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Lal AP, Dimmick S, Roche O, Wang W, Sheth S, Chakrabarti R, Del Porto LA, Fok A, Shuey N, Fraser C, White O, Van der Walt A. Developing a Quality Assurance Framework for Neuro-Ophthalmology Using a Multisite Data Registry. J Neuroophthalmol 2024; 44:267-272. [PMID: 37471150 DOI: 10.1097/wno.0000000000001943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
BACKGROUND Quality assurance (QA) in neuro-ophthalmology (NOPH) is often lacking. We aimed to assess the quality of referral assessment and time to consult for common neuro-ophthalmological conditions by implementing a quality-assurance registry, NODE (Neuro-ophthalmology Database), in a tertiary neuro-ophthalmology clinic. Australian standardized triage categories, namely, P1 (consult ≤30 days), P2 (consult ≤30-60 days), and P3 (consult ≤60-90 days), were developed and validated for neuro-ophthalmological conditions. METHODS We collected data from NODE on 676 patients at the Alfred Hospital, Melbourne and developed a consensus on the assignation of NOPH conditions to triage categories using a modified Delphi approach. A panel of 7 experienced neuro-ophthalmologists scored conditions and assignation to triage categories. Consensus was considered when ≥75% of the panel strongly agreed or agreed. We analyzed the mean days from referral to triage and from triage to the initial consultation and compared that with the developed triage category standard. RESULTS Most patients presenting to the service were female (64%). Common diagnoses were idiopathic intracranial hypertension (IIH) (19%), optic neuropathy (ON) (14%), nonspecific headaches (11%), cranial nerve defects (CND) (8%), and papilledema (7%). Consensus on triage category assignment was reached after 2 rounds of scoring from expert panel members. The mean time from referral to triage was performed in <5 days for all the common diagnosis at the NOPH clinic. The mean days (±SD) from P1 category triage to initial consult for IIH was 15 (±12) days, acute ON 16 (±14) days, CND was 20 (±15) days, and papilledema was 20 (±19) days. The mean days from P2 triage to initial consultant for nonspecific headaches was 22 (±20) days and for EOMD was 48 (±22) days. The mean time (days) from P3 triage to initial consultant for nonocular myasthenia gravis was 38 days (±29) days and for visual snow was 54 (±31) days. CONCLUSIONS We have established a consensus agreement on triage categories for neuro-ophthalmological conditions, which can be further validated using a larger panel of experts. We established a NOPH registry that will serve as a framework to benchmark quality of care between NOPH services. Data from our NOPH registry demonstrated that most conditions are appropriately triaged and seen.
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Affiliation(s)
- Anoushka P Lal
- Department of Neuroscience (APL, OR, AVdW), Central Clinical School, Alfred Hospital, Melbourne, Victoria, Australia; Neuro-Ophthalmology Service (SD, OR, WW, OW, AVdW), Alfred Hospital, Melbourne, Victoria, Australia; Save Sight Institute (CF), University of Sydney, Sydney, New South Wales, Australia; and Department of Neuro-Ophthalmology (SS, RC, LAdP, AF, NS), Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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Skierszkan EK, Carey SK, Jackson SI, Fellwock M, Fraser C, Lindsay MBJ. Seasonal controls on stream metal(loid) signatures in mountainous discontinuous permafrost. Sci Total Environ 2024; 908:167999. [PMID: 37914137 DOI: 10.1016/j.scitotenv.2023.167999] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
We assess physical and chemical processes driving seasonal fluctuations in dissolved (<0.45 μm) trace metal(loid) concentrations in subarctic streams in discontinuous permafrost. Our analysis integrates multiple years of stream hydrometric and geochemical data with geochemical analyses of bedrock, permafrost, and active-layer samples. Three principal flow regimes govern stream hydrology: winter baseflow, spring freshet, and summer high flows. Metal(oid) concentrations in streams respond seasonally to these flow regimes. Baseflows are dominated by discharge of circumneutral-pH groundwater draining fractured bedrock. This discharge acts as a source of metals found as oxyanions or neutrally charged complexes, such as uranium and molybdenum. High stream flows are associated with peak concentrations of aluminium, cobalt, copper, iron, nickel, titanium, and vanadium. Concentrations of the metal cations aluminium, cobalt, copper, nickel, and titanium peak during freshet, when infiltration of snowmelt through organic-rich and moderately acidic soils favors their complexation with dissolved organic carbon. Concentrations of vanadium peak during summer high flows, likely reflecting flow through mineral soils in the active layer and involving reductive dissolution of iron(III)-(oxyhydr)oxides. The seasonal variation of arsenic concentrations is complex; at the majority of catchments it is sourced from shallow flowpaths in the active layer, but it can also be locally associated with discharge of deeper bedrock groundwater, which is spatially constrained by the presence of permafrost. Based on our analysis, we present a conceptual model that describes the flowpaths and processes governing metal(loid) release to streams in discontinuous permafrost. This model provides a framework upon which we consider changes in metal(loid) export into water resources in the context of thawing permafrost.
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Affiliation(s)
- E K Skierszkan
- Department of Geological Sciences, University of Saskatchewan, 114 Geological Sciences Place, Saskatoon S7N 5E2, Canada.
| | - S K Carey
- School of Earth, Environment & Society, McMaster University, 1280 Main Street West, Hamilton L8S 4K1, Canada
| | - S I Jackson
- Lorax Environmental Services Ltd., 2289 Burrard Street, Vancouver V6J 3H9, Canada
| | - M Fellwock
- Department of Geological Sciences, University of Saskatchewan, 114 Geological Sciences Place, Saskatoon S7N 5E2, Canada
| | - C Fraser
- Lorax Environmental Services Ltd., 2289 Burrard Street, Vancouver V6J 3H9, Canada
| | - M B J Lindsay
- Department of Geological Sciences, University of Saskatchewan, 114 Geological Sciences Place, Saskatoon S7N 5E2, Canada
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Norman E, Fraser C, Lawlor M, Sammel A. A low Southend Giant Cell Arteritis Probability Score negates the need for a temporal artery biopsy in general and eye hospital cohorts. Rheumatology (Oxford) 2023:kead698. [PMID: 38150191 DOI: 10.1093/rheumatology/kead698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023] Open
Affiliation(s)
- Eloise Norman
- Department of Rheumatology, Prince of Wales Hospital, Sydney, NSW, Australia
- Sydney Hospital and Sydney Eye Hospital, Sydney, NSW, Australia
| | - Clare Fraser
- Sydney Hospital and Sydney Eye Hospital, Sydney, NSW, Australia
- Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Mitchell Lawlor
- Sydney Hospital and Sydney Eye Hospital, Sydney, NSW, Australia
- Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Anthony Sammel
- Department of Rheumatology, Prince of Wales Hospital, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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Jeyakumar S, Nguyen H, Robson D, Olsen N, Schnegg B, MacDonald P, Fraser C, Liew G, Hayward C, Muthiah K. Retinal Microvascular Remodelling Predicts Adverse Events in Continuous-Flow Left Ventricular Assist Device Supported Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1515] [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: 04/05/2023] Open
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Barnett T, Selfridge M, Drost A, Guarasci K, Lundgren K, Fraser C, Boothman F. A11 NEXT STEPS IN MICRO-ELIMINATION: PEER POINT OF CARE HEPATITIS C TESTING IN VICTORIA, BRITISH COLUMBIA. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991089 DOI: 10.1093/jcag/gwac036.011] [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: 03/09/2023] Open
Abstract
Background Canada is currently on target to reach the 2030 WHO goal of hepatitis C virus (HCV) elimination. Continued high rates of treatment initiation are required to meet this goal. People who use drugs (PWUD), account for the majority of new HCV cases in BC and continue to have many barriers to accessing DAA therapies, despite demonstrated high SVR rates in clinical trials. Improved elimination efforts including innovative outreach testing and treatment with this population are essential. Novel models have proven successful to engage PWUD in HCV therapy with a simplified, task-shifted cascade of care. Peer-based testing and support models have been piloted in other communities and may help connect to marginalized populations. People with lived and living experience of HCV treatment and drug use (peers) are seen as trusted sources of knowledge. Peers can vouch for the efficacy, minimal side effects and ease of HCV treatment that now exist in the current DAA era. Purpose The Peer HCV Point of Care (POC) testing project developed within our long standing nurse-led HCV treatment program seeks to determine whether an outreach peer model of HCV POC testing can be successful in Victoria, BC. The peer program focuses on finding populations who use drugs without regular access to primary care still living with HCV. This task shifting approach is the next phase of local micro-elimination efforts and has not been attempted previously. Method Six peers have been trained to provide HCV POC antibody and dried blood spot RNA tests. Our goals are to pilot the program, learn from our experiences, specifically from the direct input of peers to develop effective and supportive testing and treatment strategies. Peers have worked with nursing and research staff in two-hour blocks and are paid $26 per hour for these shifts. They provide testing at local supportive housing, shelters, social service sites and special events. Each client tested is offered a $10 incentive. Our peers are able to offer both POC antibody testing and, for those who have been exposed to HCV (currently infected, treated or cleared), RNA testing by dried blood spot. Serology by nursing from our mobile outreach van is collected as needed. Result(s) Within the first 4 months of the project peers and staff tested 304 people: 251 people with HCV POC antibody tests (227 negative and 24 positive results), 41 people with HCV dried blood spot RNA tests and 28 with nurse RNA serology. To date 12 people tested RNA+ (11 with previously unknown HCV have active RNA that require treatment), 7 people have been started on treatment. Conclusion(s) This innovative and novel approach to HCV therapy in PWUD was able to successfully use a peer-based approach to find people with limited connection to primary health care to test and treat HCV. We still have much to learn from the valuable knowledge, established relationships and novel perspectives of peers in our efforts to reduce barriers and reach PWUD and others who remain untreated. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest T. Barnett Grant / Research support from: AbbVie, Gilead, Merck, M. Selfridge Grant / Research support from: Kirby Institute, AbbVie, Gilead, Merck, ViiV, A. Drost Grant / Research support from: Abbvie, Gilead, Merck, K. Guarasci Grant / Research support from: Gliead, Abbvie, Merck , K. Lundgren Grant / Research support from: Abbvie, Gilead, Merck , C. Fraser Grant / Research support from: Abbvie, Gilead, Merck, Kirby Institute, ViiV, F. Boothman : None Declared
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Affiliation(s)
| | - M Selfridge
- Cool Aid Community Health Centre,Canadian Institute of Substance Use Research, University of Victoria, Victoria
| | - A Drost
- Cool Aid Community Health Centre
| | | | | | - C Fraser
- Cool Aid Community Health Centre,Department of Family Medicine, University of Victoria, Vancouver , Canada
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Girard MJA, Panda S, Tun TA, Wibroe EA, Najjar RP, Aung T, Thiéry AH, Hamann S, Fraser C, Milea D. Discriminating Between Papilledema and Optic Disc Drusen Using 3D Structural Analysis of the Optic Nerve Head. Neurology 2023; 100:e192-e202. [PMID: 36175153 DOI: 10.1212/wnl.0000000000201350] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The distinction of papilledema from other optic nerve head (ONH) lesions mimicking papilledema, such as optic disc drusen (ODD), can be difficult in clinical practice. We aimed the following: (1) to develop a deep learning algorithm to automatically identify major structures of the ONH in 3-dimensional (3D) optical coherence tomography (OCT) scans and (2) to exploit such information to robustly differentiate among ODD, papilledema, and healthy ONHs. METHODS This was a cross-sectional comparative study of patients from 3 sites (Singapore, Denmark, and Australia) with confirmed ODD, those with papilledema due to raised intracranial pressure, and healthy controls. Raster scans of the ONH were acquired using OCT imaging and then processed to improve deep-tissue visibility. First, a deep learning algorithm was developed to identify major ONH tissues and ODD regions. The performance of our algorithm was assessed using the Dice coefficient. Second, a classification algorithm (random forest) was designed to perform 3-class classifications (1: ODD, 2: papilledema, and 3: healthy ONHs) strictly from their drusen and prelamina swelling scores (calculated from the segmentations). To assess performance, we reported the area under the receiver operating characteristic curve for each class. RESULTS A total of 241 patients (256 imaged ONHs, including 105 ODD, 51 papilledema, and 100 healthy ONHs) were retrospectively included in this study. Using OCT images of the ONH, our segmentation algorithm was able to isolate neural and connective tissues and ODD regions/conglomerates whenever present. This was confirmed by an averaged Dice coefficient of 0.93 ± 0.03 on the test set, corresponding to good segmentation performance. Classification was achieved with high AUCs, that is, 0.99 ± 0.001 for the detection of ODD, 0.99 ± 0.005 for the detection of papilledema, and 0.98 ± 0.01 for the detection of healthy ONHs. DISCUSSION Our artificial intelligence approach can discriminate ODD from papilledema, strictly using a single OCT scan of the ONH. Our classification performance was very good in the studied population, with the caveat that validation in a much larger population is warranted. Our approach may have the potential to establish OCT imaging as one of the mainstays of diagnostic imaging for ONH disorders in neuro-ophthalmology, in addition to fundus photography.
