autorino R, Carbonara U, Mari A, Amparore D, Mastroianni R, Bove A, Anceschi U, Misuraca L, Ferriero M, Brassetti A, Perdonà S, Lau C, Koon H, Leonardo C, Schiavina R, Derweesh I, Porpiglia F, Mottrie A, Kaouk J, Minervini A, Simone G. Trifecta assessment in totally endophytic “deep” renal masses treated with robotic partial nephrectomy: comparison with a whole cohort of cT1-2 renal tumors patients from a multicenter analysis (ROSULA database). EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00754-0] [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] Open
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Joy G, Artico J, Kurdi H, Lau C, Adam RD, Menacho KM, Pierce I, Captur G, Davies R, Schelbert EB, Fontana M, Kellman P, Treibel TA, Manisty C, Moon JC. Prospective case-control study of cardiovascular abnormalities six months following mild COVID-19 in healthcare workers. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344927 DOI: 10.1093/ehjci/jeab090.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Barts Charity UCLH Charity
OnBehalf
COVIDsortium
Background
Recent CMR studies have reported cardiac abnormalities after COVID-19 are common, even after mild, non-hospitalised illness with evidence of ongoing myocardial inflammation. Such a prevalence of chronic myocarditis after mild disease has prompted societal concerns in diverse domains, and suggests that screening should be considered post COVID-19, even in asymptomatic individuals. Cardiovascular magnetic resonance (CMR) has proven utility for diagnosis in patients with COVID-19 infection and elevated troponin from unclear causes by measuring cardiac structure, function, myocardial scar (late gadolinium enhancement) and oedema (T1 and T2 mapping).
Objectives
We aimed to determine the prevalence and extent of late cardiac and cardiovascular sequelae after mild non-hospitalised SARS-CoV-2 infection.
Methods
Participants were recruited from COVIDsortium, a three-hospital prospective study of 731 healthcare workers who underwent first wave weekly symptom, PCR and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post infection, 74 seropositive and 75 age-, sex-, ethnicity-matched seronegative controls were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated Cardiovascular Magnetic Resonance and blood biomarkers). Analysis was blinded, using objective AI analytics where available.
Results
149 subjects (mean age 37 years, range 18-63, 58% female) were recruited. Seropositive infections had been mild with case definition/non-case definition/asymptomatic disease in 45(61%), 18(24%) and 11(15%) with one person hospitalised (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass; atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterisation (T1, T2, ECV mapping, late gadolinium enhancement) or biomarkers (troponin, NT-proBNP). With abnormal defined by the 75 seronegatives (2 standard deviations from mean, e.g. EF < 54%, septal T1 > 1072ms, septal T2 > 52.4ms), individuals had abnormalities including reduced EF (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), LGE (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all NT-proBNP normal). These were distributed equally between seropositive and seronegative individuals.
Conclusions
Cardiovascular abnormalities are no more common in seropositive vs seronegative otherwise healthy, workforce representative individuals 6 months post mild SARS-CoV-2 infection. Our study provides societal reassurance for the cardiovascular health of working-aged individuals with convalescence from mild SARS-CoV-2. Screening asymptomatic individuals following mild diseases is not indicated.
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Affiliation(s)
- G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Artico
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Kurdi
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - RD Adam
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - KM Menacho
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - I Pierce
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Captur
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- University College of London, London, United Kingdom of Great Britain & Northern Ireland
| | - EB Schelbert
- University of Pittsburgh, Pittsburgh, United States of America
| | - M Fontana
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - TA Treibel
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Lau C, Meaney C, Morgan M, Cook R, Zimmermann C, Wentlandt K. Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review. Palliat Med 2021; 35:1191-1201. [PMID: 33855886 PMCID: PMC8189004 DOI: 10.1177/02692163211007387] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. AIM To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. DESIGN A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. SETTING/PARTICIPANTS Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. RESULTS A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015-2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%-20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%-40% were associated with decreased rates and/or likelihood of admission. CONCLUSION Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are "sicker" with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.
