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Hedderly T, Eccles C, Malik O, Abdulsatar F, Mitchell C, Owen T, Soffer-Dudek N, Grose C, Fernandez TV, Robinson S, Somer E. Intense Imagery Movements May Lead to Maladaptive Daydreaming: A Case Series and Literature Review. Mov Disord Clin Pract 2024. [PMID: 38533626 DOI: 10.1002/mdc3.14011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/11/2024] [Accepted: 02/06/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND This case series highlights the connection between childhood intense imagery movements (IIM) and adult-reported maladaptive daydreaming (MD). Motor stereotypies occur in typically developing children and also with co-occurring neurodevelopmental differences. A subgroup with complex motor stereotypies reports accompanying intense imagery, often enhanced by the movements. This phenomenon can persist into adulthood and, in some cases, will need active management to prevent significant distress and impairment. CASES Six adults, self-reporting maladaptive daydreaming associated with stereotypies, are presented to demonstrate the associations. LITERATURE REVIEW The clinical significance and function of IIM and MD are unclear, but several hypotheses are discussed, including the mechanism of emotional regulation through sensory seeking, as a process for processing childhood psychological trauma, as intrusive thoughts or images as part of a subtype of Obsessive Compulsive Disorder, or as a result of diverse attentional networks seen in neurodevelopmental disorders. CONCLUSIONS This paper highlights important connections between IIM and MD. Many adults with MD show a childhood origin of stereotypical movements. Whilst immersive daydreaming may provide creativity and emotional regulation, there is evidence of distress and impairment of function for some adults, leading to MD diagnoses. Recognizing this phenomenon is important for all neurologists and physicians working with stereotypical movements.
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Affiliation(s)
- Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM), Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
- Department of Women and Children's Health, School of Life Course Sciences (SoLCS), King's College London, London, UK
| | - Claire Eccles
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Osman Malik
- Tic and Neurodevelopmental Movements Service (TANDeM), Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Farah Abdulsatar
- Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Children's Health Research Institute, Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Clare Mitchell
- Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Children's Health Research Institute, Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Tamsin Owen
- Tic and Neurodevelopmental Movements Service (TANDeM), Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Nirit Soffer-Dudek
- Department of Psychology, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Claire Grose
- Tic and Neurodevelopmental Movements Service (TANDeM), Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas V Fernandez
- Child Study Center and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sally Robinson
- Essex Child and Adolescent Mental Health Services, North East London NHS Foundation Trust, Rainham, UK
| | - Eli Somer
- Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
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Saleem J, Guevel B, Gillott E, Mitchell C, Widjono A, Qavi A, Domos P. Radiological analysis and outcomes of isolated greater tuberosity fracture-dislocations. Ann R Coll Surg Engl 2024; 106:270-276. [PMID: 37609692 PMCID: PMC10904254 DOI: 10.1308/rcsann.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate different radiological characteristics for isolated greater tuberosity (GT) fracture-dislocations and their effects on complication and reoperation rates. METHODS A two-centre, retrospective study was performed on patients with a minimum 1-year follow-up (median 4.5 years). Patients were split into two groups, Group A (<65 years old) and Group B (≥65 years old). Outcomes included initial injury characteristics (dislocation and fracture type, AC/BC ratio and distances), the reduction environment and postreduction outcomes including complications. RESULTS A total of 55 patients were included in this study, with a reduction in the emergency department (ED) performed in 93% of patients. Complication rates (47% overall) were similar in both groups, with an overall nonunion rate of 27%. No nonunions occurred in fractures reduced in theatre compared with 29% occurring in reductions in ED (p<0.001); 11% of patients experienced surgical neck fractures, the majority of which were in Group B (p=0.003). A larger fracture fragment (i.e. higher AC/BC or AC distances) was correlated with a higher incidence of nonunion in Group B compared with Group A (p=0.003), and a higher risk of stiffness in both groups (p=0.049); 16% of patients demonstrated delayed displacement of their GT. CONCLUSIONS This study highlights the high complication rates associated with these injuries. Age and specific radiological parameters should be taken into consideration when risk stratifying, as should reducing these fractures in a theatre setting. Interval radiographs are also advised to monitor GT displacement for at least 2-3 weeks.
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Affiliation(s)
- J Saleem
- Royal Free NHS Foundation Trust, UK
| | - B Guevel
- Royal Free NHS Foundation Trust, UK
| | | | | | | | - A Qavi
- Imperial College London,UK
| | - P Domos
- Royal Free NHS Foundation Trust, UK
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Brigden TV, Mitchell C, Kuberska K, Hall A. A Principle-Based Approach to Visual Identification Systems for Hospitalized People with Dementia. J Bioeth Inq 2023:10.1007/s11673-023-10315-x. [PMID: 38019420 DOI: 10.1007/s11673-023-10315-x] [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: 01/05/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023]
Abstract
A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier.
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Affiliation(s)
- T V Brigden
- PHG Foundation, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England.
| | - C Mitchell
- PHG Foundation, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England
| | - K Kuberska
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England
| | - A Hall
- PHG Foundation, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, England
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Mitchell C, Malalasekera V, Gill AJ, Vissers JHA, Luen SJ, Grimmond SM, Lewin J. Primary pancreatic spindle cell sarcoma with a TMEM106B::BRAF gene fusion treated with MEK inhibition. Pathology 2023; 55:127-129. [PMID: 35738942 DOI: 10.1016/j.pathol.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 01/24/2023]
Affiliation(s)
- C Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.
| | - V Malalasekera
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Vic, Australia
| | - A J Gill
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - J H A Vissers
- Centre for Cancer Research and Department of Clinical Pathology, The University of Melbourne, Melbourne, Vic, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Vic, Australia
| | - S J Luen
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Vic, Australia
| | - S M Grimmond
- Centre for Cancer Research and Department of Clinical Pathology, The University of Melbourne, Melbourne, Vic, Australia
| | - J Lewin
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Vic, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Vic, Australia
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Chen J, Hunt P, Khordoc C, Hardy E, Mitchell C. Quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF): a systematic review. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Heart failure with preserved ejection fraction (HFpEF) is associated with significant clinical unmet need as mortality and morbidity rates are high despite current treatments. Patient-reported quality of life (QoL) is an important and clinically relevant endpoint in patients with HF so understanding the impact of HFpEF on QoL is essential.
Purpose
The aim of this systematic review was to identify and summarize data on QoL in HFpEF.
Methods
Systematic searches of Medline, Medline Epub Ahead of Print (In-Process & Other Non-Indexed Citations), Embase, and EBM Reviews were conducted in October 2021. Congress proceedings from the past 3 years and reference lists of included publications were also searched. Publications were screened against eligibility criteria by title/abstract and then by full text. Eligibility criteria included clinical studies of any design reporting baseline QoL in adults with HFpEF published from 2016 onwards.
Results
The electronic database search identified 6,403 articles on HFpEF. After screening, 35 full publications reporting HFpEF and QoL were included. Study designs included observational cohort (n=17), cross-sectional (n=3), and post-hoc analyses of interventional studies (n=15). Tools used to measure QoL included KCCQ (n=17), MLHFQ (n=12), EQ-5D-VAS (n=8), SF-12 (n=2), SF-36 (n=2), and EHFSQ-1 (n=1). Health-state utility values (HSUVs) were captured using EQ-5D in four studies. HSUVs in HFpEF ranged from 0.67–0.74, indicating a substantial QoL burden. Eleven studies using various instruments compared QoL in patients with HFpEF vs non-HFpEF (Table 1). Of these, five reported statistically significantly poorer QOL in HFpEF vs non-HFpEF, one reported statistically significantly poorer QOL in non-HFpEF vs HFpEF and five found no statistically significant difference between HF subtypes. Four studies compared QoL in men vs women with three reporting statistically significantly worse QoL in women. Three studies examined the impact of comorbidities, and all reported statistically significantly poorer QoL in patients with comorbid atrial fibrillation, diabetes, or metabolic syndrome. Two studies examined the effect of age; one reported that, vs elderly patients (age ≥85 years), younger patients (age ≤55 years) with HFpEF had statistically significantly worse QoL despite having fewer comorbidities; in contrast, the second study reported that younger patients (age ≤55 years) had statistically significantly better QoL than elderly patients (age ≥75 years). Two studies reported on hospitalizations, with one reporting no difference in QoL between patients who had previously been hospitalized and those who had not and the other reporting that readmission for HF correlated with QoL.