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Affiliation(s)
- Michaël J A Girard
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia.
| | - Satish Panda
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Tin Aung Tun
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Elisabeth A Wibroe
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Raymond P Najjar
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Tin Aung
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Alexandre H Thiéry
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Steffen Hamann
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Clare Fraser
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Dan Milea
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
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Cavanagh C, Parry S, Fraser C, Dominiak BC. An acute case of Pimelea elongata toxicity in cattle in western New South Wales. Aust Vet J 2023; 101:35-40. [PMID: 36345985 DOI: 10.1111/avj.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
In May 2019, 96 cattle died from Pimelea toxicity in a period of 19 days after potential exposure, with the first deaths occurring within 5 days. After examining the circumstances, we suspect that several factors contributed to the deaths. These included that recently purchased stock and transported had access to flooded land containing Pimelea elongata. This weed species contains simplexin and 18 other compounds. Roots, flowers and seeds are significantly more toxic than the stem, branches and leaves. We suspect that thirsty and hungry stock consumed seed and roots from flooded pastures and consumed lethal doses of simplexin. Blood tests were not good indicators of the conditions. Management strategies are suggested.
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Affiliation(s)
- C Cavanagh
- Western Local Land Services, now Kidman Way Veterinary Surgery, Bourke, New South Wales, 2840, Australia
| | - S Parry
- NorthWest Vets, Coonamble, New South Wales, 2829, Australia
| | - C Fraser
- NSW Department of Primary Industries, The Ian Armstrong Building, Orange, New South Wales, 2800, Australia
| | - B C Dominiak
- NSW Department of Primary Industries, The Ian Armstrong Building, Orange, New South Wales, 2800, Australia
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Russell N, Fraser C, Grigg J. Optic disc drusen prevalence in the retinitis pigmentosa population. Eye (Lond) 2022; 36:2213. [PMID: 35217826 PMCID: PMC9581952 DOI: 10.1038/s41433-022-01970-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nicholas Russell
- Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2000, Australia.
| | - Clare Fraser
- Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2000, Australia
| | - John Grigg
- Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2000, Australia
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Panovska-Griffiths J, Swallow B, Hinch R, Cohen J, Rosenfeld K, Stuart RM, Ferretti L, Di Lauro F, Wymant C, Izzo A, Waites W, Viner R, Bonell C, Fraser C, Klein D, Kerr CC. Statistical and agent-based modelling of the transmissibility of different SARS-CoV-2 variants in England and impact of different interventions. Philos Trans A Math Phys Eng Sci 2022. [PMID: 35965458 DOI: 10.6084/m9.figshare.c.6070427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The English SARS-CoV-2 epidemic has been affected by the emergence of new viral variants such as B.1.177, Alpha and Delta, and changing restrictions. We used statistical models and the agent-based model Covasim, in June 2021, to estimate B.1.177 to be 20% more transmissible than the wild type, Alpha to be 50-80% more transmissible than B.1.177 and Delta to be 65-90% more transmissible than Alpha. Using these estimates in Covasim (calibrated 1 September 2020 to 20 June 2021), in June 2021, we found that due to the high transmissibility of Delta, resurgence in infections driven by the Delta variant would not be prevented, but would be strongly reduced by delaying the relaxation of restrictions by one month and with continued vaccination. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- J Panovska-Griffiths
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
- The Queen's College, University of Oxford, Oxford
| | - B Swallow
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - R Hinch
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - J Cohen
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - K Rosenfeld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - R M Stuart
- University of Copenhagen, Copenhagen, Denmark
| | - L Ferretti
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - F Di Lauro
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - C Wymant
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - A Izzo
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - W Waites
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
- Department of Computer and Information Sciences, University of Strathclyde, G1 1XH Glasgow, UK
| | - R Viner
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | - C Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - C Fraser
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - D Klein
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - C C Kerr
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
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Panovska-Griffiths J, Swallow B, Hinch R, Cohen J, Rosenfeld K, Stuart RM, Ferretti L, Di Lauro F, Wymant C, Izzo A, Waites W, Viner R, Bonell C, Fraser C, Klein D, Kerr CC. Statistical and agent-based modelling of the transmissibility of different SARS-CoV-2 variants in England and impact of different interventions. Philos Trans A Math Phys Eng Sci 2022; 380:20210315. [PMID: 35965458 PMCID: PMC9376711 DOI: 10.1098/rsta.2021.0315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/09/2022] [Indexed: 05/21/2023]
Abstract
The English SARS-CoV-2 epidemic has been affected by the emergence of new viral variants such as B.1.177, Alpha and Delta, and changing restrictions. We used statistical models and the agent-based model Covasim, in June 2021, to estimate B.1.177 to be 20% more transmissible than the wild type, Alpha to be 50-80% more transmissible than B.1.177 and Delta to be 65-90% more transmissible than Alpha. Using these estimates in Covasim (calibrated 1 September 2020 to 20 June 2021), in June 2021, we found that due to the high transmissibility of Delta, resurgence in infections driven by the Delta variant would not be prevented, but would be strongly reduced by delaying the relaxation of restrictions by one month and with continued vaccination. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- J. Panovska-Griffiths
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Queen's College, University of Oxford, Oxford, UK
| | - B. Swallow
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - R. Hinch
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J. Cohen
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - K. Rosenfeld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | | | - L. Ferretti
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - F. Di Lauro
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - C. Wymant
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - A. Izzo
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - W. Waites
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
- Department of Computer and Information Sciences, University of Strathclyde, G1 1XH Glasgow, UK
| | - R. Viner
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | - C. Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - C. Fraser
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - D. Klein
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - C. C. Kerr
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
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Aiemjoy K, Seidman JC, Saha S, Munira SJ, Islam Sajib MS, Sium SMA, Sarkar A, Alam N, Zahan FN, Kabir MS, Tamrakar D, Vaidya K, Shrestha R, Shakya J, Katuwal N, Shrestha S, Yousafzai MT, Iqbal J, Dehraj IF, Ladak Y, Maria N, Adnan M, Pervaiz S, Carter AS, Longley AT, Fraser C, Ryan ET, Nodoushani A, Fasano A, Leonard MM, Kenyon V, Bogoch II, Jeon HJ, Haselbeck A, Park SE, Zellweger RM, Marks F, Owusu-Dabo E, Adu-Sarkodie Y, Owusu M, Teunis P, Luby SP, Garrett DO, Qamar FN, Saha SK, Charles RC, Andrews JR. Estimating typhoid incidence from community-based serosurveys: a multicohort study. Lancet Microbe 2022; 3:e578-e587. [PMID: 35750069 PMCID: PMC9329131 DOI: 10.1016/s2666-5247(22)00114-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae (Salmonella enterica serovars Typhi and Paratyphi), is largely unknown in regions without blood culture surveillance. The aim of this study was to evaluate whether new diagnostic serological markers for typhoidal Salmonella can reliably estimate population-level incidence. METHODS We collected longitudinal blood samples from patients with blood culture-confirmed enteric fever enrolled from surveillance studies in Bangladesh, Nepal, Pakistan, and Ghana between 2016 and 2021 and conducted cross-sectional serosurveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to hemolysin E and S Typhi lipopolysaccharide. We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal antibody responses among enteric fever cases and used the joint distributions of the peak antibody titres and decay rate to estimate population-level incidence rates from cross-sectional serosurveys. FINDINGS The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The seroincidence of typhoidal Salmonella infection among children younger than 5 years ranged between 58·5 per 100 person-years (95% CI 42·1-81·4) in Dhaka, Bangladesh, to 6·6 per 100 person-years (4·3-9·9) in Kavrepalanchok, Nepal, and followed the same rank order as clinical incidence estimates. INTERPRETATION The approach described here has the potential to expand the geographical scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographical regions and time. FUNDING Bill & Melinda Gates Foundation. TRANSLATIONS For the Nepali, Bengali and Urdu translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
| | | | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Syed Muktadir Al Sium
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Council of Scientific and Industrial Research, Dhaka, Bangladesh
| | - Anik Sarkar
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Nusrat Alam
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Jivan Shakya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Nishan Katuwal
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Sony Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | | | - Junaid Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Irum Fatima Dehraj
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yasmin Ladak
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Noshi Maria
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mehreen Adnan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sadaf Pervaiz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Ashley T Longley
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clare Fraser
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Alessio Fasano
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA; Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Maureen M Leonard
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA; Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Victoria Kenyon
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Se Eun Park
- International Vaccine Institute, Seoul, South Korea
| | | | - Florian Marks
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Department of Microbiology and Parasitology, University of Antananarivo, Antananarivo, Madagascar; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Ellis Owusu-Dabo
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Michael Owusu
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Peter Teunis
- Center for Global Safe Water, Sanitation and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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McMaster C, Yang V, Malik R, Norman E, Fraser C, Sutu B, Sammel A, Liew D. AB0602 Temporal artery biopsy positivity rates vary more between similar hospitals than by length, with particular variation between geographic regions. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundClinical practice surrounding giant cell arteritis (GCA) diagnosis, including the use of temporal artery biopsy (TAB) where appropriate, needs to be consistently accurate to minimise both GCA-related end-organ damage and unnecessary glucocorticosteroid toxicity in all patients. Despite this imperative, the delivery of such clinical care, which can be measured by diagnostic investigation performance characteristics such as TAB positivity rates, varies substantially between different hospitals as it is traditionally reliant on unstructured clinical intuition. While clinical care practices plausibly might be more consistent between neighbouring hospitals given they frequently exchange medical staff and use common teaching sources, these factors are less likely to be applicable when comparing hospitals in different geographical regions within a country, even though educational standards, online information resources, and access to clinical care should be consistent. It therefore stands to reason that variation of diagnostic practice might be greater between geographically distant hospitals.ObjectivesTo compare clinical practice surrounding GCA diagnosis, using TAB positivity rates, between similar hospitals in the same city and a geographically distant city in a different region, to understand the contribution of geographic separation to variance in practice.MethodsTAB histopathological reports were reviewed at three tertiary referral hospital centres: two with neighbouring catchments in the same city, and one in a different city in a neighbouring geographical region in the same country. All three had similar resourcing and catchment demographics during the study period, and none used formal clinical risk stratification scores for GCA pre-test probability. Characteristics including age, sex, biopsy laterality, biopsy length, and hospital were captured, in addition to key histopathological features. Multivariable logistic regression with site-varying intercept was performed, using cubic splines for biopsy length to account for the non-linearity observed.ResultsTAB reports from 708 patients were captured between the three hospitals in two geographical regions. All three sites had a median age of 74 years, had 67-69% of patients being female, and reported median biopsy length between 1.7-2.0cm (Table 1). Despite these similarities, they reported positivity rates varying widely (16% and 24% in Region 1, 29% in Region 2). Apart from age, hospital site was the strongest contributing factor to TAB positivity, with length having little effect outside the very extreme high end and 90% of patients had a biopsy length <4.8cm (Figure 1). For these patients, hospital site differentiated TAB positivity across all biopsy lengths, with Region 2 reporting the highest TAB positivity odds ratio of 2.39 (95%CI: 1.37-4.19).Table 1.CharacteristicSite1Region1 N = 218Site2Region1 N = 361Site1Region2 N = 129Bilateral laterality (%)66 (30%)105 (29%)1 (0.8%)Biopsy length (cm, median (IQR))2.0 (1.4, 3.0)1.7 (1.2, 3.5)1.7 (1.4, 2.2)Female sex (%)149 (68%)249 (69%)86 (67%)Age (y, median (IQR))74 (65, 81)74 (65, 80)74 (68, 81)TAB positivity (%)34 (16%)88 (24%)38 (29%)Figure 1.Marginal probabilities of positive TAB obtained from the multivariable logistic regression model (A) across biopsy lengths, with 80% of observed lengths falling between the two vertical red lines (10% and 90% deciles); (B) across hospital sites; (C) across patient age.ConclusionHospital site contributes more greatly to variation in GCA diagnosis clinical practice than demographics or other clinical features do, with particular variation between geographic regions. As part of clinical care standards, using a replicable pre-test GCA probability score1 to select patients is likely to be as important to diagnosis as the diagnostic tool characteristics themselves.References[1]Laskou F, et al. A probability score to aid the diagnosis of suspected giant cell arteritis. Clin Exp Rheumatol. 2019 Jan 1;37(Suppl 117):104-8.Disclosure of InterestsNone declared
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13
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Waldie AM, Hobby AE, Chow I, Cornish EE, Indusegaran M, Pekacka A, Nguyen P, Fraser C, Binns AM, Stanford MR, Hammond CJ, McCluskey PJ, Grigg JR, Mahroo OA. Electrophysiological Assessment in Birdshot Chorioretinopathy: Flicker Electroretinograms Recorded With a Handheld Device. Transl Vis Sci Technol 2022; 11:23. [PMID: 35594040 PMCID: PMC9145202 DOI: 10.1167/tvst.11.5.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The flicker electroretinogram (ERG) is a sensitive indicator of retinal dysfunction in birdshot chorioretinopathy (BCR). We explored recordings from a handheld device in BCR, comparing these with conventional recordings in the same patients and with handheld ERGs from healthy individuals. Methods Non-mydriatic flicker ERGs, using the handheld RETeval system (LKC Technologies), were recorded with skin electrodes at two centers. At one center (group 1), the stimuli (85 Td·s, 850 Td background) delivered retinal illuminance equivalent to international standards; at the other center (group 2), a different protocol was used (32 Td·s, no background). Patients also underwent international standard flicker ERG recordings with conventional electrodes following mydriasis. Portable ERGs from patients were also compared with those from healthy individuals. Results Thirty-two patients with BCR (mean age ± SD, 56.4 ± 11.3 years) underwent recordings. Portable and standard ERG parameters correlated strongly (r > 0.75, P < 0.01) in both groups. Limits of agreement for peak times were tighter in group 1 (n = 21; -4.3 to +2.0 ms [right eyes], -3.9 to 1.5 ms [left eyes]) than in group 2 (n = 11; -3.4 to +6.9 ms [right eyes], -4.8 to +9.0 ms [left eyes]). Compared with healthy controls (n = 66 and n = 90 for groups 1 and 2, respectively), patients with BCR showed smaller mean amplitudes and longer peak times. Conclusions Portable ERGs correlated strongly with conventional recordings, suggesting potential in rapid assessment of cone system function in office settings. Translational Relevance Flicker ERGs, known to be useful in BCR, can be obtained rapidly with a portable device with skin electrodes and natural pupils.