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Affiliation(s)
- Christine Lau
- Division of Palliative Care, Sunnybrook Health Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Morgan
- Division of General Internal Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Ontario Health - Toronto Region, Toronto, ON, Canada
| | - Rose Cook
- Ontario Health - Toronto Region, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Ontario Health - Toronto Region, Toronto, ON, Canada.,Department of Supportive Care, Division of Palliative Care, University Health Network, Toronto, ON, Canada
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Lau C, Kalantari B, Batts KP, Ferrell LD, Nyberg SL, Graham RP, Moreira RK. The Voronoi theory of the normal liver lobular architecture and its applicability in hepatic zonation. Sci Rep 2021; 11:9343. [PMID: 33927276 PMCID: PMC8085188 DOI: 10.1038/s41598-021-88699-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
The precise characterization of the lobular architecture of the liver has been subject of investigation since the earliest historical publications, but an accurate model to describe the hepatic lobular microanatomy is yet to be proposed. Our aim was to evaluate whether Voronoi diagrams can be used to describe the classic liver lobular architecture. We examined the histology of normal porcine and human livers and analyzed the geometric relationships of various microanatomic structures utilizing digital tools. The Voronoi diagram model described the organization of the hepatic classic lobules with overall accuracy nearly 90% based on known histologic landmarks. We have also designed a Voronoi-based algorithm of hepatic zonation, which also showed an overall zonal accuracy of nearly 90%. Therefore, we have presented evidence that Voronoi diagrams represent the basis of the two-dimensional organization of the normal liver and that this concept may have wide applicability in liver pathology and research.
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Affiliation(s)
- C Lau
- Department of Computer Science, Rutgers University, Brunswick, NJ, USA
| | - B Kalantari
- Department of Computer Science, Rutgers University, Brunswick, NJ, USA
| | | | - L D Ferrell
- Department of Pathology, University of California, San Francisco, CA, USA
| | - S L Nyberg
- Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - R P Graham
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Roger K Moreira
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA.
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31
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Timofte I, Wells C, Hersi K, Ryan A, Varghese A, Vesselinov R, Iacono A, Assadi J, Davis D, Li G, Herr D, Harrington T, Griffith B, Lau C, Krupnick A, Madathil R, Rabin J, Alon G, Parker E, Baer D, Magder L, Terrin M, Verceles A. Nutritional Supplementation and Neuromuscular Electrical Stimulation in Lung Transplant Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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32
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Joy G, Crane JD, Lau C, Augusto J, Brown LAE, Chowdhary A, Kotecha T, Plein S, Fontana M, Moon JC, Kellman P, Xue H, Cruickshank JK, Mcgowan BM, Manisty C. Impact of obesity on myocardial microvasculature assessed using fully-automated inline myocardial perfusion mapping CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.296] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Guy"s and St Thomas" Charity University College London Hospitals Biomedical Research Centre
Background
Obesity and cardiovascular disease are associated, but the relationship is poorly understood. Myocardial perfusion, metabolic derangement and lipotoxicity appear adversely associated in many scenarios (myocardial injury, diastolic dysfunction, diabetes). Altered perfusion (by PET) predicts outcome, and it is hypothesised that perfusion derangement is part of causality for cardiac disease and adverse outcomes.
Purpose
To assess the presence and pattern of myocardial microvascular dysfunction in patients with obesity (scheduled for bariatric surgery) using stress quantitative perfusion mapping.
Methods
38 subjects with obesity planned to undergo bariatric surgery and 38 age and sex matched healthy volunteers (no diabetes, no hypertension) underwent anthropometry, biochemistry and CMR at 1.5T (Siemens) with cine imaging, stress (adenosine 140-210 mcg/kg/min) and rest fully-automated quantitative perfusion mapping.
Results
Bariatric patients had a higher BMI (44 ± 6.4 vs 26.5 ± 4kg/m2 p = 0.001); 58%(22) were diabetic and 58%(22) had hypertension. Bariatric patients had higher absolute but lower indexed end-diastolic volumes, and overall higher ejection fractions (+5%) (see Table). Rest myocardial blood flow (MBF) in bariatric patients was the same (1.00 ± 0.3 vs 0.88 ± 0.24 p = 0.052), but stress perfusion results were significantly lower both for stress MBF (2.35 ± 0.69 vs 2.93 ± 0.76ml/g/min p = 0.001) and myocardial perfusion reserve (MPR 2.48 ± 0.82 vs 3.4 ± 0.81ml/g/min p = 0.0001). Although this was transmural, the endocardial stress MBF was particularly negatively affected in the bariatric cohort compared to controls (endocardial MBF 2.16 ± 0.65 vs 2.82 ± 0.73ml/g/min, p = 0.0001 vs epicardial MBF: 2.52 ± 0.76 vs 3.06 ± 0.79 p = 0.003), meaning there was an increased endo-epicardial stress MBF gradient in bariatric patients (0.87 ± 0.12 vs 0.92 ± 0.07 p = 0.03).