Conclusions
QoL burden among HFpEF patients is substantial. QoL may be affected by age, comorbidities, gender, and prior hospitalization, and may be associated with poorer outcomes. QoL in HFpEF is generally poorer than in non-HFpEF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- J Chen
- AstraZenca, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D , Gaithersburg , United States of America
| | - P Hunt
- AstraZenca, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D , Gaithersburg , United States of America
| | - C Khordoc
- AstraZenca, CVRM, Biopharmaceuticals, Global Medical , Wilmington , United States of America
| | - E Hardy
- Mtech Access Ltd , York , United Kingdom
| | - C Mitchell
- Mtech Access Ltd , Bicester , United Kingdom
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Chen L, Zheng M, Chen Z, Peng Y, Jones C, Graves S, Chen P, Ruan R, Papadimitriou J, Carey-Smith R, Leys T, Mitchell C, Huang YG, Wood D, Bulsara M, Zheng MH. The burden of end-stage osteoarthritis in Australia: a population-based study on the incidence of total knee replacement attributable to overweight/obesity. Osteoarthritis Cartilage 2022; 30:1254-1262. [PMID: 34890810 DOI: 10.1016/j.joca.2021.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population. METHODS This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015 and 2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence. RESULTS The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged >75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 14,287 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category. CONCLUSIONS Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.
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Affiliation(s)
- L Chen
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - M Zheng
- Institute for Health Research, Medical School, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Z Chen
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Y Peng
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - C Jones
- Department of Orthopaedic Surgery, Fiona Stanley Hospital Group, Perth, Western Australia, Australia
| | - S Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - P Chen
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - R Ruan
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - J Papadimitriou
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Pathwest Laboratories, Perth, Western Australia, Australia
| | - R Carey-Smith
- Department of Orthopaedic Surgery, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - T Leys
- Department of Orthopaedic Surgery, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - C Mitchell
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Y G Huang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - D Wood
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - M Bulsara
- Institute for Health Research, Medical School, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
| | - M H Zheng
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.
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Wight R, Murphy A, Bower J, Morgan R, Flanagan L, Maycock S, Lal S, Teubner A, Abraham A, Mitchell C, Hasan J, Jayson G, Clamp A, Salih Z. 43P Malignant bowel obstruction in advanced ovarian cancer: A retrospective analysis of patients supported with parenteral nutrition. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.061] [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: 11/01/2022] Open
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8
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Mitchell C, Cheuk SJ, O'Donnell CM, Bampoe S, Walker D. What is the impact of dexamethasone on postoperative pain in adults undergoing general anaesthesia for elective abdominal surgery: a systematic review and meta-analysis. Perioper Med (Lond) 2022; 11:13. [PMID: 35321728 PMCID: PMC8942613 DOI: 10.1186/s13741-022-00243-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background Previous meta-analysis of heterogeneous surgical cohorts demonstrated reduction in postoperative pain with perioperative intravenous dexamethasone, but none have addressed adults undergoing elective abdominal surgery. The aim of this study was to determine the impact of intravenous perioperative dexamethasone on postoperative pain in adults undergoing elective abdominal surgery under general anaesthesia. Methods This review was prospectively registered on the international prospective register of systematic reviews (CRD42020176202). Electronic databases Medical Analysis and Retrieval System Online (MEDLINE), Exerpta Medica Database (EMBASE), (CINAHL) Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and trial registries were searched to January 28 2021 for randomised controlled trials, comparing dexamethasone to placebo or alternative antiemetic, that reported pain. The primary outcome was pain score, and secondary outcomes were time to first analgesia, opioid requirements and time to post-anaesthesia care unit (PACU) discharge. Results Fifty-two studies (5768 participants) were included in the meta-analysis. Pain scores ≤ 4 hour (h) were reduced in patients who received dexamethasone at rest (mean difference (MD), − 0.54, 95% confidence interval (CI) − 0.72 to − 0.35, I2 = 81%) and on movement (MD − 0.42, 95% CI − 0.62 to − 0.22, I2 = 35). In the dexamethasone group, 4–24 h pain scores were less at rest (MD − 0.31, 95% CI − 0.47 to − 0.14, I2 = 96) and on movement (MD − 0.26, 95% CI − 0.39 to − 0.13, I2 = 29) and pain scores ≥ 24 h were reduced at rest (MD − 0.38, 95% CI − 0.52 to − 0.24, I2 = 88) and on movement (MD − 0.38, 95% CI − 0.65 to − 0.11, I2 = 71). Time to first analgesia (minutes) was increased (MD 22.92, 95% CI 11.09 to 34.75, I2 = 98), opioid requirements (mg oral morphine) decreased (MD − 6.66, 95% CI − 9.38 to − 3.93, I2 = 88) and no difference in time to PACU discharge (MD − 3.82, 95% CI − 10.87 to 3.23, I2 = 59%). Conclusions Patients receiving dexamethasone had reduced pain scores, postoperative opioid requirements and longer time to first analgesia. Dexamethasone is an effective analgesic adjunct for patients undergoing abdominal surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-022-00243-6.
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Affiliation(s)
- C Mitchell
- Department of Anaesthesia, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - S J Cheuk
- Department of Anaesthesia, Royal Belfast Hospital for Sick Children, Royal Group of Hospitals, Belfast, Northern Ireland
| | - C M O'Donnell
- Department of Anaesthesia, Royal Victoria Hospital, Royal Group of Hospitals, Belfast, Northern Ireland
| | - S Bampoe
- UCL Centre for Perioperative Medicine, University College London, London, UK
| | - D Walker
- UCL Centre for Perioperative Medicine, University College London, London, UK.
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Craig S, Powell CVE, Nixon GM, Oakley E, Hort J, Armstrong DS, Ranganathan S, Kochar A, Wilson C, George S, Phillips N, Furyk J, Lawton B, Borland ML, O'Brien S, Neutze J, Lithgow A, Mitchell C, Watkins N, Brannigan D, Wood J, Gray C, Hearps S, Ramage E, Williams A, Lew J, Jones L, Graudins A, Dalziel S, Babl FE. Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study. BMJ Open Respir Res 2022; 9:9/1/e001137. [PMID: 35301198 PMCID: PMC8932260 DOI: 10.1136/bmjresp-2021-001137] [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: 11/01/2021] [Accepted: 02/27/2022] [Indexed: 11/04/2022] Open
Abstract
RATIONALE Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only. OBJECTIVES To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. METHODS Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). MEASUREMENTS AND MAIN RESULTS Of 14 029 children (median age 3 (IQR 1-3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3-63.2 hours) than children without escalation 6.7 hours, IQR 3.5-16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%). CONCLUSIONS Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. There is wide variation treatment escalation.