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Affiliation(s)
- Anna M. Waldie
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Angharad E. Hobby
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
- Division of Optometry and Visual Sciences, City, University of London, London, UK
| | - Isabelle Chow
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Elisa E. Cornish
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Mathura Indusegaran
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | | | - Phuc Nguyen
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Clare Fraser
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Alison M. Binns
- Division of Optometry and Visual Sciences, City, University of London, London, UK
| | - Miles R. Stanford
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Christopher J. Hammond
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Peter J. McCluskey
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - John R. Grigg
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Omar A. Mahroo
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
- Institute of Ophthalmology, University College London, London, UK
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14
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Barnes S, You Y, Shen T, Hardy TA, Fraser C, Reddel SW, Brilot F, Ramanathan S, Klistorner A, Yiannikas C. Structural and functional markers of optic nerve damage in myelin oligodendrocyte glycoprotein antibody-associated optic neuritis. Mult Scler J Exp Transl Clin 2022; 7:20552173211063126. [PMID: 35035987 PMCID: PMC8753081 DOI: 10.1177/20552173211063126] [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: 04/17/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Optic neuritis (ON) occurs in immune-mediated disorders including multiple
sclerosis (MS), aquaporin-4 antibody-positive (AQP4) neuromyelitis optica
spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein (MOG)
antibody-associated demyelination (MOGAD). Accurate determination of
aetiology is critical for appropriate treatment and prognostication. Objective To evaluate demyelination and axonal loss in MOG-ON to facilitate
differentiation from MS-ON and AQP4-ON. Methods 15 MOGAD patients with previous ON (25 eyes) underwent multifocal visual
evoked potential (mfVEP) recordings and optical coherence tomography scans.
Comparison was made to previously reported MS patients
(n = 67, 69 eyes) and AQP4-NMOSD patients
(n = 15, 23 eyes) with prior ON and healthy controls
(n = 37, 74 eyes). Results MOG-ON patients had less retinal nerve fibre layer (RNFL) loss than AQP4-ON
patients (p < 0.05) and less mfVEP latency prolongation
than MS-ON patients (p < 0.01). Number of ON episodes in
MOGAD was associated with reduced RNFL thickness (global,
p = 0.07; temporal, p < 0.001) and
mfVEP amplitude (p < 0.001). There was no abnormality in
non-ON eyes. Conclusions Our study demonstrated a distinct pattern of damage in MOG-ON compared to
AQP4-ON and MS-ON. ON in MOGAD produces less axonal loss than AQP4-NMOSD.
Damage accumulates with relapses, supporting the role of maintenance
immunosuppression to induce remission. Compared to MS, MOGAD causes less
demyelination.
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Affiliation(s)
- Stephanie Barnes
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Yuyi You
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Ting Shen
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Clare Fraser
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Stephen W Reddel
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre at Kids Research, The Children's Hospital at Westmead; Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Alexandr Klistorner
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Con Yiannikas
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
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15
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Gorey S, McAteer C, Antonenko A, Abrahams E, Cameron S, Egan A, Ero A, Fraser C, Tey ZH, Boochoon L, Koay WJ, Sitram R, Deegan K, Quinn C. 77 INCONTINENCE AND DECONDITIONING IN A NONFRAIL SAMPLE OF INPATIENTS AT A UNIVERSITY TEACHING HOSPITAL. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Incontinence occurs in 26% of hospitalised adults1. Deconditioning in hospitalised adults is common and contributes to increased hospital stay2. The #endpjparalysis movement motivates us to reduce harms of hospitalisation older adults.
Methods
We surveyed inpatients to capture the point prevalence of incontinence. We also collected information regarding functional status, continence status and use of continence wear. Local ethical review-board approval was obtained. All participants provided informed consent.
Results
There were 86 responses. Mean age of participants was 71.5 years. 45.4% were female, >95% were admitted from home and were functionally independent. Mean length of stay for respondents was 7.4 days ±12. The median Clinical Frailty Scale, for respondents aged >65 years, was 3, indicating this cohort is not frail.
17 respondents reported incontinence on the day of survey; 8 of these reported that incontinence was a new experience for them since their admission. 24 respondents wore incontinence wear at home, 31 were wearing incontinence wear on the day of survey.
Of 80 respondents who could toilet independently at home, 23 (26%) reported a new dependency to toilet. Of 83 respondents who mobilised independently at home (with or without an aid), 11 reported needing assistance of one-person to walk, 3 needed the assistance of two-people to walk or stand, five people required a hoist, while 3 were bedbound on the day of survey.
Conclusion
We describe increased dependency in mobility, toileting and increased use of continence wear in non-frail hospitalised older adults. Future work is needed to maintain function during admission to hospital.
References
1. Condon, M., et al. (2019). ‘Urinary and Faecal Incontinence: Point Prevalence and Predictors in a University Hospital.’ Int J Environ Res Public Health 16.
2. Guilcher, S., et al. (2021). ‘A qualitative study exploring the lived experiences of deconditioning in hospital in Ontario, Canada.’ BMC Geriatrics 21.
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Affiliation(s)
- S Gorey
- University Hospital Limerick , Limerick, Ireland
| | - C McAteer
- University Hospital Limerick , Limerick, Ireland
| | - A Antonenko
- University Hospital Limerick , Limerick, Ireland
| | - E Abrahams
- University Hospital Limerick , Limerick, Ireland
| | - S Cameron
- University Hospital Limerick , Limerick, Ireland
| | - A Egan
- University Hospital Limerick , Limerick, Ireland
| | - A Ero
- University Hospital Limerick , Limerick, Ireland
| | - C Fraser
- University Hospital Limerick , Limerick, Ireland
| | - Z H Tey
- University Hospital Limerick , Limerick, Ireland
| | - L Boochoon
- University Hospital Limerick , Limerick, Ireland
| | - W J Koay
- University Hospital Limerick , Limerick, Ireland
| | - R Sitram
- University Hospital Limerick , Limerick, Ireland
| | - K Deegan
- University Hospital Limerick , Limerick, Ireland
| | - C Quinn
- University Hospital Limerick , Limerick, Ireland
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16
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Abstract
The Queen Square Screening Test for Visual Deficits (QS test) screens for changes in visual processing. Our pilot study aimed to review the applicability of the QS test in individuals with dementia compared with those with normal cognition. Participants with major and minor neurocognitive disorder scored 50/71 (n=12) and 61/71 (n=10) respectively on the QS test, compared to 65/71 for age-matched healthy controls (n=11). The QS test score correlated with cognitive impairment as measured using the Rowland Universal Dementia Assessment Scale (r = 0.74). The QS test is an affordable and easy bedside screening test for visual processing changes.
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Affiliation(s)
- Leah N Kim
- Department of Neurology, Liverpool Hospital, Liverpool, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.,Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
| | - Dennis Cordato
- Department of Neurology, Liverpool Hospital, Liverpool, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.,South Western Sydney Stroke and Neurology Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Alan McDougall
- Department of Neurology, Liverpool Hospital, Liverpool, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.,South Western Sydney Stroke and Neurology Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Clare Fraser
- Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
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17
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Abstract
First described in 1991 and introduced into clinical practice in 1996, optical coherence tomography (OCT) now has a very extensive role in many different areas of ophthalmological practice. It is non-invasive, cheap, highly reproducible, widely available and easy to perform. OCT also has a role in managing patients with neurological disorders, particularly idiopathic intracranial hypertension. This review provides an overview of the technology underlying OCT and the information it can provide that is relevant to the practising neurologist. Particular conditions discussed include papilloedema, optic disc drusen, multiple sclerosis and neuromyelitis optica, other optic neuropathies, compression of the anterior visual pathway and various neurodegenerative conditions.
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Wiens KE, Mawien PN, Rumunu J, Slater D, Jones FK, Moheed S, Caflisch A, Bior BK, Jacob IA, Lako RL, Guyo AG, Olu OO, Maleghemi S, Baguma A, Hassen JJ, Baya SK, Deng L, Lessler J, Demby MN, Sanchez V, Mills R, Fraser C, Charles RC, Harris JB, Azman AS, Wamala JF. Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020 1. Emerg Infect Dis 2021; 27:1598-1606. [PMID: 34013872 PMCID: PMC8153877 DOI: 10.3201/eid2706.210568] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Relatively few coronavirus disease cases and deaths have been reported from sub-Saharan Africa, although the extent of its spread remains unclear. During August 10-September 11, 2020, we recruited 2,214 participants for a representative household-based cross-sectional serosurvey in Juba, South Sudan. We found 22.3% of participants had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor binding domain IgG titers above prepandemic levels. After accounting for waning antibody levels, age, and sex, we estimated that 38.3% (95% credible interval 31.8%-46.5%) of the population had been infected with SARS-CoV-2. At this rate, for each PCR-confirmed SARS-CoV-2 infection reported by the Ministry of Health, 103 (95% credible interval 86-126) infections would have been unreported, meaning SARS-CoV-2 has likely spread extensively within Juba. We also found differences in background reactivity in Juba compared with Boston, Massachusetts, USA, where the immunoassay was validated. Our findings underscore the need to validate serologic tests in sub-Saharan Africa populations.