Conclusion
Compared to healthy controls, patients with obesity have abnormal myocardial stress perfusion with reduced global perfusion, perfusion reserve and an increased transmyocardial perfusion gradient.
Table - myocardial perfusion parameters Category Bariatric patients n = 38 Controls n = 38 p value Age (years) 48 ± 11 45 ± 13 0.25 n male (%) 12 (32%) 10 (36%) 0.32 LVEDV (ml) 168 ± 37 149 ± 31 0.017 LVEDVi (ml/m2) 70.4 ± 12.3 78.8 ± 12.1 0.004 LV Mass (g) 116 ± 31 99 ± 28 0.019 EF (%) 70 ± 8 65 ± 5 0.002 LVEDV - left ventricular end-diastolic volume, EF - ejection fraction
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Affiliation(s)
- G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JD Crane
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - LAE Brown
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chowdhary
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Kotecha
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, United States of America
| | - H Xue
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, United States of America
| | - JK Cruickshank
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - BM Mcgowan
- King"s College London, Department of Diabetes and Nutritional Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
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Tigert M, Lau C, Mackay H, L'Heureux S, Gien LT. Factors impacting length of stay and survival in patients with advanced gynecologic malignancies and malignant bowel obstruction. Int J Gynecol Cancer 2021; 31:727-732. [PMID: 33509803 DOI: 10.1136/ijgc-2020-002133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Malignant bowel obstruction in patients with gynecologic malignancies can impose a large symptomatic burden. The objectives of this study were to identify factors associated with shorter length of hospital stay and overall survival in gynecologic oncology patients with malignant bowel obstructions. METHODS A retrospective chart review was performed from December 2014 to March 2019 on patients admitted to a tertiary care center with a malignant bowel obstruction and advanced gynecologic malignancy. Data collection included patient and tumor characteristics, malignant bowel obstruction management (such as conservative management with bowel rest, nasogastric tube, pharmacotherapy or active intervention with surgery, chemotherapy, radiation, total parenteral nutrition or interventional stents), length of hospital stay, and survival outcomes. Statistical analysis included comparisons with Student's t-test and χ2 test, multivariable analysis, and survival analysis. RESULTS A total of 107 patients with gynecologic cancer with malignant bowel obstruction were included. The majority of patients (63%, n=67) had ovarian cancer. The median length of hospital stay was 12 days (range 1-23), with a median overall survival after malignant bowel obstruction diagnosis of 7 months (range 0.1-64.1). Patients with active interventions had a longer length of stay compared with those with conservative management (13 vs 6 days, p<0.001). However, patients who received multiple active interventions had increased overall survival (9.1 vs 2.9 months, p=0.049). CONCLUSION Patients who received multimodal treatment for malignant bowel obstruction had an increased length of stay and improvement in survival of over 6 months. This emphasizes the importance of a multidisciplinary approach to actively manage malignant bowel obstruction in advanced gynecologic cancer.
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Affiliation(s)
- Melissa Tigert
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine Lau
- Palliative Care, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Helen Mackay
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephanie L'Heureux
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Division of Medical Oncology, Princess Margaret Hospital Department of Medical Oncology and Hematology, Toronto, Ontario, Canada
| | - Lilian T Gien
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada .,Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Lim A, N.A.Rahim, Periyasamy P, Mat W, Lau C. Mortality and microbiological clearance among critically ill patients receiving Polymyxin B in a Malaysian ICU: A 10 years retrospective study. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bicho Augusto J, Johner N, Shah D, Nordin S, Knott K, Lau C, Alfarih M, Seraphim A, Vijapurapu R, Ramaswami U, Steeds R, Kozor R, Hughes D, Moon J, Namdar M. The myocardial phenotype of Fabry disease pre-hypertrophy and pre-detectable storage. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2132] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac involvement in Fabry Disease (FD) occurs prior to left ventricular hypertrophy (LVH) and is characterized by low myocardial native T1 with storage reflected by cardiovascular magnetic resonance (CMR) and ECG changes.
Objectives
We hypothesize that a pre-storage myocardial phenotype might occur even earlier, prior to T1 lowering.
Methods
FD patients and age, sex and heart rate matched healthy controls underwent same-day ECG with advanced analysis and multiparametric CMR (cines, global longitudinal strain [GLS], T1 and T2 mapping, stress perfusion [myocardial blood flow, MBF] and late gadolinium enhancement [LGE]).