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Affiliation(s)
- Simon Craig
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia .,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Department of Emergency Medicine, Sidra Medicine, Ad-Dawhah, Doha, Qatar
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Jason Hort
- Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - David S Armstrong
- Respiratory and Sleep Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Sarath Ranganathan
- Respiratory Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Catherine Wilson
- Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Shane George
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Emergency Medicine and Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia.,Child Health Research Centre, Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - Natalie Phillips
- Child Health Research Centre, Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia.,Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Jeremy Furyk
- Emergency Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ben Lawton
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Emergency Department, Logan Hospital, Loganholme, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Nursing, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Jocelyn Neutze
- Kidz First Emergency Department, Middlemore Hospital, Auckland, New Zealand
| | - Anna Lithgow
- Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory of Australia, Australia
| | - Clare Mitchell
- Emergency Department, Royal Darwin Hospital, Tiwi, Northern Territory of Australia, Australia
| | - Nick Watkins
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Domhnall Brannigan
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Joanna Wood
- Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Charmaine Gray
- Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Hearps
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Emma Ramage
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.,Paediatric Intensive Care, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Amanda Williams
- Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jamie Lew
- Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Leonie Jones
- Emergency Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Andis Graudins
- Emergency Department, Dandenong Hospital, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, Auckland, New Zealand.,Departments of Surgery and Paediatrics, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Auckland, New Zealand
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
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10
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Noton T, Benshetrit G, Bradley A, Mitchell C. 341 Consenting Practices in Plastic Surgery. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Informed consent is a vital aspect of safe patient care within any surgical specialty, and if not completed thoroughly, may result in misinformation and patient dissatisfaction.
Traditional paper consent forms are notoriously poorly completed by medical professionals, with common issues ranging from ineligible handwriting, to missing key components of the form.
The aim of this audit was to assess our departments’ compliance with standard trust consent forms and compare adherence to local and national consenting policies.
Method
All elective and emergency plastic surgical procedures carried out over a one-week period from 17/05/2021 to 23/05/2021 were identified using eTrauma and Cerner operative records. In total, 40 procedures were identified. Consent forms were then reviewed and assessed for completion in key areas. 4 procedures were excluded due to the consent form not being available for review, and 1 procedure was excluded due to a cancellation.
Results
The risks and benefits of procedures were generally documented to a high standard. Providing written information to patients, confirmation of consent if the procedure was being performed on a different day, and possible additional procedures were poorly completed throughout. 90% of consent forms screened, failed to include confirmation of the surgical site within the specific section of the form.
Conclusions
Overall, the department demonstrated good compliance with completing trust consent forms. Electronic consent forms would likely address the shortcomings identified in this audit and should be adopted. Continued responsibility from the whole team should be highlighted and maintained to ensure a high standard of consenting.
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Affiliation(s)
- T. Noton
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - G. Benshetrit
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - A. Bradley
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - C. Mitchell
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
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11
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Lim K, Neal-Smith G, Mitchell C, Xerri J, Chuanromanee P. Perceptions of the use of artificial intelligence in the diagnosis of skin cancer: an outpatient survey. Clin Exp Dermatol 2021; 47:542-546. [PMID: 34610153 DOI: 10.1111/ced.14969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/04/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Convolutional neural networks (artificial intelligence, AI) are rapidly appearing within the field of dermatology, with diagnostic accuracy matching that of dermatologists. As technologies become available for use by both the health professionals and the general public, their uptake in healthcare will become more acceptable. National Health Service England recognizes the potential of AI for healthcare but emphasizes that patient-centred care should be at the forefront of these technological advancements. AIM To obtain opinions of patients on the use of AI in a dermatology setting, when aiding the diagnosis of skin cancers. METHODS A cross-sectional 14-point questionnaire was handed out to patients attending dermatology outpatient skin cancer clinics in two UK hospitals, between March and August 2018. RESULTS In total, 603 patient questionnaires were completed. Nearly half (47%; n = 282) of respondents were not concerned if AI technology was used by a skin specialist to aid skin cancer diagnosis. However, the majority (81%; n = 491) of respondents, considered it important for a dermatologist to examine and confirm a diagnosis and to be present for discussion of a cancer diagnosis. CONCLUSION Although the majority of respondents were not reluctant about the use of AI for skin cancer diagnosis, respondents still considered it important that dermatologists are involved in the diagnosis and/or confirmation of skin cancer. Furthermore, the study results demonstrate that personal interaction with a clinician is important. This is in keeping with proposals that AI be used as an adjunctive technology to increase accuracy of skin cancer diagnoses, but not as a substitute for a dermatologist.
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Affiliation(s)
- K Lim
- Department of Dermatology, Oxford University NHS Hospitals Trust, Oxford, UK
| | - G Neal-Smith
- Department of Dermatology, Oxford University NHS Hospitals Trust, Oxford, UK
| | - C Mitchell
- Department of Dermatology, St Mary's Hospital, Portsmouth NHS Hospital Trust, Portsmouth, UK
| | - J Xerri
- Department of Statistics, University of Oxford, Oxford, UK
| | - P Chuanromanee
- Department of Statistics, University of Oxford, Oxford, UK
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12
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Banerjee I, Edwards L, Halvey P, Alioto S, Cluckley D, Mitchell C, Cox C, Lurier E, Cianci M, Bengeri S, Borthakur S, Kis-Toth K, Higginson-Scott N, Viney J, Otipoby KL. AB0034 PD-1 AGONISM INHIBITS ACTIVATION OF PLASMACYTOID DENDRITIC CELLS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Background:T cell function is regulated by complex signaling networks of interconnected activators and inhibitors. Blockade of inhibitory receptors such as programmed death-1 (PD-1) has emerged as a novel treatment for multiple forms of cancer. One of the most common adverse events associated with blockade of the endogenous PD-1/PD-L1 pathway is the induction of autoimmune pathology in multiple tissues, demonstrating that PD-1 activation is necessary for normal immune homeostasis in humans (Kostine, et al., 2018). Given this body of clinical data, we sought to develop a PD-1 agonist antibody as a therapeutic approach to restore immune homeostasis in patients living with autoimmune diseases. PD-1 expression and function has been primarily described on T cells (Ishida, et al., 1992), with additional data available from several other immune cell populations (Ohaegbulam, et al., 2015).Objectives:To study the effect of PD-1 agonism on plasmacytoid dendritic cell (pDC) function.Methods:Human PBMCs stimulated with or without toll-like receptor (TLR)-9 agonist, CpG were analyzed by flow cytometry for PD-1 expression on immune cell subsets. To assess the impact of PD-1 agonist on pDC function human PBMCs were activated by CpG in the presence or absence of PD-1 agonist. Type-I interferon (IFN) levels were quantified using ELISA from culture supernatants. The expression of interferon stimulated genes was analyzed by qPCR as a measure of type-I IFN activation.Results:We have discovered that TLR9 activation can induce PD-1 expression on plasmacytoid dendritic cells, which has not been previously reported. Further, we have demonstrated that PD-1 agonism inhibits TLR9-mediated activation and the effector functions of plasmacytoid dendritic cells.Conclusion:These data suggest the potential of PD-1 as a target for regulating diseases with pathology generated by type-I IFN.References:[1]Ishida, Y., Agata, Y., Shihibahara, K., & Honjo, T. (1992). Induced expression of PD-1, a novel member of the immunoglobulin gene superfamily, upon programmed cell death. EMBO J., 11(11):3887-95.[2]Kostine, M., Rouxel, L., Barnetche, T., Veillon, R., Martin, F., Dutriaux, C., . . . Schaeverbeke, T. (2018). Rheumatic disorders associated with immune checkpoint inhibitors in patients with cancer-clinical aspects and relationship with tumour response: a single-centre prospective cohort study. Annual Rheumatic Disease, 77(3):393-398.[3]Ohaegbulam, K. C., Assal, A., Lazar-Molnar, E., Yao, Y., & Zang, X. (2015). Human cancer immunotherapy with antibodies to the PD-1 and PD-L1 pathway. Trends in Molecular Medicine, 21(1); 24-33.Disclosure of Interests:Ishita Banerjee Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Lindsay Edwards Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Patrick Halvey Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Salvatore Alioto Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, David Cluckley Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Caitlin Mitchell Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Christopher Cox Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Emily Lurier Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Michael Cianci Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Soumya Bengeri Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Susmita Borthakur Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Katalin Kis-Toth Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Nathan Higginson-Scott Shareholder of: Pandion Therapeutics, Consultant of: Biotech Companies, Employee of: Pandion Therapeutics, Jo Viney Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Kevin L. Otipoby Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics