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Affiliation(s)
- Kirsten E. Wiens
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Pinyi Nyimol Mawien
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - John Rumunu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Damien Slater
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Forrest K. Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Serina Moheed
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Andrea Caflisch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Bior K. Bior
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Iboyi Amanya Jacob
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Richard Lino Lako
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Argata Guracha Guyo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Olushayo Oluseun Olu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Sylvester Maleghemi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Andrew Baguma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Juma John Hassen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Sheila K. Baya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Lul Deng
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Justin Lessler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Maya N. Demby
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Vanessa Sanchez
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Rachel Mills
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Clare Fraser
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
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Wiens KE, Mawien PN, Rumunu J, Slater D, Jones FK, Moheed S, Caflish A, Bior BK, Jacob IA, Lako RLL, Guyo AG, Olu OO, Maleghemi S, Baguma A, Hassen JJ, Baya SK, Deng L, Lessler J, Demby MN, Sanchez V, Mills R, Fraser C, Charles RC, Harris JB, Azman AS, Wamala JF. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Juba, South Sudan: a population-based study. medRxiv 2021:2021.03.08.21253009. [PMID: 33758900 PMCID: PMC7987059 DOI: 10.1101/2021.03.08.21253009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Relatively few COVID-19 cases and deaths have been reported through much of sub-Saharan Africa, including South Sudan, although the extent of SARS-CoV-2 spread remains unclear due to weak surveillance systems and few population-representative serosurveys. METHODS We conducted a representative household-based cross-sectional serosurvey in Juba, South Sudan. We quantified IgG antibody responses to SARS-CoV-2 spike protein receptor-binding domain and estimated seroprevalence using a Bayesian regression model accounting for test performance. RESULTS We recruited 2,214 participants from August 10 to September 11, 2020 and 22.3% had anti-SARS-CoV-2 IgG titers above levels in pre-pandemic samples. After accounting for waning antibody levels, age, and sex, we estimated that 38.5% (32.1 - 46.8) of the population had been infected with SARS-CoV-2. For each RT-PCR confirmed COVID-19 case, 104 (87-126) infections were unreported. Background antibody reactivity was higher in pre-pandemic samples from Juba compared to Boston, where the serological test was validated. The estimated proportion of the population infected ranged from 30.1% to 60.6% depending on assumptions about test performance and prevalence of clinically severe infections. CONCLUSIONS SARS-CoV-2 has spread extensively within Juba. Validation of serological tests in sub-Saharan African populations is critical to improve our ability to use serosurveillance to understand and mitigate transmission.
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Affiliation(s)
- Kirsten E. Wiens
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John Rumunu
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | - Damien Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Forrest K. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Serina Moheed
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Caflish
- Displacement Tracking Matrix, International Organization for Migration, Juba, South Sudan
| | - Bior K. Bior
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | | | | | | | | | | | - Andrew Baguma
- World Health Organization, Juba, South Sudan
- Kabale University School of Medicine, Department of Microbiology and Immunology
| | | | | | - Lul Deng
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maya N. Demby
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vanessa Sanchez
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Mills
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Clare Fraser
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Médecins Sans Frontières, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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20
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Phua CS, Murad A, Fraser C, Bray V, Cappelen-Smith C. Myasthenia gravis and concurrent myositis following PD-L1 checkpoint inhibitor for non-small cell lung cancer. BMJ Neurol Open 2021; 2:e000028. [PMID: 33681778 PMCID: PMC7871726 DOI: 10.1136/bmjno-2019-000028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 11/04/2022] Open
Abstract
Background There are increasing reports of myasthenia gravis (MG) following oncological treatment with immune checkpoint inhibitors (ICIs). Methods and results A 66-year-old man with stage 3A lung adenocarcinoma was treated with second weekly infusions of durvalumab, a programmed cell death ligand-1 inhibitor, at a dose of 10 mg/kg. After the fourth infusion, he developed diplopia, dyspnoea and constitutional symptoms including headache, weakness and anorexia. 1 month later, he developed dysphagia and dysphonia. Examination showed proximal limb weakness with fatigability. An ice pack test was positive. Blood tests revealed a raised creatine kinase and positive PM-Scl75 antibody. Antititin antibody was strongly positive in the serum and cerebrospinal fluid. Antibodies for acetylcholinesterase receptor and antimuscle-specific kinase were negative. Electromyography showed myopathic changes. The patient was treated with steroids, pyridostigmine, mycophenolate mofetil and intravenous immunoglobulin. Eight weeks after treatment initiation ptosis, eye movements and limb strength were markedly improved and repeat creatine kinase was normal. Conclusion Clinicians using ICIs should have a high index of suspicion for ICI-induced MG and concurrent myositis as disease can be severe and is associated with high mortality rates.
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Affiliation(s)
- Chun Seng Phua
- Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ari Murad
- Department of Immunology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Clare Fraser
- Department of Ophthalmology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Victoria Bray
- Department of Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Cecilia Cappelen-Smith
- Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
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21
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Pfeifle RL, Beasley EM, Crabtree NE, Fraser C, Elbert JA, Ducker E, Nagata K, Garner BC, Sakamoto K. Osteosarcoma in the femur of a horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. L. Pfeifle
- Department of Large Animal Medicine University of Georgia Athens GeorgiaUSA
| | - E. M. Beasley
- Department of Large Animal Medicine University of Georgia Athens GeorgiaUSA
| | - N. E. Crabtree
- Department of Large Animal Medicine University of Georgia Athens GeorgiaUSA
| | - C. Fraser
- Department of Pathology University of Georgia Athens GeorgiaUSA
| | - J. A. Elbert
- Department of Pathology University of Georgia Athens GeorgiaUSA
| | - E. Ducker
- Department of Veterinary Biosciences and Diagnostic Imaging University of Georgia Athens Georgia USA
| | - K. Nagata
- Department of Veterinary Biosciences and Diagnostic Imaging University of Georgia Athens Georgia USA
| | - B. C. Garner
- Department of Pathology University of Georgia Athens GeorgiaUSA
| | - K. Sakamoto
- Department of Pathology University of Georgia Athens GeorgiaUSA
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Tan A, Fraser C, Khoo P, Watson S, Ooi K. Statins in Neuro-ophthalmology. Neuroophthalmology 2020; 45:219-237. [PMID: 34366510 PMCID: PMC8312600 DOI: 10.1080/01658107.2020.1755872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/05/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022] Open
Abstract
Statins are effective and well-tolerated hypolipidaemic agents which have been increasingly studied for their pleiotropic immunomodulatory and anti-inflammatory effects. Statins have potential therapeutic benefit in a range of neuro-ophthalmological conditions but may also induce or exacerbate certain neurological disorders. This literature review examines evidence from clinical and in vitro studies assessing the effects of statins in myasthenia gravis, myopathy, multiple sclerosis, neuromyelitis optica, idiopathic intracranial hypertension (pseudotumour cerebri), migraine, giant cell arteritis, Bell's palsy, ocular ischaemia, stroke, Alzheimer's disease and Parkinson's disease.
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Affiliation(s)
- Alvin Tan
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Clare Fraser
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Pauline Khoo
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Stephanie Watson
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Kenneth Ooi
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
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Abstract
Objectives: The recognition and management of concussion has become a major health concern across all sports. Despite recent attention, concussion assessment and return-to-play protocols appear to be highly variable between leading professional sporting bodies across Australia. Without readily available guidelines, players at all levels may be at risk of suboptimal management following in-game trauma. The purpose of this study was to explore the publicly available concussion guidelines of the major Australian sporting codes with an aim to identify potential opportunities to develop a national sporting consensus.Methods: Internet sites of the major sporting organizations within Australia were accessed between June 2018 to July 2018. Sites were reviewed for information pertaining to an available concussion protocol or guidelines including; concussion definition, player education documentation, requirement of baseline testing, standard concussion diagnostic measures, use of sideline testing and removal from play guidelines, return-to-play, minimum return-to-play intervals and the implementation of external evaluation of potential concussion cases.Results: Twelve sites were visited. There was consensus between many of the sporting organizations in terms of concussion definition, removal of play and sideline testing protocols. A step-wise return-to-play protocol was prevalent across most sports. A number of sporting sites however did not have readily available information.Conclusions: There is notable room for the development of concussion guidelines in Australian sport. Researchers and sporting organizations need to continuously amend current protocols to ensure this reflects best evidence-based practice.
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Affiliation(s)
- Premkumar Gunasekaran
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Christopher Hodge
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney, Australia.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
| | - Alan Pearce
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Doug King
- School of Science and Technology, University of New England, Armidale, Australia
| | - Clare Fraser
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
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24
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Petzold A, Biousse V, Bursztyn L, Costello F, Crum A, Digre K, Fraser C, Fraser JA, Katz B, Jurkute N, Newman N, Lautrup-Battistini J, Lawlor M, Liskova P, Lorenz B, Malmqvist L, Peragallo J, Sibony P, Subramanian P, Rejdak R, Nowomiejska K, Touitou V, Warner J, Wegener M, Wong S, Yu-Wai-Man P, Hamann S. Multirater Validation of Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS). Neuroophthalmology 2020; 44:413-414. [PMID: 33408429 PMCID: PMC7746256 DOI: 10.1080/01658107.2020.1760891] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a new retinal optical coherence tomography (OCT) finding. The Optic Disc Drusen Studies Consortium had made recommendations to distinguish PHOMS from true optic disc drusen (ODD) in 2018. While publications on PHOMS have increased since then, the accuracy of the definition of PHOMS and reliability of detection is unknown. In this multi-rater study, we demonstrate that the 2018 definition of PHOMS resulted in a poor multi-rater kappa of 0.356. We performed a Delphi consensus process to develop a consistent and refined definition of PHOMS with clear principles around the nature of PHOMS and how they differ from normal anatomy. Fifty explanatory teaching slides, provided as supplementary material, allowed our expert group of raters to achieve a good level of agreement (kappa 0.701, 50 OCT scans, 21 raters). We recommend adopting the refined definition for PHOMS.
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Affiliation(s)
- Axel Petzold
- Moorfields Eye Hospital NHS Foundation Trust and the National Hospital for Neurology and Neurosurgery, Queen Square, Institute of Neurology, University College London, London, UK
- Neurology and Ophthalmology, Amsterdam UMC, Locatie VUMC, Amsterdam, Netherlands
- CONTACT Axel Petzold
| | | | | | - Fiona Costello
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alison Crum
- Utah System of Higher Education, Salt Lake City, Utah, USA
| | - Kathleen Digre
- Department of Neurology-Ophthalmology and Visual Science, John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Clare Fraser
- Save Sight Institute, The University of Sydney, Sydney, North South Wales, Australia
| | - J. Alex Fraser
- Department of Clinical Neurological Sciences and Department of Ophthalmology, Western University, London, Ontario, Canada
| | - Bradley Katz
- Utah System of Higher Education, Salt Lake City, Utah, USA
| | | | - Nancy Newman
- Department of Neuro-Ophthalmology, Emory University, School of Medicine, Atlanta, Georgia, USA
| | | | - Mitchell Lawlor
- Save Sight Institute, The University of Sydney, Sydney, North South Wales, Australia
| | - Petra Liskova
- Ophthalmology, Charles University, Prague, Czech Republic
| | - Birgit Lorenz
- Ophthalmology, Justus Liebig University, Giessen, Germany
| | | | | | | | - Prem Subramanian
- Sue Anschutz-Rodgers UC Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert Rejdak
- Department of General Opthalmology, Medical University, Lublin, Poland
| | | | - Valerie Touitou
- Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, DHU Vision Et Handicaps, Paris, France
| | - Judith Warner
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | - Sui Wong
- Moorfields Eye Hospital City Road Campus, London, UK
| | - Patrick Yu-Wai-Man
- Cambridge University, Cambridge, UK
- Moorfields Eye Hospital NHS, Foundation Trust, Medical Retina, London, UK
| | - Steffen Hamann
- Ophthalmology, ODDS Consortium and ERN-EYE Rigshospitalet Glostrup, Denmark
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Jaworski L, Griffith K, Mancini B, Jolly S, Boike T, Moran J, Dominello M, Wilson M, Parker J, Burmeister J, Gardner S, Fraser C, Miller L, Baldwin K, Mietzel M, Grubb M, Kendrick D, Pierce L, Spratt D, Hayman J. Contemporary Practice Patterns for Radiotherapy of Bone Metastases: Preliminary Analysis of Prospective Data from a Statewide Consortium Focusing on Extended Fractionation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.162] [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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26
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Jolly S, Hochstedler K, Paximadis P, Hayman J, Dominello M, Burmeister J, Grills I, Dess R, Dragovic A, Movsas B, Ajlouni M, Fraser C, Kestin L, Wilson M, Bergsma D, Spratt D, Moran J, Pierce L, Schipper M, Matuszak M. Changing Practice Patterns in the Radiation Treatment Delivery for Locally Advanced Lung Cancer: Results from a Statewide Consortium. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1387] [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: 10/26/2022]
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27
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Dziemianowicz E, Gardner S, Snyder K, Walker E, Fraser C, Reding A, Wen N. RT for Patients with Compressed Air Tissue Expanders: Treatment Planning Solutions and Limitations. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.738] [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: 10/26/2022]
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29
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Kim L, Cordato D, McDougall A, Fraser C. 129 Pilot study: the validity of the queens square screening test for visual deficits in a cohort of patients with dementia. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionThere is limited research on the visual deficits found in dementia. The Queens Square Screening Test for Visual Deficits (QS test) is designed to screen for changes in visual processing. Our study aimed to validate this test and examine the types of visual processing deficits found in dementia.MethodsWe assessed the QS test in participants with dementia, mild cognitive impairment (MCI), and healthy controls. Participants were recruited from the Neurology and Geriatrics departments of a tertiary hospital over 3-months. Cognitive impairment was measured using the Rowland Universal Dementia Assessment Scale (RUDAS).ResultsTwenty-six patients were examined. There were no statistically significant differences in age, gender, English fluency, and education between the three groups. Participants with dementia (n=8, mean RUDAS 17.5/30) scored 51.4/71 on the QS test, compared to 60.7/71 in MCI (n=7, mean RUDAS 25.0/30) and 64.6/71 in controls (n=11, mean RUDAS 27.4/30). The mean scores for each subset of the QS test for dementia, MCI and normal cognition, respectively, were: early visual processing – 19.6/25, 22.4/25, 23.7/25; object perception – 5.6/11, 7.9/11, 8.7/11; space perception – 11.4/14, 11.1/14, 12.4/14; face perception – 4.4/8, 6.4/8, 7.0/8; reading – 10.4/13, 12.9/13, 12.8/13.ConclusionIn this pilot study, the QS test was markedly abnormal in dementia but did not differentiate between MCI and normal cognition. Our findings suggest that deficits in early visual processing, reading, and the perception of objects and faces are common in dementia. Understanding the types of visual difficulties may improve the care of patients with dementia.