Results
114 Fabry patients (46±13 years, 61% female) and 76 controls (49±15 years, 50% female) were included. In pre-LVH FD (n=72, 63%), a low T1 (n=32/72, 44%) was associated with a constellation of ECG and functional abnormalities compared to normal T1 FD patients and controls. However, pre-LVH FD with normal T1 (n=40/72, 56%) also had abnormalities compared to controls: reduced GLS (−18±2 vs −20±2%, P<0.001), microvascular changes (lower MBF 2.5±0.7 vs 3.0±0.8mL/g/min, P=0.028), subtle T2 elevation (50±4 vs 48±2ms, p=0.027) and limited LGE (%LGE 0.3±1.1 vs 0%, P=0.004). ECG abnormalities included shorter P wave duration (88±12 vs 94±15ms, P=0.010) and T wave peak time (Tonset–Tpeak; 104±28 vs 115±20ms, P=0.015), resulting in a more symmetric T wave with lower T wave time ratio (Tonset–Tpeak)/(Tpeak–Tend) (1.5±0.4 vs 1.8±0.4, P<0.001) compared to controls.
Conclusions
FD has a measurable myocardial phenotype pre-LVH and pre-detectable myocyte storage with microvascular dysfunction, subtly impaired GLS and altered atrial depolarization and ventricular repolarization intervals.
Proposed stages of cardiac involvement
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - N Johner
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
| | - D Shah
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
| | - S Nordin
- Barts Health NHS Trust, London, United Kingdom
| | - K Knott
- University College London, London, United Kingdom
| | - C Lau
- Barts Health NHS Trust, London, United Kingdom
| | - M Alfarih
- University College London, London, United Kingdom
| | - A Seraphim
- University College London, London, United Kingdom
| | - R Vijapurapu
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - U Ramaswami
- Royal Free Hospital, lysosomal storage disorders unit, London, United Kingdom
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - R Kozor
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - D Hughes
- Royal Free Hospital, lysosomal storage disorders unit, London, United Kingdom
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom
| | - M Namdar
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
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Lau C. Discussion. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)31010-2. [PMID: 32622566 DOI: 10.1016/j.jtcvs.2020.02.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lau C, Turcich MR, Smith EO. Early detection of parenting stress in mothers of preterm infants during their first-year home. BMC Psychol 2020; 8:66. [PMID: 32576260 PMCID: PMC7313173 DOI: 10.1186/s40359-020-00435-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background Maternal stress following the birth of an infant is well acknowledged. It is particularly so when infants are born prematurely as their mothers cannot fully take on their parenting role until their infant(s) is discharged from neonatal intensive care units (NICUs). In this exploratory study, we examined whether these mothers’ parenting stress would lessen during their first-year reunification with their infant(s) as they settle into motherhood at home. Methods Two groups of mothers with infants born between 24- and 33-week gestational age were recruited. A group of 25 mothers were monitored at their infants’ 1-month corrected age (CA) and a second group of 24 mothers were monitored at their infants’ 12-month CA. Subjects completed the long form Parental Stress Index (PSI) ranking how stressful they perceive the individual subscales in the Child and Parent Domains of the self-reported questionnaire (PSI-3; Abidin; PAR Inc). The PSI theorizes that the stress mothers perceive is a resultant of their respective characteristics, interactions with their infant(s), family, and environment. Statistical analyses include descriptive statistics, χ2 square analysis, and independent t-test. Results There was no significant difference in the levels of perceived stress in the PSI subscales between the two groups of mothers at 1- and 12-month CA. Scores for the majority of respondents fell within the 15th to 80th percentile (% ile) distribution of Abidin’s normative population, with some mothers falling below the 15th % ile. Discussion/conclusion The data collected suggest that: 1. the perceived stress experienced by mothers during their first-year reunited with their preterm infants is within the normal range observed in Abidin’s normative population. 2. As the PSI is a self-reported survey, care providers need to be aware that some mothers may downplay their stress responses. 3. With the ability to monitor individual participants, the PSI can be readily offered to mothers at their infants’ first year routine clinical visits to assist in the early identification of parenting issues that may threaten the development of a healthy mother-infant dyad. Early appropriate guidance and social support would help “at-risk” mothers develop more constructive parenting routines.