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13
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Jacobs PJ, Oosthuizen MK, Mitchell C, Blount JD, Bennett NC. Oxidative stress in response to heat stress in wild caught Namaqua rock mice, Micaelamys namaquensis. J Therm Biol 2021; 98:102958. [PMID: 34016369 DOI: 10.1016/j.jtherbio.2021.102958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022]
Abstract
Modelling of anthropogenic induced climate suggests more frequent and severe heatwaves in the future, which are likely to result in the mass die-off of several species of organisms. Oxidative stress induced by severe heat stress has previously been associated with a reduction in animal cognitive performance, depressed reproduction and lower life expectancy. Little is known about the non-lethal consequences of species should they survive extreme heat exposure. We investigated the oxidative stress experienced by the Namaqua rock mouse, a nocturnal rodent, using two experimental heat stress protocols, a 6 hour acute heat stress protocol without access to water and a 3-day heatwave simulation with ad libitum water. Oxidative stress was determined in the liver, kidney and brain using malondialdehyde (MDA) and protein carbonyl (PC) as markers of oxidative damage, and superoxide dismutase (SOD) and total antioxidant capacity (TAC) as markers of antioxidant defence. Incubator heat stress (heat and dehydration stress) was brought about by increasing the body temperatures of animals to 39-40.8 °C for 6 hours. Following incubator heat stress, significantly higher levels of MDA were observed in the liver. Dehydration did not explain the variation in oxidative markers and is likely a combined effect of thermal and dehydration stress. Individual body mass was significantly negatively correlated to kidney SOD and lipid peroxidation. A heatwave was simulated using a temperature cycle that would naturally occur during a heatwave in the species' local habitat, with a maximal ambient temperature of 38 °C. Following the simulated heatwave, SOD activity of the kidney demonstrated significantly lowered activity suggesting oxidative stress. Current heat waves in this species have the potential of causing oxidative stress. Heat and dehydration stress following exacerbated temperatures are likely to incur significant oxidative stress in multiple tissues demonstrating the importance of water availability to allow for rehydration to prevent oxidative stress.
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Affiliation(s)
- Paul J Jacobs
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, Pretoria, 0002, South Africa.
| | - M K Oosthuizen
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, Pretoria, 0002, South Africa.
| | - C Mitchell
- Centre for Ecology and Conservation, College of Life & Environmental Sciences, University of Exeter, Penryn Campus, Penryn, Cornwall, TR10 9FE, UK.
| | - J D Blount
- Centre for Ecology and Conservation, College of Life & Environmental Sciences, University of Exeter, Penryn Campus, Penryn, Cornwall, TR10 9FE, UK.
| | - N C Bennett
- Mammal Research Institute, Department of Zoology and Entomology, University of Pretoria, Pretoria, 0002, South Africa.
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14
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Abstract
AIMS To assess the prevalence of carriage of Salmonella spp. in wild reptiles translocated from multiple locations to a single island, and determine changes in their body condition (BC) during quarantine. METHODS Between 2007 and 2009, six endemic reptile species (Oligosoma aeneum, O. moco, O. ornatum, O. smithi, Dactylocnemis pacificus, and Woodworthia maculata) were caught from several locations in the northern North Island of New Zealand. Reptiles were held in quarantine for 14-41 days while being tested for carriage of Salmonella spp. Morphometric data were collected, and scaled body mass index for each species was calculated to determine changes in BC during the quarantine. RESULTS Of 221 individuals tested 12 (5%) were positive for Salmonella spp. All 12 were shore skinks (O. smithi; n = 30), with a test prevalence of 0.4 (95% CI = 0.25-0.58). Eleven were carrying Salmonella enterica Warragul and one S. enterica Mississipi. There was no difference in BC at the start of quarantine of shore skinks between those that tested negative and those that tested positive for Salmonella spp. (p = 0.184). Reptiles that were quarantined for 15-20 days (three species) lost 3-5% of BC (mean proportional change 0.03-0.05), while those quarantined for >30 days increased BC by 3-13% (mean proportional change 0.03-0.13). All animals except the one individual positive for S. Mississippi were translocated to the recipient island, while the latter was returned to the source site. CONCLUSIONS AND CLINICAL RELEVANCE The prevalence of Salmonella spp. carriage in the translocated reptiles was low overall and consistent with other records of Salmonella spp. in wild New Zealand reptiles. However, the prevalence of 0.4 in shore skinks is the highest recorded in this species. In addition to time required for health-screening, we recommend that duration of quarantine should include time to allow animals to recover from captive stress and to provide an opportunity to increase their BC before release.
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Affiliation(s)
- M Baling
- School of Natural and Computational Sciences, Massey University (Albany Campus), Auckland, New Zealand
| | - C Mitchell
- Friends of Matakohe/Limestone Island Society, Whangarei, New Zealand
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15
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Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - C Mitchell
- Academic Unit of Primary Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - J Balen
- Public Health Section, School of Health and Related Research, University of Sheffield
| | - T C Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield
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16
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Jacobs PJ, Oosthuizen MK, Mitchell C, Blount JD, Bennett NC. Heat and dehydration induced oxidative damage and antioxidant defenses following incubator heat stress and a simulated heat wave in wild caught four-striped field mice Rhabdomys dilectus. PLoS One 2020; 15:e0242279. [PMID: 33186409 PMCID: PMC7665817 DOI: 10.1371/journal.pone.0242279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/29/2020] [Indexed: 01/22/2023] Open
Abstract
Heat waves are known for their disastrous mass die-off effects due to dehydration and cell damage, but little is known about the non-lethal consequences of surviving severe heat exposure. Severe heat exposure can cause oxidative stress which can have negative consequences on animal cognition, reproduction and life expectancy. We investigated the current oxidative stress experienced by a mesic mouse species, the four striped field mouse, Rhabdomys dilectus through a heat wave simulation with ad lib water and a more severe temperature exposure with minimal water. Wild four striped field mice were caught between 2017 and 2019. We predicted that wild four striped field mice in the heat wave simulation would show less susceptibility to oxidative stress as compared to a more severe heat stress which is likely to occur in the future. Oxidative stress was determined in the liver, kidney and brain using malondialdehyde (MDA) and protein carbonyl (PC) as markers for oxidative damage, and superoxide dismutase (SOD) and total antioxidant capacity (TAC) as markers of antioxidant defense. Incubator heat stress was brought about by increasing the body temperatures of animals to 39-40.8°C for 6 hours. A heat wave (one hot day, followed by a 3-day heatwave) was simulated by using temperature cycle that wild four striped field mice would experience in their local habitat (determined through weather station data using temperature and humidity), with maximal ambient temperature of 39°C. The liver and kidney demonstrated no changes in the simulated heat wave, but the liver had significantly higher SOD activity and the kidney had significantly higher lipid peroxidation in the incubator experiment. Dehydration significantly contributed to the increase of these markers, as is evident from the decrease in body mass after the experiment. The brain only showed significantly higher lipid peroxidation following the simulated heat wave with no significant changes following the incubator experiment. The significant increase in lipid peroxidation was not correlated to body mass after the experiment. The magnitude and duration of heat stress, in conjunction with dehydration, played a critical role in the oxidative stress experienced by each tissue, with the results demonstrating the importance of measuring multiple tissues to determine the physiological state of an animal. Current heat waves in this species have the potential of causing oxidative stress in the brain with future heat waves to possibly stress the kidney and liver depending on the hydration state of animals.