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30
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Ramanathan S, Fraser C, Curnow SR, Ghaly M, Leventer RJ, Lechner-Scott J, Henderson A, Reddel S, Dale RC, Brilot F. Uveitis and optic perineuritis in the context of myelin oligodendrocyte glycoprotein antibody seropositivity. Eur J Neurol 2019; 26:1137-e75. [PMID: 30748058 DOI: 10.1111/ene.13932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/07/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Antibodies to myelin oligodendrocyte glycoprotein (MOG) have been identified in both children and adults with demyelination, with a strong association with bilateral or recurrent optic neuritis (ON). However, the full clinical spectrum of this newly described condition is unknown. We sought to describe non-ON inflammatory ophthalmological presentations such as uveitis and optic perineuritis in the context of MOG antibody seropositivity. METHODS Using a live cell-based assay analysed by flow cytometry, we identified seropositive patients referred for MOG antibody testing in Australasia between 2014 and 2017. We identified four MOG antibody-positive patients with non-ON inflammatory ophthalmological presentations and present their detailed clinical information in this case series. RESULTS Three patients had uveitis either in association with, or remote from, ON. One patient had optic perineuritis and peripheral ulcerative keratitis. We describe the presentation, examination, investigation findings and clinical course of these four patients. CONCLUSIONS Recognition of these novel clinical associations may expand the clinical spectrum of MOG antibody-associated presentations. An expedited diagnosis may guide the management of these complex patients.
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Affiliation(s)
- S Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre at Kids Research, The Children's Hospital, Westmead, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Department of Neurology, Westmead Hospital, Sydney, New South Wales
| | - C Fraser
- Save Sight Institute, University of Sydney, Sydney, New South Wales
| | - S R Curnow
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria
| | - M Ghaly
- University Hospital Geelong, Geelong, Victoria
| | - R J Leventer
- Department of Paediatrics, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria
| | - J Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales.,Hunter Medical Research Institute, Faculty of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales
| | - A Henderson
- Department of Neurology, Westmead Hospital, Sydney, New South Wales.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales
| | - S Reddel
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales.,Department of Neurology, Concord Repatriation General Hospital, Sydney, New South Wales
| | - R C Dale
- Brain Autoimmunity Group, Kids Neuroscience Centre at Kids Research, The Children's Hospital, Westmead, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales.,TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales
| | - F Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre at Kids Research, The Children's Hospital, Westmead, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales.,Applied Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Scovil CY, Delparte JJ, Walia S, Flett HM, Guy SD, Wallace M, Burns AS, Wolfe DL, Wolfe D, Kras-Dupuis A, Walia S, Guy S, Askes H, Casalino A, Fraser C, Paiva M, Miles S, Gagliardi J, Orenczuk S, Sommerdyk J, Genereaux M, Jarvis D, Wesenger J, Bloetjes L, Flett H, Burns A, Scovil C, Delparte J, Leber D, McMillan L, Domingo T, Wallace M, Stoesz B, Aguillon G, Koning C, Mumme L, Cwiklewich M, Bayless K, Crouse L, Crocker J, Erickson G, Mark M, Charbonneau R, Lloyd A, Van Doesburg C, Knox J, Wright P, Mouneimne M, Parmar R, Isaacs T, Reader J, Oga C, Birchall N, McKenzie N, Nicol S, Joly C, Laramée M, Robidoux I, Casimir M, Côté S, Lubin C, Lemay J, Beaulieu J, Truchon C, Noreau L, Lemay V, Vachon J, Bélanger D, Proteau F, O'Connell C, Savoie J, McCullum S, Brown J, Duda M, Bassett-Spiers K, Riopelle R, Hsieh J, Reinhart-McMillan W, Joshi P, Noonan V, Humphreys S, Hamilton L, MacIsaac G. Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network. Arch Phys Med Rehabil 2019; 100:327-335. [DOI: 10.1016/j.apmr.2018.07.444] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
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32
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Alshowaeir D, Yiannikas C, Fraser C, Klistorner A. Mechanism of delayed conduction of fellow eyes in patients with optic neuritis. Int J Ophthalmol 2018; 11:329-332. [PMID: 29487827 DOI: 10.18240/ijo.2018.02.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022] Open
Abstract
To test the hypothesis that latency delay in the fellow eyes of optic neuritis (ON) patients and to compensate for delayed transmission of visual information, latency change of multi-focal visual evoked potential (mfVEP) traces in fellow eyes of 15 ON patients were analyzed. Patients with low risk (LR) for developing multiple sclerosis (MS) were examined separately from MS patients to isolate effect of cortical plasticity from potential pathological changes in disseminated disease. The small increase in latency in fellow eyes of LR group was statistically not significant. In MS patients, the latency was significantly delayed (P<0.02). The magnitude of the latency change in the fellow eyes did not correlate with the severity of latency delay in the affected eyes (R2<0.02, P=0.3). The differences between ON patients with and without MS, reported here, suggest that the presence of disseminated disease plays critical role in latency delay of the fellow eye.
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Affiliation(s)
- Daniah Alshowaeir
- Department of Ophthalmology, University of Sydney, Sydney 2000, Australia.,Department of Ophthalmology, King Saud University, Riyadh 11411, Saudi Arabia
| | - Con Yiannikas
- Department of Neurology, Concord Hospital, Sydney 2139, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Clare Fraser
- Department of Ophthalmology, University of Sydney, Sydney 2000, Australia
| | - Alexander Klistorner
- Department of Ophthalmology, University of Sydney, Sydney 2000, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney 2109, Australia
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33
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Feld J, Conway B, Bruneau J, Cooper C, Cox J, Deshaies L, Fraser C, Macphail G, Powis J, Steingart C, Stewart K, Thomas R, Webster D, Drolet M, Mcgovern M, Trepanier J. A27 CHARACTERIZATION OF HCV INFECTED PWID IN THE SETTING OF CLINICAL CARE IN CANADA (CAPICA): FINAL RESULTS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.028] [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)
- J Feld
- Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - B Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - J Bruneau
- CHUM:Hopital St-Luc, Montreal, QC, Canada
| | - C Cooper
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - J Cox
- McGill University Health Center, Montreal, QC, Canada
| | - L Deshaies
- Clinique Médicale Lauberivière, Quebec, QC, Canada
| | - C Fraser
- Cool Aid Community Health Center, Victoria, BC, Canada
| | - G Macphail
- Calgary Urban Project Society (CUPS), Calgary, AB, Canada
| | - J Powis
- Toronto Community Hep C Program, Toronto, ON, Canada
| | | | - K Stewart
- Saskatoon Infectious Disease Care Network, Saskatoon, SK, Canada
| | - R Thomas
- Clinique Médicale l’Actuel, Montreal, QC, Canada
| | - D Webster
- Dalhousie University, Saint John, NB, Canada
| | - M Drolet
- Merck Canada, Kirkland, QC, Canada
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Grundy AC, Walker L, Meade O, Fraser C, Cree L, Bee P, Lovell K, Callaghan P. Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning. J Psychiatr Ment Health Nurs 2017; 24:358-366. [PMID: 28218977 PMCID: PMC5574013 DOI: 10.1111/jpm.12378] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers. ABSTRACT Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median 'acceptability' score = 34/36; median 'perceived impact' score = 22/27). There were six qualitative themes: the value of the co-production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response. Discussion The training was found to be acceptable and comprehensive with participants valuing the co-production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training. Implications for practice Mental health nurses should use co-production models of continuing professional development training that involve service users and carers as co-facilitators.
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Affiliation(s)
- A C Grundy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - L Walker
- Health Sciences Research, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - O Meade
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - C Fraser
- Health Sciences Research, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - L Cree
- Health Sciences Research, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - P Bee
- Health Sciences Research, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - K Lovell
- Health Sciences Research, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - P Callaghan
- Mental Health Nursing, School of Health Sciences, University of Nottingham, Nottingham, UK
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Fraser C, Grundy A, Meade O, Callaghan P, Lovell K. EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning. J Psychiatr Ment Health Nurs 2017; 24:367-376. [PMID: 28105690 DOI: 10.1111/jpm.12361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Accepted: 11/04/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: UK NHS policy highlights the importance of user and carer involvement in health professional training. We know little about service user and carer motivations and experiences of accessing training courses for delivering training to health professionals and how well such courses prepare them for delivering training to healthcare professionals. 'Involvement' in training has often been tokenistic and too narrowly focused on preregistration courses. There is limited data on how best to prepare and support potential service user and carer trainers. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study adds to the international literature by highlighting service user and carer motivations for accessing a training course for delivering training to health professionals. Service users and carers wanted to gain new skills and confidence in presentation/facilitation as well as to make a difference to healthcare practice. We also learned that service users desired different levels of involvement in training facilitation - some wanted to take a more active role than others. A one-size-fits-all approach is not always appropriate. Encountering resistance from staff in training was a previously unidentified challenge to service user and carers' experience of delivering training in practice and is a key challenge for trainers to address in future. Professional training involvement can be enhanced via specialist training such as the EQUIP training the trainers programme evaluated here. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When training service users and carers to deliver training to mental health professionals, it is important that service users are equipped to deal with resistance from staff. It is important that service user and carer roles are negotiated and agreed prior to delivering training to healthcare professionals to accommodate individual preferences and allay anxieties. Training for service users and carers must be offered alongside ongoing support and supervision. Mental health nurses (and other health professionals) will be better able to involve service users and carers in care planning. Service users and carers may feel more involved in care planning in future. ABSTRACT Introduction Limited evidence exists on service user and carer perceptions of undertaking a training course for delivering care planning training to qualified mental health professionals. We know little about trainee motivations for engaging with such train the trainers courses, experiences of attending courses and trainees' subsequent experiences of codelivering training to health professionals, hence the current study. Aim To obtain participants' views on the suitability and acceptability of a training programme that aimed to prepare service users and carers to codeliver training to health professionals. Method Semi-structured interviews with nine service users and carers attending the training programme. Transcripts were analysed using inductive thematic analysis. Results Participants' reasons for attending training included skill development and making a difference to mental health practice. Course content was generally rated highly but may benefit from review and/or extension to allow the range of topics and resulting professional training programme to be covered in more depth. Trainees who delivered the care planning training reported a mix of expectations, support experiences, preparedness and personal impacts. Implications for Practice Mental health nurses are increasingly coproducing and delivering training with service users and carers. This study identifies possibilities and pitfalls in this endeavour, highlighting areas where user and carer involvement and support structures might be improved in order to fully realize the potential for involvement in training.