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Affiliation(s)
- C Lau
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - M R Turcich
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - E O Smith
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
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Farry T, Lau C, Keates H, McEwen M, Woldeyohannes S, Barnes T, Perkins N, Goodwin W. Comparison of two formulations of alfaxalone in laboratory zebra fish (Danio rerio) for use in immersion anaesthesia. Vet Anaesth Analg 2019. [DOI: 10.1016/j.vaa.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caneses JF, Piotrowicz PA, Biewer TM, Goulding RH, Lau C, Showers M, Rapp J. Ion Fluxes and Neutral Gas Ionization Efficiency of the 100-kW Light-Ion Helicon Plasma Source Concept for the Material Plasma Exposure eXperiment. Fusion Science and Technology 2019. [DOI: 10.1080/15361055.2019.1622988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J. F. Caneses
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - P. A. Piotrowicz
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- University of Illinois at Urbana-Champaign, Department of Nuclear, Plasma and Radiological Engineering, Center for Plasma-Material Interactions, Urbana, Illinois 61801
| | - T. M. Biewer
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - R. H. Goulding
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - C. Lau
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - M. Showers
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- University of Tennessee, Knoxville, Tennessee 37996
| | - J. Rapp
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
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Bhuva A, Bai W, Lau C, Davies R, Yang Y, Bulluck H, Mcalindon E, Cole GD, Petersen SE, Greenwood JP, Bucciarelli-Ducci C, Hughes AD, Rueckert D, Moon JC, Manisty CH. 349Fully automated left ventricular analysis matches clinician precision: a multi-centre, multi-vendor, multi-field strength, multi-disease scan:rescan CMR study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Bhuva
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - W Bai
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - Y Yang
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Bulluck
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - E Mcalindon
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G D Cole
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - D Rueckert
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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41
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Illes J, McCall IC, Lau C, Minielly N. Ethical considerations for brain recording and stimulating neurotechnologies available in the open marketplace. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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42
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Donald PM, Illes J, Lau C, McCall IC. Regulatory oversight for DBS: Current framework for device recall in North America. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Landsem A, Fure H, Krey Ludviksen J, Christiansen D, Lau C, Mathisen M, Bergseth G, Nymo S, Lappegård KT, Woodruff TM, Espevik T, Mollnes TE, Brekke OL. Complement component 5 does not interfere with physiological hemostasis but is essential for Escherichia coli-induced coagulation accompanied by Toll-like receptor 4. Clin Exp Immunol 2018; 196:97-110. [PMID: 30444525 PMCID: PMC6422650 DOI: 10.1111/cei.13240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2018] [Indexed: 12/18/2022] Open
Abstract
There is a close cross-talk between complement, Toll-like receptors (TLRs) and coagulation. The role of the central complement component 5 (C5) in physiological and pathophysiological hemostasis has not, however, been fully elucidated. This study examined the effects of C5 in normal hemostasis and in Escherichia coli-induced coagulation and tissue factor (TF) up-regulation. Fresh whole blood obtained from six healthy donors and one C5-deficient individual (C5D) was anti-coagulated with the thrombin inhibitor lepirudin. Blood was incubated with or without E. coli in the presence of the C5 inhibitor eculizumab, a blocking anti-CD14 monoclonal antibody (anti-CD14) or the TLR-4 inhibitor eritoran. C5D blood was reconstituted with purified human C5. TF mRNA was measured by quantitative polymerase chain reaction (qPCR) and monocyte TF and CD11b surface expression by flow cytometry. Prothrombin fragment 1+2 (PTF1·2) in plasma and microparticles exposing TF (TF-MP) was measured by enzyme-linked immunosorbent assay (ELISA). Coagulation kinetics were analyzed by rotational thromboelastometry and platelet function by PFA-200. Normal blood with eculizumab as well as C5D blood with or without reconstitution with C5 displayed completely normal biochemical hemostatic patterns. In contrast, E. coli-induced TF mRNA and TF-MP were significantly reduced by C5 inhibition. C5 inhibition combined with anti-CD14 or eritoran completely inhibited the E. coli-induced monocyte TF, TF-MP and plasma PTF1·2. Addition of C5a alone did not induce TF expression on monocytes. In conclusion, C5 showed no impact on physiological hemostasis, but substantially contributed to E. coli-induced procoagulant events, which were abolished by the combined inhibition of C5 and CD14 or TLR-4.