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Affiliation(s)
- Paul J. Jacobs
- Department of Zoology and Entomology, Mammal Research Institute, University of Pretoria, Pretoria, South Africa
| | - M. K. Oosthuizen
- Department of Zoology and Entomology, Mammal Research Institute, University of Pretoria, Pretoria, South Africa
| | - C. Mitchell
- Centre for Ecology and Conservation, College of Life & Environmental Sciences, University of Exeter, Penryn, Cornwall, United Kingdom
| | - Jonathan D. Blount
- Centre for Ecology and Conservation, College of Life & Environmental Sciences, University of Exeter, Penryn, Cornwall, United Kingdom
| | - Nigel C. Bennett
- Department of Zoology and Entomology, Mammal Research Institute, University of Pretoria, Pretoria, South Africa
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17
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McSweeney SM, Christou EAA, Dand N, Boalch A, Holmes S, Harries M, Palamaras I, Cunningham F, Parkins G, Kaur M, Farrant P, McDonagh A, Messenger A, Jones J, Jolliffe V, Ali I, Ardern-Jones M, Mitchell C, Burrows N, Atkar R, Banfield C, Alexandroff A, Champagne C, Cooper HL, Patel GK, Macbeth A, Page M, Bryden A, Mowbray M, Wahie S, Armstrong K, Cooke N, Goodfield M, Man I, de Berker D, Dunnil G, Takwale A, Rao A, Siah TW, Sinclair R, Wade MS, Bhargava K, Fenton DA, McGrath JA, Tziotzios C. Frontal fibrosing alopecia: a descriptive cross-sectional study of 711 cases in female patients from the UK. Br J Dermatol 2020; 183:1136-1138. [PMID: 32652611 DOI: 10.1111/bjd.19399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- S M McSweeney
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - E A A Christou
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - N Dand
- Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - A Boalch
- Greenwich and Lewisham NHS Foundation Trust, London, SE13 6LH, UK
| | - S Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | - F Cunningham
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | - G Parkins
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - K Bhargava
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - D A Fenton
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - J A McGrath
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - C Tziotzios
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
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18
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Clarke M, Mackay A, Ismer B, Pickles JC, Tatevossian RG, Newman S, Bale TA, Stoler I, Izquierdo E, Temelso S, Carvalho DM, Molinari V, Burford A, Howell L, Virasami A, Fairchild AR, Avery A, Chalker J, Kristiansen M, Haupfear K, Dalton JD, Orisme W, Wen J, Hubank M, Kurian KM, Rowe C, Maybury M, Crosier S, Knipstein J, Schüller U, Kordes U, Kram DE, Snuderl M, Bridges L, Martin AJ, Doey LJ, Al-Sarraj S, Chandler C, Zebian B, Cairns C, Natrajan R, Boult JKR, Robinson SP, Sill M, Dunkel IJ, Gilheeney SW, Rosenblum MK, Hughes D, Proszek PZ, Macdonald TJ, Preusser M, Haberler C, Slavc I, Packer R, Ng HK, Caspi S, Popović M, Faganel Kotnik B, Wood MD, Baird L, Davare MA, Solomon DA, Olsen TK, Brandal P, Farrell M, Cryan JB, Capra M, Karremann M, Schittenhelm J, Schuhmann MU, Ebinger M, Dinjens WNM, Kerl K, Hettmer S, Pietsch T, Andreiuolo F, Driever PH, Korshunov A, Hiddingh L, Worst BC, Sturm D, Zuckermann M, Witt O, Bloom T, Mitchell C, Miele E, Colafati GS, Diomedi-Camassei F, Bailey S, Moore AS, Hassall TEG, Lowis SP, Tsoli M, Cowley MJ, Ziegler DS, Karajannis MA, Aquilina K, Hargrave DR, Carceller F, Marshall LV, von Deimling A, Kramm CM, Pfister SM, Sahm F, Baker SJ, Mastronuzzi A, Carai A, Vinci M, Capper D, Popov S, Ellison DW, Jacques TS, Jones DTW, Jones C. Infant High-Grade Gliomas Comprise Multiple Subgroups Characterized by Novel Targetable Gene Fusions and Favorable Outcomes. Cancer Discov 2020; 10:942-963. [PMID: 32238360 PMCID: PMC8313225 DOI: 10.1158/2159-8290.cd-19-1030] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/03/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
Infant high-grade gliomas appear clinically distinct from their counterparts in older children, indicating that histopathologic grading may not accurately reflect the biology of these tumors. We have collected 241 cases under 4 years of age, and carried out histologic review, methylation profiling, and custom panel, genome, or exome sequencing. After excluding tumors representing other established entities or subgroups, we identified 130 cases to be part of an "intrinsic" spectrum of disease specific to the infant population. These included those with targetable MAPK alterations, and a large proportion of remaining cases harboring gene fusions targeting ALK (n = 31), NTRK1/2/3 (n = 21), ROS1 (n = 9), and MET (n = 4) as their driving alterations, with evidence of efficacy of targeted agents in the clinic. These data strongly support the concept that infant gliomas require a change in diagnostic practice and management. SIGNIFICANCE: Infant high-grade gliomas in the cerebral hemispheres comprise novel subgroups, with a prevalence of ALK, NTRK1/2/3, ROS1, or MET gene fusions. Kinase fusion-positive tumors have better outcome and respond to targeted therapy clinically. Other subgroups have poor outcome, with fusion-negative cases possibly representing an epigenetically driven pluripotent stem cell phenotype.See related commentary by Szulzewsky and Cimino, p. 904.This article is highlighted in the In This Issue feature, p. 890.