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Affiliation(s)
- C Fraser
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A Grundy
- School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - O Meade
- School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - P Callaghan
- School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - K Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Witt SH, Streit F, Jungkunz M, Frank J, Awasthi S, Reinbold CS, Treutlein J, Degenhardt F, Forstner AJ, Heilmann-Heimbach S, Dietl L, Schwarze CE, Schendel D, Strohmaier J, Abdellaoui A, Adolfsson R, Air TM, Akil H, Alda M, Alliey-Rodriguez N, Andreassen OA, Babadjanova G, Bass NJ, Bauer M, Baune BT, Bellivier F, Bergen S, Bethell A, Biernacka JM, Blackwood DHR, Boks MP, Boomsma DI, Børglum AD, Borrmann-Hassenbach M, Brennan P, Budde M, Buttenschøn HN, Byrne EM, Cervantes P, Clarke TK, Craddock N, Cruceanu C, Curtis D, Czerski PM, Dannlowski U, Davis T, de Geus EJC, Di Florio A, Djurovic S, Domenici E, Edenberg HJ, Etain B, Fischer SB, Forty L, Fraser C, Frye MA, Fullerton JM, Gade K, Gershon ES, Giegling I, Gordon SD, Gordon-Smith K, Grabe HJ, Green EK, Greenwood TA, Grigoroiu-Serbanescu M, Guzman-Parra J, Hall LS, Hamshere M, Hauser J, Hautzinger M, Heilbronner U, Herms S, Hitturlingappa S, Hoffmann P, Holmans P, Hottenga JJ, Jamain S, Jones I, Jones LA, Juréus A, Kahn RS, Kammerer-Ciernioch J, Kirov G, Kittel-Schneider S, Kloiber S, Knott SV, Kogevinas M, Landén M, Leber M, Leboyer M, Li QS, Lissowska J, Lucae S, Martin NG, Mayoral-Cleries F, McElroy SL, McIntosh AM, McKay JD, McQuillin A, Medland SE, Middeldorp CM, Milaneschi Y, Mitchell PB, Montgomery GW, Morken G, Mors O, Mühleisen TW, Müller-Myhsok B, Myers RM, Nievergelt CM, Nurnberger JI, O'Donovan MC, Loohuis LMO, Ophoff R, Oruc L, Owen MJ, Paciga SA, Penninx BWJH, Perry A, Pfennig A, Potash JB, Preisig M, Reif A, Rivas F, Rouleau GA, Schofield PR, Schulze TG, Schwarz M, Scott L, Sinnamon GCB, Stahl EA, Strauss J, Turecki G, Van der Auwera S, Vedder H, Vincent JB, Willemsen G, Witt CC, Wray NR, Xi HS, Tadic A, Dahmen N, Schott BH, Cichon S, Nöthen MM, Ripke S, Mobascher A, Rujescu D, Lieb K, Roepke S, Schmahl C, Bohus M, Rietschel M. Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia. Transl Psychiatry 2017; 7:e1155. [PMID: 28632202 PMCID: PMC5537640 DOI: 10.1038/tp.2017.115] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/10/2017] [Indexed: 01/02/2023] Open
Abstract
Borderline personality disorder (BOR) is determined by environmental and genetic factors, and characterized by affective instability and impulsivity, diagnostic symptoms also observed in manic phases of bipolar disorder (BIP). Up to 20% of BIP patients show comorbidity with BOR. This report describes the first case-control genome-wide association study (GWAS) of BOR, performed in one of the largest BOR patient samples worldwide. The focus of our analysis was (i) to detect genes and gene sets involved in BOR and (ii) to investigate the genetic overlap with BIP. As there is considerable genetic overlap between BIP, major depression (MDD) and schizophrenia (SCZ) and a high comorbidity of BOR and MDD, we also analyzed the genetic overlap of BOR with SCZ and MDD. GWAS, gene-based tests and gene-set analyses were performed in 998 BOR patients and 1545 controls. Linkage disequilibrium score regression was used to detect the genetic overlap between BOR and these disorders. Single marker analysis revealed no significant association after correction for multiple testing. Gene-based analysis yielded two significant genes: DPYD (P=4.42 × 10-7) and PKP4 (P=8.67 × 10-7); and gene-set analysis yielded a significant finding for exocytosis (GO:0006887, PFDR=0.019; FDR, false discovery rate). Prior studies have implicated DPYD, PKP4 and exocytosis in BIP and SCZ. The most notable finding of the present study was the genetic overlap of BOR with BIP (rg=0.28 [P=2.99 × 10-3]), SCZ (rg=0.34 [P=4.37 × 10-5]) and MDD (rg=0.57 [P=1.04 × 10-3]). We believe our study is the first to demonstrate that BOR overlaps with BIP, MDD and SCZ on the genetic level. Whether this is confined to transdiagnostic clinical symptoms should be examined in future studies.
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Affiliation(s)
- S H Witt
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F Streit
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Jungkunz
- Central Institute of Mental Health, Clinic of Psychosomatic and Psychotherapeutic Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Central Institute of Mental Health, Institute for Psychiatric and Psychosomatic Psychotherapy (IPPP)/Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Frank
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - S Awasthi
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - C S Reinbold
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - J Treutlein
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F Degenhardt
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
| | - A J Forstner
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - L Dietl
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - C E Schwarze
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - D Schendel
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Strohmaier
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A Abdellaoui
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R Adolfsson
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | - T M Air
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - H Akil
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - N Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - O A Andreassen
- Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, University of Oslo, Oslo, Norway
| | - G Babadjanova
- Institute of Pulmonology, Russian State Medical University, Moscow, Russian Federation
| | - N J Bass
- Division of Psychiatry, University College London, London, UK
| | - M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - B T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - F Bellivier
- Inserm, U1144, AP-HP, GH Saint-Louis, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - S Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - A Bethell
- National Center for Mental Health, Cardiff University, Cardiff, UK
| | - J M Biernacka
- Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - D H R Blackwood
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - M P Boks
- Urain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A D Børglum
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | | | - P Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - M Budde
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
- Medical Center of the University of Munich, Campus Innenstadt, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
| | - H N Buttenschøn
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - E M Byrne
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - P Cervantes
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - T-K Clarke
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - N Craddock
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - C Cruceanu
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - D Curtis
- Centre for Psychiatry, Queen Mary University of London, London, UK
- UCL Genetics Institute, University College London, London, UK
| | - P M Czerski
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - U Dannlowski
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Münste, Münster, Germany
| | - T Davis
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - E J C de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Di Florio
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - S Djurovic
- Department of Medical Genetics, Oslo University Hospital Ullevål, Oslo, Norway
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - E Domenici
- Centre for Integrative Biology, Università degli Studi di Trento, Trento, Italy
| | - H J Edenberg
- Indiana University School of Medicine, Department of Biochemistry and Molecular Biology, Indianapolis, IN, USA
- Indiana University School of Medicine, Department of Medical and Molecular Genetics, Indianapolis, IN, USA
| | - B Etain
- Faculté de Médecine, Université Paris Est, Créteil, France
| | - S B Fischer
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - L Forty
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - C Fraser
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - M A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - J M Fullerton
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - K Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
- Medical Center of the University of Munich, Campus Innenstadt, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
| | - E S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - I Giegling
- Department of Psychiatry, University of Halle, Halle, Germany
| | - S D Gordon
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - K Gordon-Smith
- Department of Psychological Medicine, University of Worcester, Worcester, UK
| | - H J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - E K Green
- School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - T A Greenwood
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - M Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - J Guzman-Parra
- Mental Health Department, Biomedicine Institute, University Regional Hospital, Málaga, Spain
| | - L S Hall
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - M Hamshere
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - J Hauser
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - M Hautzinger
- Department of Psychology, Eberhard Karls Universität Tübingen, Tubingen, Germany
| | - U Heilbronner
- Medical Center of the University of Munich, Campus Innenstadt, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
| | - S Herms
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
| | - S Hitturlingappa
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - P Hoffmann
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
| | - P Holmans
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - J-J Hottenga
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S Jamain
- Faculté de Médecine, Université Paris Est, Créteil, France
- Inserm U955, Psychiatrie Translationnelle, Créteil, France
| | - I Jones
- National Center for Mental Health, Cardiff University, Cardiff, UK
| | - L A Jones
- Department of Psychological Medicine, University of Worcester, Worcester, UK
| | - A Juréus
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - R S Kahn
- University Medical Center Utrecht, Division of Neuroscience, Department of Psychiatry, Utrecht, The Netherlands
| | | | - G Kirov
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - S Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - S Kloiber
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Max Planck Institute of Psychiatry, Munich, Germany
| | - S V Knott
- Department of Psychological Medicine, University of Worcester, Worcester, UK
| | - M Kogevinas
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - M Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - M Leber
- Clinic for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - M Leboyer
- Inserm U955, Translational Psychiatry Laboratory, AP-HP, DHU PePSY, Department of Psychiatry, Université Paris Est, Créteil, France
| | - Q S Li
- Janssen Research and Development, LLC, Neuroscience Therapeutic Area, Titusville, NJ, USA
| | - J Lissowska
- M. Sklodowska-Curie Cancer Center and Institute of Oncology, Cancer Epidemiology and Prevention, Warsaw, Poland
| | - S Lucae
- Max Planck Institute of Psychiatry, Munich, Germany
| | - N G Martin
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - F Mayoral-Cleries
- Mental Health Department, Biomedicine Institute, University Regional Hospital, Málaga, Spain
| | - S L McElroy
- Lindner Center of HOPE, Research Institute, Mason, OH, USA
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - J D McKay
- Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, Lyon, France
| | - A McQuillin
- Division of Psychiatry, University College London, London, UK
| | - S E Medland
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - C M Middeldorp
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Y Milaneschi
- VU University Medical Center and GGZ inGeest, Department of Psychiatry, Amsterdam, The Netherlands
| | - P B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
| | - G W Montgomery
- Institute for Molecular Biology, University of Queensland, Brisbane, QLD, Australia
| | - G Morken
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
| | - O Mors
- Risskov, Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - T W Mühleisen
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-1), Juelich, Germany
- Division of Medical Genetics, University of Basel, Basel, Switzerland
| | - B Müller-Myhsok
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- University of Liverpool, Liverpool, UK
| | - R M Myers
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - C M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - J I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M C O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - L M O Loohuis
- Center for Neurobehavioral Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | - R Ophoff
- University Medical Center Utrecht, Division of Brain Research, Utrecht, The Netherlands
| | - L Oruc
- Psychiatry Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia-Herzegovina
| | - M J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - S A Paciga
- Pfizer Global Research and Development, Human Genetics and Computational Biomedicine, Groton, CT, USA
| | - B W J H Penninx
- VU University Medical Center and GGZ inGeest, Department of Psychiatry, Amsterdam, The Netherlands
| | - A Perry
- Department of Psychological Medicine, University of Worcester, Worcester, UK
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - J B Potash
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - M Preisig
- Department of Psychiatry, Psychiatric University Hospital of Lausanne, Lausanne, Switzerland
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - F Rivas
- Mental Health Department, Biomedicine Institute, University Regional Hospital, Málaga, Spain
| | - G A Rouleau
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute and Hospital, Montreal, QC, Canada
| | - P R Schofield
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - T G Schulze
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
- Medical Center of the University of Munich, Campus Innenstadt, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- NIMH Division of Intramural Research Programs, Human Genetics Branch, Bethesda, MD, USA
| | - M Schwarz
- Psychiatric Center Nordbaden, Wiesloch, Germany
| | - L Scott
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - G C B Sinnamon
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - E A Stahl
- Broad Institute of MIT and Harvard, Medical and Population Genetics, Cambridge, MA, USA
- Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Strauss
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - G Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - S Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - H Vedder
- Psychiatric Center Nordbaden, Wiesloch, Germany
| | - J B Vincent
- Centre for Addiction and Mental Health, Molecular Neuropsychiatry and Development Laboratory, Toronto, ON, Canada
| | - G Willemsen
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C C Witt
- Department of Anaesthesiology and Operative Intensive Care, University Hospital Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - N R Wray
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - H S Xi
- Pfizer Global Research and Development, Computational Sciences Center of Emphasis, Cambridge, MA, USA
| | - Bipolar Disorders Working Group of the Psychiatric Genomics Consortium
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Central Institute of Mental Health, Clinic of Psychosomatic and Psychotherapeutic Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Central Institute of Mental Health, Institute for Psychiatric and Psychosomatic Psychotherapy (IPPP)/Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, University of Oslo, Oslo, Norway
- Institute of Pulmonology, Russian State Medical University, Moscow, Russian Federation
- Division of Psychiatry, University College London, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
- Inserm, U1144, AP-HP, GH Saint-Louis, Département de Psychiatrie et de Médecine Addictologique, Paris, France
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- National Center for Mental Health, Cardiff University, Cardiff, UK
- Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Urain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Medical and Quality Assurance, Clinics of Upper Bavaria, Munich, Germany
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
- Medical Center of the University of Munich, Campus Innenstadt, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- Centre for Psychiatry, Queen Mary University of London, London, UK
- UCL Genetics Institute, University College London, London, UK
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Münste, Münster, Germany
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Department of Medical Genetics, Oslo University Hospital Ullevål, Oslo, Norway
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Centre for Integrative Biology, Università degli Studi di Trento, Trento, Italy
- Indiana University School of Medicine, Department of Biochemistry and Molecular Biology, Indianapolis, IN, USA
- Indiana University School of Medicine, Department of Medical and Molecular Genetics, Indianapolis, IN, USA
- Faculté de Médecine, Université Paris Est, Créteil, France
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, University of Halle, Halle, Germany
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Psychological Medicine, University of Worcester, Worcester, UK
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
- Mental Health Department, Biomedicine Institute, University Regional Hospital, Málaga, Spain
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychology, Eberhard Karls Universität Tübingen, Tubingen, Germany
- Inserm U955, Psychiatrie Translationnelle, Créteil, France
- University Medical Center Utrecht, Division of Neuroscience, Department of Psychiatry, Utrecht, The Netherlands
- Center of Psychiatry Weinsberg, Weinsberg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Max Planck Institute of Psychiatry, Munich, Germany
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Clinic for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
- Inserm U955, Translational Psychiatry Laboratory, AP-HP, DHU PePSY, Department of Psychiatry, Université Paris Est, Créteil, France
- Janssen Research and Development, LLC, Neuroscience Therapeutic Area, Titusville, NJ, USA
- M. Sklodowska-Curie Cancer Center and Institute of Oncology, Cancer Epidemiology and Prevention, Warsaw, Poland