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Affiliation(s)
- A Landsem
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - H Fure
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway
| | - J Krey Ludviksen
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway
| | - D Christiansen
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway
| | - C Lau
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway
| | - M Mathisen
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway
| | - G Bergseth
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway
| | - S Nymo
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway.,Division of Medicine, Nordland Hospital Trust, Bodø, Norway
| | - K T Lappegård
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Division of Medicine, Nordland Hospital Trust, Bodø, Norway
| | - T M Woodruff
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - T Espevik
- Centre of Molecular Inflammation Research, and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - T E Mollnes
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,K. G. Jebsen TREC, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Immunology, Oslo University Hospital Rikshospitalet and University of Oslo, Norway.,Centre of Molecular Inflammation Research, and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - O-L Brekke
- Research Laboratory and Department of Laboratory Medicine, Nordland Hospital Trust, Bodø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
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Gupta R, Chevalier D, Saluja J, Lau C, Wang C, Fakih M. ctDNA assays identify alterations in RAS, EGFR, and cMET that are unique to RAS-WT patients progressing on anti-EGFR therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.090] [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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Amanam I, Chao J, Lim D, Rahmanuddin S, Schrock A, Ali S, Lau C, Chevalier D, Harris E, Saluja J, Wang C, Fakih M. Lower tumor mutational burden (TMB) and hepatic metastases may predict for lack of response to PD-1 blockade in MSI-H metastatic colorectal cancer (MCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martin EH, Lau C, Brookman MW, Lohr J. A spectroscopic electric field vector imaging diagnostic for electron cyclotron heating systems. Rev Sci Instrum 2018; 89:10D117. [PMID: 30399893 DOI: 10.1063/1.5038670] [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] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
An experimental measurement of the wave electric field vector provides important data that can be used to directly compare against 3D full-wave simulations. This direct comparison yields the fastest approach toward identifying missing physics in computational models and providing a high fidelity validation platform. In this paper, we present a diagnostic that is capable of imaging the Electron Cyclotron (EC) wave electric field vector by acquiring filtered images of polarized D β spectral satellites. The diagnostic is designed to have a spatial and temporal resolution on the order of 100 μm and 100 μs, respectively. The diagnostic purpose is to provide experimental data for the direct validation of full-wave codes used to predict EC beam propagation and absorption and to provide real-time monitoring of EC waves.
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Affiliation(s)
- E H Martin
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - C Lau
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - M W Brookman
- General Atomics, 3550 General Atomics Ct., San Diego, California 92121, USA
| | - J Lohr
- General Atomics, 3550 General Atomics Ct., San Diego, California 92121, USA
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47
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Schmitz L, Deng B, Thompson M, Gota H, Lau C, Fulton DP, Lin Z, Tajima T, Binderbauer M. Combination Doppler backscattering/cross-polarization scattering diagnostic for the C-2W field-reversed configuration. Rev Sci Instrum 2018; 89:10H116. [PMID: 30399746 DOI: 10.1063/1.5038914] [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] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
A versatile combination Doppler backscattering and Cross-Polarization Scattering (CPS) diagnostic for the C-2W beam-driven field-reversed configuration is described. This system is capable of measuring density fluctuations and perpendicular magnetic field fluctuations across a wide wavenumber range (2.5 ≤ k θ ρ s ≤ 50), with typical resolution Δk θ/k θ ≤ 0.4-0.8. Four tunable frequencies (26 GHz ≤ f ≤ 60 GHz corresponding to plasma cut-off densities 0.8 × 1019 ≤ n e ≤ 4.4 × 1019 m-3) are launched via quasi-optical beam combiners/polarizers and an adjustable parabolic focusing mirror selecting the beam incidence angle. GENRAY ray tracing shows that the incident O-mode and backscattered CPS X-mode beam trajectories for C-2W plasma parameters nearly overlap, allowing simultaneous detection of ñ and B̃ r or B̃ θ from essentially the same scattering volume.