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Affiliation(s)
- Matthew Clarke
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Alan Mackay
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Britta Ismer
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Jessica C Pickles
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ruth G Tatevossian
- Department of Neuropathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Scott Newman
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tejus A Bale
- Department of Neuropathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Iris Stoler
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
| | - Elisa Izquierdo
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Sara Temelso
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Diana M Carvalho
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Valeria Molinari
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Anna Burford
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Louise Howell
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Alex Virasami
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Amy R Fairchild
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Aimee Avery
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jane Chalker
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mark Kristiansen
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kelly Haupfear
- Department of Neuropathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James D Dalton
- Department of Neuropathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wilda Orisme
- Department of Neuropathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ji Wen
- Department of Neuropathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael Hubank
- Molecular Diagnostics, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Kathreena M Kurian
- Brain Tumour Research Centre, University of Bristol, Bristol, United Kingdom
| | - Catherine Rowe
- Brain Tumour Research Centre, University of Bristol, Bristol, United Kingdom
| | - Mellissa Maybury
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Australia
- Oncology Service, Queensland Children's Hospital, Brisbane, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Stephen Crosier
- Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Jeffrey Knipstein
- Division of Pediatric Hematology/Oncology/BMT, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ulrich Schüller
- Department of Neuropathology, University Hospital Hamburg-Eppendorf, and Research Institute Children's Cancer Center, Hamburg, Germany
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Kordes
- Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - David E Kram
- Section of Pediatric Hematology-Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matija Snuderl
- Department of Neuropathology, NYU Langone Health, New York, New York
| | - Leslie Bridges
- Department of Neuropathology, St George's Hospital NHS Trust, London, United Kingdom
| | - Andrew J Martin
- Department of Neurosurgery, St George's Hospital NHS Trust, London, United Kingdom
| | - Lawrence J Doey
- Department of Clinical Neuropathology, Kings College Hospital NHS Trust, London, United Kingdom
| | - Safa Al-Sarraj
- Department of Clinical Neuropathology, Kings College Hospital NHS Trust, London, United Kingdom
| | - Christopher Chandler
- Department of Neurosurgery, Kings College Hospital NHS Trust, London, United Kingdom
| | - Bassel Zebian
- Department of Neurosurgery, Kings College Hospital NHS Trust, London, United Kingdom
| | - Claire Cairns
- Department of Neurosurgery, Kings College Hospital NHS Trust, London, United Kingdom
| | - Rachael Natrajan
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Jessica K R Boult
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Martin Sill
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephen W Gilheeney
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Marc K Rosenblum
- Department of Neuropathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Debbie Hughes
- Molecular Diagnostics, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Paula Z Proszek
- Molecular Diagnostics, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Tobey J Macdonald
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Matthias Preusser
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christine Haberler
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Roger Packer
- Center for Neuroscience and Behavioural Medicine, Children's National Medical Center, Washington, DC
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, China
| | - Shani Caspi
- Cancer Research Center, Sheba Medical Center, Tel Aviv, Israel
| | - Mara Popović
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Faganel Kotnik
- Department of Hematology and Oncology, University Children's Hospital, Ljubljana, Slovenia
| | - Matthew D Wood
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Lissa Baird
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Monika Ashok Davare
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, California
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, California
| | - Thale Kristin Olsen
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Michael Farrell
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Jane B Cryan
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | - Michael Capra
- Paediatric Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Michael Karremann
- Department of Pediatrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jens Schittenhelm
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Germany
| | | | - Martin Ebinger
- Department of Pediatric Hematology and Oncology, University Hospital Tübingen, Germany
| | - Winand N M Dinjens
- Department of Pathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Hospital Muenster, Germany
| | - Simone Hettmer
- Department of Pediatric Hematology and Oncology, University Hospital Freiburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Felipe Andreiuolo
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Pablo Hernáiz Driever
- Department of Paediatric Haematology/Oncology Charité Universitätsmedizin, Berlin, Germany
| | - Andrey Korshunov
- Department of Neuropathology, University Hospital Heidelberg, Germany
| | - Lotte Hiddingh
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara C Worst
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dominik Sturm
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Zuckermann
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Olaf Witt
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tabitha Bloom
- BRAIN UK, University of Southampton, Southampton, United Kingdom
| | - Clare Mitchell
- BRAIN UK, University of Southampton, Southampton, United Kingdom
| | - Evelina Miele
- Department of Onco-haematology, Cell and Gene Therapy, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | | | - Simon Bailey
- Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Andrew S Moore
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Australia
- Oncology Service, Queensland Children's Hospital, Brisbane, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Timothy E G Hassall
- Oncology Service, Queensland Children's Hospital, Brisbane, Australia
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Stephen P Lowis
- Brain Tumour Research Centre, University of Bristol, Bristol, United Kingdom
| | - Maria Tsoli
- Children's Cancer Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Mark J Cowley
- Children's Cancer Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - David S Ziegler
- Children's Cancer Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Matthias A Karajannis
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Darren R Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Fernando Carceller
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Children & Young People's Unit, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Lynley V Marshall
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Children & Young People's Unit, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Centre Göttingen, Germany
| | - Stefan M Pfister
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Department of Paediatric Haematology/Oncology Charité Universitätsmedizin, Berlin, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Suzanne J Baker
- Department of Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angela Mastronuzzi
- Neuro-oncology Unit, Department of Onco-haematology, Cell and Gene Therapy, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Andrea Carai
- Oncological Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Maria Vinci
- Department of Onco-haematology, Cell and Gene Therapy, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - David Capper
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sergey Popov
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
- Department of Pathology, University of Wales Hospital NHS Trust, Cardiff, United Kingdom
| | - David W Ellison
- Department of Neuropathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Thomas S Jacques
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - David T W Jones
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom.
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Mitchell C, Burke K, Halford N, Rothwell K, Darley S, Woodward-Nutt K, Bowen A, Patchwood E. Value and learning from carer involvement in a cluster randomised controlled trial and process evaluation - Organising Support for Carers of Stroke Survivors (OSCARSS). Res Involv Engagem 2020; 6:21. [PMID: 32419954 PMCID: PMC7210672 DOI: 10.1186/s40900-020-00193-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/14/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patient, Carer and Public Involvement (PCPI) should be embedded in health care research. Delivering PCPI can be challenging, but even when PCPI is carried out it is rarely reported resulting in lost opportunities for learning. This paper aims to describe PCPI in the OSCARSS study, a pragmatic-cluster randomised controlled trial with an embedded economic and process evaluation. METHODS A carer research user group (RUG) co-developed OSCARSS to evaluate how to best deliver support to caregivers of stroke survivors. The PCPI activity involved regular meetings and preparatory work, from the initial conceptualisation of the study through to dissemination. Written reports, structured group discussions and individual interviews were carried out with the RUG and researchers to capture the added value and learning. This paper was co-authored by two of the RUG members with contributions from the wider RUG and researchers. RESULTS The core six members of the caregiver RUG attended the majority of the meetings alongside three researchers, one of whom was the co-chief investigator. PCPI was instrumental in changing many aspects of the research protocol, design and delivery and contributed to dissemination and sharing of good practice. There were challenges due to the emotional toll when PCPI members shared their stories and the extensive time commitment. Positive experiences of learning and fulfilment were reported by the individual researchers and PCPI members. Wider organisational administrative and financial support facilitated the PCPI. The researchers' existing positive regard for PCPI and the clear focus of the group were key to the successful co-design of this research. CONCLUSIONS The value and learning from the PCPI collaborative work with the researchers was of benefit to the study and the individuals involved. Specific PCPI influences were a challenge to pinpoint as successful co-design meant the researchers' and carers' contributions were intertwined and decision-making shared.
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Affiliation(s)
- C. Mitchell
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K. Burke
- Patient and Carer Public Involvement (PCPI) contributors: lay members of the OSCARSS Carer Research User Group, Manchester, UK
| | - N. Halford
- Patient and Carer Public Involvement (PCPI) contributors: lay members of the OSCARSS Carer Research User Group, Manchester, UK
| | - K. Rothwell
- Stroke Association support services, Stroke Association, London, UK
| | - S. Darley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K. Woodward-Nutt
- Research & Innovation, Northern Care Alliance NHS Group, Salford, UK
| | - A. Bowen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - E. Patchwood
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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20
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Pickles JC, Fairchild AR, Stone TJ, Brownlee L, Merve A, Yasin SA, Avery A, Ahmed SW, Ogunbiyi O, Gonzalez Zapata J, Peary AF, Edwards M, Wilkhu L, Dryden C, Ladon D, Kristiansen M, Rowe C, Kurian KM, Nicoll JAR, Mitchell C, Bloom T, Hilton DA, Al-Sarraj S, Doey L, Johns PN, Bridges LR, Chakrabarty A, Ismail A, Rathi N, Syed K, Lammie GA, Limback-Stanic C, Smith C, Torgersen A, Rae F, Hill RM, Clifford SC, Grabovska Y, Williamson D, Clarke M, Jones C, Capper D, Sill M, von Deimling A, Pfister SM, Jones DTW, Hargrave D, Chalker J, Jacques TS. DNA methylation-based profiling for paediatric CNS tumour diagnosis and treatment: a population-based study. Lancet Child Adolesc Health 2020; 4:121-130. [PMID: 31786093 DOI: 10.1016/s2352-4642(19)30342-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Marked variation exists in the use of genomic data in tumour diagnosis, and optimal integration with conventional diagnostic technology remains uncertain despite several studies reporting improved diagnostic accuracy, selection for targeted treatments, and stratification for trials. Our aim was to assess the added value of molecular profiling in routine clinical practice and the impact on conventional and experimental treatments. METHODS This population-based study assessed the diagnostic and clinical use of DNA methylation-based profiling in childhood CNS tumours using two large national cohorts in the UK. In the diagnostic cohort-which included routinely diagnosed CNS tumours between Sept 1, 2016, and Sept 1, 2018-we assessed how the methylation profile altered or refined diagnosis in routine clinical practice and estimated how this would affect standard patient management. For the archival cohort of diagnostically difficult cases, we established how many cases could be solved using modern standard pathology, how many could only be solved using the methylation profile, and how many remained unsolvable. FINDINGS Of 484 patients younger than 20 years with CNS tumours, 306 had DNA methylation arrays requested by the neuropathologist and were included in the diagnostic cohort. Molecular profiling added a unique contribution to clinical diagnosis in 107 (35%; 95% CI 30-40) of 306 cases in routine diagnostic practice-providing additional molecular subtyping data in 99 cases, amended the final diagnosis in five cases, and making potentially significant predictions in three cases. We estimated that it could change conventional management in 11 (4%; 95% CI 2-6) of 306 patients. Among 195 historically difficult-to-diagnose tumours in the archival cohort, 99 (51%) could be diagnosed using standard methods, with the addition of methylation profiling solving a further 34 (17%) cases. The remaining 62 (32%) cases were unresolved despite specialist pathology and methylation profiling. INTERPRETATION Together, these data provide estimates of the impact that could be expected from routine implementation of genomic profiling into clinical practice, and indicate limitations where additional techniques will be required. We conclude that DNA methylation arrays are a useful diagnostic adjunct for childhood CNS tumours. FUNDING The Brain Tumour Charity, Children with Cancer UK, Great Ormond Street Hospital Children's Charity, Olivia Hodson Cancer Fund, Cancer Research UK, and the National Institute of Health Research.