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
- Lindner Center of HOPE, Research Institute, Mason, OH, USA
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, Lyon, France
- Division of Psychiatry, University College London, London, UK
- VU University Medical Center and GGZ inGeest, Department of Psychiatry, Amsterdam, The Netherlands
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
- Institute for Molecular Biology, University of Queensland, Brisbane, QLD, Australia
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
- Risskov, Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-1), Juelich, Germany
- Division of Medical Genetics, University of Basel, Basel, Switzerland
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- University of Liverpool, Liverpool, UK
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Center for Neurobehavioral Genetics, University of California Los Angeles, Los Angeles, CA, USA
- University Medical Center Utrecht, Division of Brain Research, Utrecht, The Netherlands
- Psychiatry Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia-Herzegovina
- Pfizer Global Research and Development, Human Genetics and Computational Biomedicine, Groton, CT, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, Psychiatric University Hospital of Lausanne, Lausanne, Switzerland
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute and Hospital, Montreal, QC, Canada
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- NIMH Division of Intramural Research Programs, Human Genetics Branch, Bethesda, MD, USA
- Psychiatric Center Nordbaden, Wiesloch, Germany
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Broad Institute of MIT and Harvard, Medical and Population Genetics, Cambridge, MA, USA
- Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Centre for Addiction and Mental Health, Molecular Neuropsychiatry and Development Laboratory, Toronto, ON, Canada
- Department of Anaesthesiology and Operative Intensive Care, University Hospital Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Pfizer Global Research and Development, Computational Sciences Center of Emphasis, Cambridge, MA, USA
- AGAPLESION Elisabethenstift gGmbh, Department of Psychiatry, Psychosomatics and Psychotherapy, Darmstadt, Germany
- University Medical Center, Department of Psychiatry and Psychotherapy, Mainz, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Stanley Center for Psychiatric Research and Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Central Institute of Mental Health, Clinic of Psychosomatic and Psychotherapeutic Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Central Institute of Mental Health, Institute for Psychiatric and Psychosomatic Psychotherapy (IPPP)/Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, University of Oslo, Oslo, Norway
- Institute of Pulmonology, Russian State Medical University, Moscow, Russian Federation
- Division of Psychiatry, University College London, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
- Inserm, U1144, AP-HP, GH Saint-Louis, Département de Psychiatrie et de Médecine Addictologique, Paris, France
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- National Center for Mental Health, Cardiff University, Cardiff, UK
- Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Urain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Medical and Quality Assurance, Clinics of Upper Bavaria, Munich, Germany
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
- Medical Center of the University of Munich, Campus Innenstadt, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- Centre for Psychiatry, Queen Mary University of London, London, UK
- UCL Genetics Institute, University College London, London, UK
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Münste, Münster, Germany
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Department of Medical Genetics, Oslo University Hospital Ullevål, Oslo, Norway
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Centre for Integrative Biology, Università degli Studi di Trento, Trento, Italy
- Indiana University School of Medicine, Department of Biochemistry and Molecular Biology, Indianapolis, IN, USA
- Indiana University School of Medicine, Department of Medical and Molecular Genetics, Indianapolis, IN, USA
- Faculté de Médecine, Université Paris Est, Créteil, France
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, University of Halle, Halle, Germany
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Psychological Medicine, University of Worcester, Worcester, UK
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
- Mental Health Department, Biomedicine Institute, University Regional Hospital, Málaga, Spain
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychology, Eberhard Karls Universität Tübingen, Tubingen, Germany
- Inserm U955, Psychiatrie Translationnelle, Créteil, France
- University Medical Center Utrecht, Division of Neuroscience, Department of Psychiatry, Utrecht, The Netherlands
- Center of Psychiatry Weinsberg, Weinsberg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Max Planck Institute of Psychiatry, Munich, Germany
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Clinic for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
- Inserm U955, Translational Psychiatry Laboratory, AP-HP, DHU PePSY, Department of Psychiatry, Université Paris Est, Créteil, France
- Janssen Research and Development, LLC, Neuroscience Therapeutic Area, Titusville, NJ, USA
- M. Sklodowska-Curie Cancer Center and Institute of Oncology, Cancer Epidemiology and Prevention, Warsaw, Poland
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
- Lindner Center of HOPE, Research Institute, Mason, OH, USA
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, Lyon, France
- Division of Psychiatry, University College London, London, UK
- VU University Medical Center and GGZ inGeest, Department of Psychiatry, Amsterdam, The Netherlands
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
- Institute for Molecular Biology, University of Queensland, Brisbane, QLD, Australia
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
- Risskov, Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-1), Juelich, Germany
- Division of Medical Genetics, University of Basel, Basel, Switzerland
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- University of Liverpool, Liverpool, UK
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Center for Neurobehavioral Genetics, University of California Los Angeles, Los Angeles, CA, USA
- University Medical Center Utrecht, Division of Brain Research, Utrecht, The Netherlands
- Psychiatry Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia-Herzegovina
- Pfizer Global Research and Development, Human Genetics and Computational Biomedicine, Groton, CT, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, Psychiatric University Hospital of Lausanne, Lausanne, Switzerland
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute and Hospital, Montreal, QC, Canada
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- NIMH Division of Intramural Research Programs, Human Genetics Branch, Bethesda, MD, USA
- Psychiatric Center Nordbaden, Wiesloch, Germany
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Broad Institute of MIT and Harvard, Medical and Population Genetics, Cambridge, MA, USA
- Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Centre for Addiction and Mental Health, Molecular Neuropsychiatry and Development Laboratory, Toronto, ON, Canada
- Department of Anaesthesiology and Operative Intensive Care, University Hospital Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Pfizer Global Research and Development, Computational Sciences Center of Emphasis, Cambridge, MA, USA
- AGAPLESION Elisabethenstift gGmbh, Department of Psychiatry, Psychosomatics and Psychotherapy, Darmstadt, Germany
- University Medical Center, Department of Psychiatry and Psychotherapy, Mainz, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Stanley Center for Psychiatric Research and Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Schizophrenia Working Group of the Psychiatric Genomics Consortium
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Central Institute of Mental Health, Clinic of Psychosomatic and Psychotherapeutic Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Central Institute of Mental Health, Institute for Psychiatric and Psychosomatic Psychotherapy (IPPP)/Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, University of Oslo, Oslo, Norway
- Institute of Pulmonology, Russian State Medical University, Moscow, Russian Federation
- Division of Psychiatry, University College London, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
- Inserm, U1144, AP-HP, GH Saint-Louis, Département de Psychiatrie et de Médecine Addictologique, Paris, France
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- National Center for Mental Health, Cardiff University, Cardiff, UK
- Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Urain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Medical and Quality Assurance, Clinics of Upper Bavaria, Munich, Germany
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
- Medical Center of the University of Munich, Campus Innenstadt, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- Centre for Psychiatry, Queen Mary University of London, London, UK
- UCL Genetics Institute, University College London, London, UK
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Münste, Münster, Germany
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Department of Medical Genetics, Oslo University Hospital Ullevål, Oslo, Norway
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Centre for Integrative Biology, Università degli Studi di Trento, Trento, Italy
- Indiana University School of Medicine, Department of Biochemistry and Molecular Biology, Indianapolis, IN, USA
- Indiana University School of Medicine, Department of Medical and Molecular Genetics, Indianapolis, IN, USA
- Faculté de Médecine, Université Paris Est, Créteil, France
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, University of Halle, Halle, Germany
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Psychological Medicine, University of Worcester, Worcester, UK
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
- Mental Health Department, Biomedicine Institute, University Regional Hospital, Málaga, Spain
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychology, Eberhard Karls Universität Tübingen, Tubingen, Germany
- Inserm U955, Psychiatrie Translationnelle, Créteil, France
- University Medical Center Utrecht, Division of Neuroscience, Department of Psychiatry, Utrecht, The Netherlands
- Center of Psychiatry Weinsberg, Weinsberg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Max Planck Institute of Psychiatry, Munich, Germany
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Clinic for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
- Inserm U955, Translational Psychiatry Laboratory, AP-HP, DHU PePSY, Department of Psychiatry, Université Paris Est, Créteil, France
- Janssen Research and Development, LLC, Neuroscience Therapeutic Area, Titusville, NJ, USA
- M. Sklodowska-Curie Cancer Center and Institute of Oncology, Cancer Epidemiology and Prevention, Warsaw, Poland
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
- Lindner Center of HOPE, Research Institute, Mason, OH, USA
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, Lyon, France
- Division of Psychiatry, University College London, London, UK
- VU University Medical Center and GGZ inGeest, Department of Psychiatry, Amsterdam, The Netherlands
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
- Institute for Molecular Biology, University of Queensland, Brisbane, QLD, Australia
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
- Risskov, Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-1), Juelich, Germany
- Division of Medical Genetics, University of Basel, Basel, Switzerland
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- University of Liverpool, Liverpool, UK
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Center for Neurobehavioral Genetics, University of California Los Angeles, Los Angeles, CA, USA
- University Medical Center Utrecht, Division of Brain Research, Utrecht, The Netherlands
- Psychiatry Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia-Herzegovina
- Pfizer Global Research and Development, Human Genetics and Computational Biomedicine, Groton, CT, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, Psychiatric University Hospital of Lausanne, Lausanne, Switzerland
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute and Hospital, Montreal, QC, Canada
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- NIMH Division of Intramural Research Programs, Human Genetics Branch, Bethesda, MD, USA
- Psychiatric Center Nordbaden, Wiesloch, Germany
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Broad Institute of MIT and Harvard, Medical and Population Genetics, Cambridge, MA, USA
- Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Centre for Addiction and Mental Health, Molecular Neuropsychiatry and Development Laboratory, Toronto, ON, Canada
- Department of Anaesthesiology and Operative Intensive Care, University Hospital Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Pfizer Global Research and Development, Computational Sciences Center of Emphasis, Cambridge, MA, USA
- AGAPLESION Elisabethenstift gGmbh, Department of Psychiatry, Psychosomatics and Psychotherapy, Darmstadt, Germany
- University Medical Center, Department of Psychiatry and Psychotherapy, Mainz, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Stanley Center for Psychiatric Research and Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - A Tadic
- AGAPLESION Elisabethenstift gGmbh, Department of Psychiatry, Psychosomatics and Psychotherapy, Darmstadt, Germany
- University Medical Center, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - N Dahmen
- University Medical Center, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - B H Schott
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - S Cichon
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-1), Juelich, Germany
- Division of Medical Genetics, University of Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - M M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life and Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
| | - S Ripke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Stanley Center for Psychiatric Research and Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - A Mobascher
- University Medical Center, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - D Rujescu
- Department of Psychiatry, University of Halle, Halle, Germany
| | - K Lieb
- University Medical Center, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - S Roepke
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - C Schmahl
- Central Institute of Mental Health, Clinic of Psychosomatic and Psychotherapeutic Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Bohus
- Central Institute of Mental Health, Institute for Psychiatric and Psychosomatic Psychotherapy (IPPP)/Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Rietschel
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Wong TH, Sinclair S, Smith B, Fraser C, Morton CA. Real-world, single-centre experience of apremilast for the treatment of moderate to severe psoriasis. Clin Exp Dermatol 2017. [PMID: 28621002 DOI: 10.1111/ced.13150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- T H Wong
- Department of Dermatology, Stirling Community Hospital, Livilands Gate, Stirling, FK8 2AU, UK
| | - S Sinclair
- Department of Dermatology, Stirling Community Hospital, Livilands Gate, Stirling, FK8 2AU, UK
| | - B Smith
- Department of Dermatology, Stirling Community Hospital, Livilands Gate, Stirling, FK8 2AU, UK
| | - C Fraser
- Department of Dermatology, Stirling Community Hospital, Livilands Gate, Stirling, FK8 2AU, UK
| | - C A Morton
- Department of Dermatology, Stirling Community Hospital, Livilands Gate, Stirling, FK8 2AU, UK
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Malmqvist L, Fraser C, Fraser JA, Lawlor M, Hamann S. RE: Traber et al.: Enhanced depth imaging optical coherence tomography of optic nerve head drusen: a comparison of cases with and without visual field loss ( Ophthalmology . 2017;124:66-73). Ophthalmology 2017; 124:e55-e56. [DOI: 10.1016/j.ophtha.2017.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/28/2022] Open
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Malmqvist L, De Santiago L, Fraser C, Klistorner A, Hamann S. Exploring the methods of data analysis in multifocal visual evoked potentials. Doc Ophthalmol 2016; 133:41-8. [DOI: 10.1007/s10633-016-9546-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/09/2016] [Indexed: 11/24/2022]
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Devpura S, Li H, Liu C, Fraser C, Ajlouni M, Movsas B, Chetty I. SU-D-204-07: Retrospective Correlation of Dose Accuracy with Regions of Local Failure for Early Stage Lung Cancer Patients Treated with Stereotactic Body Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4955612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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41
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Ma AS, Grigg JR, Ho G, Prokudin I, Farnsworth E, Holman K, Cheng A, Billson FA, Martin F, Fraser C, Mowat D, Smith J, Christodoulou J, Flaherty M, Bennetts B, Jamieson RV. Sporadic and Familial Congenital Cataracts: Mutational Spectrum and New Diagnoses Using Next-Generation Sequencing. Hum Mutat 2016; 37:371-84. [PMID: 26694549 PMCID: PMC4787201 DOI: 10.1002/humu.22948] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022]
Abstract
Congenital cataracts are a significant cause of lifelong visual loss. They may be isolated or associated with microcornea, microphthalmia, anterior segment dysgenesis (ASD) and glaucoma, and there can be syndromic associations. Genetic diagnosis is challenging due to marked genetic heterogeneity. In this study, next-generation sequencing (NGS) of 32 cataract-associated genes was undertaken in 46 apparently nonsyndromic congenital cataract probands, around half sporadic and half familial cases. We identified pathogenic variants in 70% of cases, and over 68% of these were novel. In almost two-thirds (20/33) of these cases, this resulted in new information about the diagnosis and/or inheritance pattern. This included identification of: new syndromic diagnoses due to NHS or BCOR mutations; complex ocular phenotypes due to PAX6 mutations; de novo autosomal-dominant or X-linked mutations in sporadic cases; and mutations in two separate cataract genes in one family. Variants were found in the crystallin and gap junction genes, including the first report of severe microphthalmia and sclerocornea associated with a novel GJA8 mutation. Mutations were also found in rarely reported genes including MAF, VIM, MIP, and BFSP1. Targeted NGS in presumed nonsyndromic congenital cataract patients provided significant diagnostic information in both familial and sporadic cases.