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Affiliation(s)
- L Schmitz
- Department of Physics and Astronomy, University of California Los Angeles, Los Angeles, California 90095, USA
| | - B Deng
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - M Thompson
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - H Gota
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - C Lau
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - D P Fulton
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - Z Lin
- Department of Physics and Astronomy, University of California Irvine, Irvine, California 92697, USA
| | - T Tajima
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
| | - M Binderbauer
- TAE Technologies, Inc., Foothill Ranch, California 92610, USA
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48
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Lau C. Effect of short-term high-intensity noise exposure on auditory physiology: a functional magnetic resonance imaging study. Hong Kong Med J 2018; 24 Suppl 4:46-47. [PMID: 30135276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- C Lau
- Department of Physics, City University of Hong Kong
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49
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Nguyen-Truong CKY, Pedhiwala N, Nguyen V, Le C, Vy Le T, Lau C, Lee J, Lee-Lin F. Feasibility of a Multicomponent Breast Health Education Intervention for Vietnamese American Immigrant Women. Oncol Nurs Forum 2018; 44:615-625. [PMID: 28820521 DOI: 10.1188/17.onf.615-625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine the feasibility and acceptability of an intervention with targeted cultural and health belief messages to increase rates of mammography among Vietnamese American (VA) immigrant women.
. DESIGN One-group, pre-/post-test, pilot, quasiexperimental design.
. SETTING Portland, Oregon, metropolitan area.
. SAMPLE 40 VA immigrant women aged 50 years or older.
. METHODS Participants who had not had a mammogram within the past 12 months were recruited. The intervention consisted of one interactive group teaching session, followed by individual counseling delivered about 10 days later to overcome barriers to screening. Participants completed a baseline survey prior to the group teaching and again at 12 weeks after the session.
. MAIN RESEARCH VARIABLES The intervention, guided by the Transtheoretical Model of Change and the Health Belief Model, involved movement in stage of change based on women's readiness, as well as perceived susceptibility, perceived benefits, perceived common barriers, and perceived cultural barriers. Mammogram completion and knowledge of breast cancer and mammography were examined.
. FINDINGS The recruitment response rate was 58%. Knowledge about breast cancer, breast cancer susceptibility, and the benefits of mammography as related to breast cancer significantly increased following the intervention.
. CONCLUSIONS Acceptability of the targeted program, good feasibility, and very low attrition was achieved.
. IMPLICATIONS FOR NURSING This intervention can be adapted for other populations, including other Asian groups, and other cancer screenings.
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Affiliation(s)
| | | | | | - Cang Le
- Asian Health and Service Center
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Spong DA, Heidbrink WW, Paz-Soldan C, Du XD, Thome KE, Van Zeeland MA, Collins C, Lvovskiy A, Moyer RA, Austin ME, Brennan DP, Liu C, Jaeger EF, Lau C. First Direct Observation of Runaway-Electron-Driven Whistler Waves in Tokamaks. Phys Rev Lett 2018; 120:155002. [PMID: 29756886 DOI: 10.1103/physrevlett.120.155002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Indexed: 06/08/2023]
Abstract
DIII-D experiments at low density (n_{e}∼10^{19} m^{-3}) have directly measured whistler waves in the 100-200 MHz range excited by multi-MeV runaway electrons. Whistler activity is correlated with runaway intensity (hard x-ray emission level), occurs in novel discrete frequency bands, and exhibits nonlinear limit-cycle-like behavior. The measured frequencies scale with the magnetic field strength and electron density as expected from the whistler dispersion relation. The modes are stabilized with increasing magnetic field, which is consistent with wave-particle resonance mechanisms. The mode amplitudes show intermittent time variations correlated with changes in the electron cyclotron emission that follow predator-prey cycles. These can be interpreted as wave-induced pitch angle scattering of moderate energy runaways. The tokamak runaway-whistler mechanisms have parallels to whistler phenomena in ionospheric plasmas. The observations also open new directions for the modeling and active control of runaway electrons in tokamaks.
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Affiliation(s)
- D A Spong
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - W W Heidbrink
- University of California-Irvine, Irvine, California 92697, USA
| | - C Paz-Soldan
- General Atomics, San Diego, California 92186-5608, USA
| | - X D Du
- University of California-Irvine, Irvine, California 92697, USA
| | - K E Thome
- Oak Ridge Associated Universities, P.O. Box 117, Oak Ridge, Tennessee 37831, USA
| | | | - C Collins
- General Atomics, San Diego, California 92186-5608, USA
| | - A Lvovskiy
- Oak Ridge Associated Universities, P.O. Box 117, Oak Ridge, Tennessee 37831, USA
| | - R A Moyer
- University of California-San Diego, La Jolla, California 92093, USA
| | - M E Austin
- University of Texas, Austin, Texas 78705, USA
| | - D P Brennan
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - C Liu
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - E F Jaeger
- XCEL Engineering, Oak Ridge, Tennessee 37830, USA
| | - C Lau
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
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