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Affiliation(s)
- Jessica C Pickles
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Amy R Fairchild
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas J Stone
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorelle Brownlee
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ashirwad Merve
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Shireena A Yasin
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Aimee Avery
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Saira W Ahmed
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Olumide Ogunbiyi
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jamie Gonzalez Zapata
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Abigail F Peary
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marie Edwards
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lisa Wilkhu
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Carryl Dryden
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dariusz Ladon
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mark Kristiansen
- UCL Genomics, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catherine Rowe
- Department of Neuropathology, North Bristol NHS Trust, Bristol, UK
| | | | - James A R Nicoll
- Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; BRAIN UK, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Clare Mitchell
- BRAIN UK, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Tabitha Bloom
- BRAIN UK, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - David A Hilton
- Cellular and Anatomical Pathology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Safa Al-Sarraj
- Department of Clinical Neuropathology, Kings College Hospital NHS Trust, London, UK
| | - Lawrence Doey
- Department of Clinical Neuropathology, Kings College Hospital NHS Trust, London, UK
| | - Paul N Johns
- Department of Cellular Pathology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Aruna Chakrabarty
- St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Azzam Ismail
- St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nitika Rathi
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Khaja Syed
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Clara Limback-Stanic
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Colin Smith
- Western General Hospital, NHS Lothian, Edinburgh, UK
| | | | - Frances Rae
- Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Rebecca M Hill
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Yura Grabovska
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Williamson
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Clarke
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - David Capper
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany; German Cancer Consortium Partner Site Berlin, German Cancer Research Center, Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany; Department of Pediatric Oncology, Hematology, Immunology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany; Division of Pediatric Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Darren Hargrave
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane Chalker
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Steele L, Mitchell C, Sharma S, Keohane SG. Primary scalp dermatofibrosarcoma protuberans with periosteal involvement. Clin Exp Dermatol 2020; 45:661-663. [PMID: 31960488 DOI: 10.1111/ced.14166] [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] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- L Steele
- Department of Dermatology, St Mary's Hospital, Portsmouth, UK
| | - C Mitchell
- Department of Dermatology, St Mary's Hospital, Portsmouth, UK
| | - S Sharma
- Department of Oral and Maxillofacial surgery, University Hospital Southampton, Southampton, UK
| | - S G Keohane
- Department of Dermatology, St Mary's Hospital, Portsmouth, UK
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22
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McGrath M, Eramo M, Gurung R, Sriratana A, Feeney S, Gehrig S, Lynch G, Lazarou M, McLean C, Mitchell C. O.36Defective lysosome homeostasis during autophagy causes skeletal muscle disease. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.319] [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: 10/25/2022]
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23
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Bond A, Teubner A, Taylor M, Willbraham L, Gillespie L, Farrer K, McMahon M, Leahy G, Abraham A, Soop M, Clamp AR, Hasan J, Mitchell C, Jayson GC, Lal S. A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition. J Hum Nutr Diet 2019; 32:492-500. [PMID: 31006921 DOI: 10.1111/jhn.12650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of home parenteral nutrition (HPN) for palliative indications is increasing internationally and is the leading indication in some countries. Discharge on HPN can be complex in metabolically unstable patients and requires intestinal failure expertise. METHODS Between 2012 and 2018, we performed a retrospective analysis aiming to assess the impact of a novel remote discharge pathway for palliative HPN patients. This was evaluated using a quality improvement approach. RESULTS One hundred and twenty-five patients with active malignancy [mean (range) age 58 (25-80) years] were referred to the intestinal failure unit (IFU) for remote discharge. Of 82 patients were discharged from the oncology Centre on HPN using the pathway. The remaining 43 patients either declined HPN or the Oncology team felt that the patient became too unwell for HPN or died prior to discharge. There was an increase in patients referred for remote discharge from 13 in 2012 to 43 in 2017. The mean number of days between receipt of referral by the IFU to discharge on HPN from the oncology centre reduced from 29.4 days to 10.1 days. Following remote discharge, the mean number of days on HPN was 215.9 days. Catheter-related blood stream infection rates in this cohort were very low at 0.169 per 1000 catheter days. CONCLUSIONS This is the first study to demonstrate the remote safe, effective and rapid discharge of patients requiring palliative HPN between two hospital sites. This allows patients with a short prognosis more time in their desired location.
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Affiliation(s)
- A Bond
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - A Teubner
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - M Taylor
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - L Willbraham
- The Christie NHS Foundation Trust, Manchester, UK
| | - L Gillespie
- The Christie NHS Foundation Trust, Manchester, UK
| | - K Farrer
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - M McMahon
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - G Leahy
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - A Abraham
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - M Soop
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - A R Clamp
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Hasan
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Mitchell
- The Christie NHS Foundation Trust, Manchester, UK
| | - G C Jayson
- The Christie NHS Foundation Trust, Manchester, UK.,The University of Manchester, Manchester, UK
| | - S Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK.,The University of Manchester, Manchester, UK
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24
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Sannibale F, Filippetto D, Qian H, Mitchell C, Zhou F, Vecchione T, Li RK, Gierman S, Schmerge J. High-brightness beam tests of the very high frequency gun at the Advanced Photo-injector EXperiment test facility at the Lawrence Berkeley National Laboratory. Rev Sci Instrum 2019; 90:033304. [PMID: 30927765 DOI: 10.1063/1.5088521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
The very-high-frequency gun (VHF-Gun) is a new concept photo-injector developed and built at the Lawrence Berkeley National Laboratory (LBNL) for generating high-brightness electron beams capable of driving X-ray free electron lasers (FELs) at MHz-class repetition rates. The gun that purposely uses established and mature radiofrequency and mechanical technologies has demonstrated over the last many years the capability of reliably operating in continuous wave mode at the design accelerating fields and required vacuum and mechanical performance. The results of VHF-Gun technology demonstration were reported elsewhere [Sannibale et al., Phys. Rev. Spec. Top.-Accel. Beams 15, 103501 (2012)]; here in this paper, we provide and analyze examples of the experimental results of the first high-brightness beam tests performed at the Advanced Photo-injector EXperiment test facility at LBNL that demonstrated the gun capability of delivering the beam quality required for driving high repetition rate X-ray FELs.