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Affiliation(s)
- Alan S. Ma
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Clinical GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - John R. Grigg
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Gladys Ho
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Ivan Prokudin
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Elizabeth Farnsworth
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Katherine Holman
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Anson Cheng
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Frank A. Billson
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Frank Martin
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Clare Fraser
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - David Mowat
- Department of Medical GeneticsSydney Children's HospitalSydneyNew South WalesAustralia
| | - James Smith
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - John Christodoulou
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Maree Flaherty
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Bruce Bennetts
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Robyn V. Jamieson
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Clinical GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
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Martinez-Lapiscina EH, Arnow S, Wilson JA, Saidha S, Preiningerova JL, Oberwahrenbrock T, Brandt AU, Pablo LE, Guerrieri S, Gonzalez I, Outteryck O, Mueller AK, Albrecht P, Chan W, Lukas S, Balk LJ, Fraser C, Frederiksen JL, Resto J, Frohman T, Cordano C, Zubizarreta I, Andorra M, Sanchez-Dalmau B, Saiz A, Bermel R, Klistorner A, Petzold A, Schippling S, Costello F, Aktas O, Vermersch P, Oreja-Guevara C, Comi G, Leocani L, Garcia-Martin E, Paul F, Havrdova E, Frohman E, Balcer LJ, Green AJ, Calabresi PA, Villoslada P. Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study. Lancet Neurol 2016; 15:574-84. [PMID: 27011339 DOI: 10.1016/s1474-4422(16)00068-5] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fibre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available. METHODS In this multicentre, cohort study, we collected data about patients (age ≥16 years old) with clinically isolated syndrome, relapsing-remitting multiple sclerosis, and progressive multiple sclerosis. Patients were recruited from centres in Spain, Italy, France, Germany, Czech Republic, Netherlands, Canada, and the USA, with the first cohort starting in 2008 and the latest cohort starting in 2013. We assessed disability worsening using the Expanded Disability Status Scale (EDSS). The pRNFL thickness and macular volume were assessed once at study entry (baseline) by optical coherence tomography (OCT) and was calculated as the mean value of both eyes without optic neuritis for patients without a history of optic neuritis or the value of the non-optic neuritis eye for patients with previous unilateral optic neuritis. Researchers who did the OCT at baseline were masked to EDSS results and the researchers assessing disability with EDSS were masked to OCT results. We estimated the association of pRNFL thickness or macular volume at baseline in eyes without optic neuritis with the risk of subsequent disability worsening by use of proportional hazards models that included OCT metrics and age, disease duration, disability, presence of previous unilateral optic neuritis, and use of disease-modifying therapies as covariates. FINDINGS 879 patients with clinically isolated syndrome (n=74), relapsing-remitting multiple sclerosis (n=664), or progressive multiple sclerosis (n=141) were included in the primary analyses. Disability worsening occurred in 252 (29%) of 879 patients with multiple sclerosis after a median follow-up of 2·0 years (range 0·5-5 years). Patients with a pRNFL of less than or equal to 87 μm or less than or equal to 88 μm (measured with Spectralis or Cirrus OCT devices) had double the risk of disability worsening at any time after the first and up to the third years of follow-up (hazard ratio 2·06, 95% CI 1·36-3·11; p=0·001), and the risk was increased by nearly four times after the third and up to the fifth years of follow-up (3·81, 1·63-8·91; p=0·002). We did not identify meaningful associations for macular volume. INTERPRETATION Our results provide evidence of the usefulness of monitoring pRNFL thickness by OCT for prediction of the risk of disability worsening with time in patients with multiple sclerosis. FUNDING Instituto de Salud Carlos III.
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Affiliation(s)
| | - Sam Arnow
- University of California, San Francisco, CA, USA
| | | | - Shiv Saidha
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Timm Oberwahrenbrock
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité University Medicine and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité University Medicine and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | - Clare Fraser
- Save Sight Institute, University of Sydney, NSW, Australia
| | | | | | - Teresa Frohman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Irati Zubizarreta
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Magi Andorra
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Albert Saiz
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Axel Petzold
- VU Medical Center, Amsterdam, Netherlands; Moorfields Eye Hospital, London, UK
| | | | | | - Orhan Aktas
- University of Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | - Friedemann Paul
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Charité University Medicine and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | - Elliot Frohman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laura J Balcer
- University of Pennsylvania, Philadelphia, PA, USA; New York University, New York, NY, USA
| | - Ari J Green
- University of California, San Francisco, CA, USA
| | | | - Pablo Villoslada
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; University of California, San Francisco, CA, USA.
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Eckstein K, Robinson JC, Fraser C. Physiological responses of banana (MusaAAA; Cavendish sub-group) in the subtropics. Y. Influence of leaf tearing on assimilation potential and yield. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/14620316.1996.11515431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sevak P, Aldridge K, Fraser C, Glide-Hurst C, Walker E. Dosimetric and Clinical Outcomes with Use of a Breast Cup in Cancer Patients With Large or Pendulous Breasts. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.655] [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: 10/22/2022]
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Kumarasiri A, Kim J, Liu C, Jomaa M, Fraser C, Chetty I, Siddiqui F. Substantial Volumetric and Dosimetric Changes to the Pharyngeal Constrictor Elucidated From Daily Deformable Dose Accumulation in Head and Neck Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1342] [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: 10/22/2022]
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Moran J, Feng M, Marsh R, Griffith K, Benedetti L, Grills I, Walker E, Fraser C, Raymond S, Blauser J, Gielda B, Vicini F, Wilson M, Dryden D, Parent K, Ewald A, Matuszak M, Jagsi R, Grubb M, Pierce L. Impact of Cardiac Sparing Techniques on Cardiac Doses for Left Breast Cancer Patients: A Multicenter Analysis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.609] [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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Albert JG, Humbla O, McAlindon ME, Davison C, Seitz U, Fraser C, Hagenmüller F, Noetzel E, Spada C, Riccioni ME, Barnert J, Filmann N, Keuchel M. A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses: A Prospective Observational European Multicenter Study. Medicine (Baltimore) 2015; 94:e1941. [PMID: 26512623 PMCID: PMC4985436 DOI: 10.1097/md.0000000000001941] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse.Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n = 2), Italy (n = 2), Germany (n = 2), Finland (n = 1), and nationally in Germany (n = 10), applying similar 8-hour curricula with 50% lectures and 50% hands-on training. The Given PillCam System was used in 12 courses, the Olympus EndoCapsule system in 5, respectively. A simple evaluation tool for capsule endoscopy training (ET-CET) was developed using 10 short SBCE videos including relevant lesions and normal or irrelevant findings. For each video, delegates were required to record a diagnosis (achievable total score from 0 to 10) and the clinical relevance (achievable total score 0 to 10). ET-CET was performed at baseline before the course and repeated, with videos in altered order, after the course.Two hundred ninety-four delegates (79.3% physicians, 16.3% nurses, 4.4% others) were included for baseline analysis, 268 completed the final evaluation. Forty percent had no previous experience in SBCE, 33% had performed 10 or less procedures. Median scores for correct diagnosis improved from 4.0 (IQR 3) to 7.0 (IQR 3) during the courses (P < 0.001, Wilcoxon), and for correct classification of relevance of the lesions from 5.0 (IQR 3) to 7.0 (IQR 3) (P < 0.001), respectively. Improvement was not dependent on experience, profession, SBCE system, or course setting. Previous experience in SBCE was associated with higher baseline scores for correct diagnosis (P < 0.001; Kruskal-Wallis). Additionally, independent nonparametric partial correlation with experience in gastroscopy (rho 0.33) and colonoscopy (rho 0.27) was observed (P < 0.001).A simple ET-CET demonstrated significant improvement of diagnostic skills on completion of formal basic SBCE courses with hands-on training, regardless of preexisting experience, profession, and course setting. Baseline scores for correct diagnoses show a plateau after interpretation of 25 SBCE before courses, supporting this number as a compromise for credentialing. Experience in flexible endoscopy may be useful before attending an SBCE course.
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Affiliation(s)
- J G Albert
- From the Department of Internal Medicine I, JW Goethe Universität, Frankfurt, Germany (JGA); Department of Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany (OH, MK); Department of Gastroenterology, University Hospital, Sheffield, United Kingdom (MEM); Department of Gastroenterology, South Tyneside NHS Trust, South Tyneside, United Kingdom (CD); Department of Gastroenterology, Kreiskrankenhaus Bergstrasse, Heppenheim, Germany (US); Wolfson Unit, St. Marks's Hospital, London, United Kingdom (CF); 1st Medical Department, Asklepios Klinik Altona, Hamburg, Germany (FH, MK); Department of Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany (EN); Endoscopy Unit, Università Cattolica, Roma, Italy (CS, MER); Department of Gastroenterology, Klinikum, Augsburg, Germany (JB); Institute of Biostatistics and Mathematical Modeling, JW Goethe Universität, Frankfurt, Germany (NF)
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Kumarasiri A, Siddiqui F, Liu C, Kamal M, Fraser C, Chetty I, Kim J. SU-E-J-66: Significant Anatomical and Dosimetric Changes Observed with the Pharyngeal Constrictor During Head and Neck Radiotherapy Elicited From Daily Deformable Image Registration and Dose Accumulation. Med Phys 2015. [DOI: 10.1118/1.4924153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Snyder K, Kim J, Reding A, Fraser C, Lu S, Gordon J, Ajlouni M, Movsas B, Chetty I. MO-F-CAMPUS-T-04: Development and Evaluation of a Knowledge-Based Model for Treatment Planning of Lung Cancer Patients Using Stereotactic Body Radiotherapy (SBRT). Med Phys 2015. [DOI: 10.1118/1.4925460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kerman R, Jindra P, Jeewa A, Burki S, Fraser C, Adachi I. Immune Profiling Pre/Post Berlin VAD Implant and Pre/Post Transplantation of Pediatric Heart Failure Patients. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.927] [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] Open
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