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Affiliation(s)
- F Sannibale
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720, USA
| | - D Filippetto
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720, USA
| | - H Qian
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720, USA
| | - C Mitchell
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720, USA
| | - F Zhou
- SLAC, Menlo Park, California 94025, USA
| | | | - R K Li
- SLAC, Menlo Park, California 94025, USA
| | - S Gierman
- SLAC, Menlo Park, California 94025, USA
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Bullock B, Donovan P, Mitchell C, Whitty JA, Coombes I. The impact of a pharmacist on post-take ward round prescribing and medication appropriateness. Int J Clin Pharm 2019; 41:65-73. [PMID: 30610543 PMCID: PMC6394496 DOI: 10.1007/s11096-018-0775-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/18/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
Background Medication communication and prescribing on the post-take ward round following patient admission to hospital can be suboptimal leading to worse patient outcomes. Objective To evaluate the impact of clinical pharmacist participation on the post-take ward round on the appropriateness of medication prescribing, medication communication, and overall patient health care outcomes. Setting Tertiary referral teaching hospital, Brisbane, Australia. Method A pre-post intervention study was undertaken that compared the addition of a senior clinical pharmacist attending the post-take ward was compared to usual wardbase pharmacist service, with no pharmacist present of the post-take ward round. We assessed the proportion of patients with an improvement in medication appropriateness from admission to discharge, using the START/STOPP checklists. Medication communication was assessed by the mean number of brief and in-depth discussions, with health care outcomes measured by comparing length of stay and 28-day readmission rates. Main outcome measures: Medication appropriateness according to the START/STOPP list, number and type of discussions with team members and length of stay and readmission rate. Results Two hundred and sixty patients were recruited (130 pre- and 130-post-intervention), across 23 and 20 post-take ward rounds, respectively. Post-intervention, there was increase in the proportion of patients who had an improvement medication appropriateness (pre-intervention 25.4%, post-intervention 36.9%; p = 0.004), the number of in-depth discussions about patients’ medication (1.9 ± 1.7 per patient pre-intervention, 2.7 ± 1.7 per patient post-, p < 0.001), and the number relating to high-risk medications (0.71 ± 1.1 per patient pre-intervention, to 1.2 ± 1.2 per patient post-, p < 0.05). Length of stay and 28-day mortality were unchanged. Conclusion Clinical pharmacist participation on the post-take ward round leads to improved medication-related communication and improved medication appropriateness but did not significantly improve health care outcomes.
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Affiliation(s)
- B Bullock
- Pharmacy Department, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, QLD, 4029, Australia. .,School of Pharmacy, University of Queensland, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia. .,Medical Education Unit, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
| | - P Donovan
- School of Medicine, University of Queensland, Level 5, Building 69, St Lucia, QLD, 4072, Australia.,Department Clinical Pharmacology, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, QLD, 4029, Australia
| | - C Mitchell
- School of Medicine, University of Queensland, Level 5, Building 69, St Lucia, QLD, 4072, Australia
| | - J A Whitty
- School of Pharmacy, University of Queensland, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia.,Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - I Coombes
- Pharmacy Department, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, QLD, 4029, Australia.,School of Pharmacy, University of Queensland, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
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Choksi N, Hayward M, Kwon D, Marrazzo J, Mitchell C. Genetic variation of lactobacilllus crispatus strains isolated from a woman during and after bacterial vaginosis. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.061] [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: 10/27/2022]
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Sudhof L, Bergerat-Thompson A, McIver L, Briggs D, Wilkinson J, Andrews E, Ananthakrishnan A, Huttenhower C, Xavier R, Mitchell C. The vaginal microbiota is altered in women with inflammatory bowel disease. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oshi DC, Ricketts-Roomes T, Oshi SN, Mitchell C, Agu CF, Belinfante A, Mitchell G, Whitehorne-Smith P, Harrison J, Atkinson U, Abel WD. Gender differences in the factors associated with early age of initiation of cannabis use in Jamaica. Journal of Substance Use 2018. [DOI: 10.1080/14659891.2018.1531946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D. C. Oshi
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - T. Ricketts-Roomes
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - S. N. Oshi
- Department of General Studies and Behavioural Sciences, University of the Commonwealth Caribbean, Kingston, Jamaica
| | - C. Mitchell
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - C. F. Agu
- School of Nursing, The University of the West Indies, Kingston, Jamaica
| | - A. Belinfante
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - G. Mitchell
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - P. Whitehorne-Smith
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - Joy Harrison
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - U. Atkinson
- National Council on Drug Abuse, Kingston, Jamaica
| | - W. D. Abel
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
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Edwards RM, Currigan DA, Bradbeer S, Mitchell C. Does A Catheter over Needle System Reduce Infusate Leak in Continuous Peripheral Nerve Blockade: A Randomised Controlled Trial. Anaesth Intensive Care 2018; 46:468-473. [DOI: 10.1177/0310057x1804600507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuous peripheral nerve blockade is a common technique in the analgesic management for many procedures. Leakage of local anaesthetic from around the nerve catheter insertion site can increase the chance of catheter dislodgement, risks infective complications, and could divert anaesthetic away from the nerve causing the block to fail. We conducted a randomised controlled trial to assess whether the type of nerve catheter influenced local anaesthetic leak rate. One hundred and ten patients scheduled for elective unilateral total knee arthroplasty were randomised to receive a perineural catheter with either a catheter over needle (CON) system (Pajunk® E-Cath) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany), or catheter through needle (CTN) system (Pajunk® SonoLong) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany). There was no statistically significant difference in the rate of leaking catheters between groups (CON 1.8% versus CTN 3.7%; P=0.618), however, the overall leak rate was much lower than anticipated from pilot data. The CON system was on average faster to insert (CON 357 seconds versus CTN 482 seconds; P=0.004), but associated with poorer needle visibility under ultrasound (Likert scale 1–5, mean [SD], CON 3.31 [0.96] versus CTN 3.89 [0.84]; P=0.001). All seven instances of inadvertent catheter dislodgement occurred in the CTN group (P=0.006). There was no statistically significant difference between groups in the proportion of patients who had adequate analgesia on day one (CON 80% versus CTN 86.5%; P=0.294) and day two postoperatively (CON 85.5% versus CTN 91.8%; P=0.369). Our findings show the overall leak rate to be very low with both catheter systems; however, the CON system may have advantages in terms of speed of use and rate of inadvertent catheter dislodgement.
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Affiliation(s)
- R. M. Edwards
- Department of Anaesthesia, Royal United Hospital, Bath, United Kingdom
| | - D. A. Currigan
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - S. Bradbeer
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - C. Mitchell
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
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Bombil I, Louw L, Mitchell C, Mahlobo F, Muganza RA, Madima NR. Sonar guided focused parathyroidectomy under cervical block. S AFR J SURG 2018; 56:30-33. [PMID: 30010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Presentation of hyperparathyroidism varies and is highly non-specific. The automated calcium analyzer has made the diagnosis easy. Similarly, the advent of Sestamibi scan has paved the way to minimally invasive parathyroidectomy indicated for parathyroid adenoma. There is no uniformity in the extent of minimally invasive parathyroidectomy that is done through limited incision under radio or sonar guidance and endoscopically. In this study, we are presenting the focused parathyroidectomy performed under sonar guidance and superficial cervical block (SCB). The prerequisite is concordant preoperative Sestamibi and ultrasound imaging. METHOD A two-year review of parathyroidectomies performed between January 2013 and December 2014. OBJECTIVE To reflect on the result of sonar-guided focused parathyroidectomy under SCB. RESULTS There was good correlation between the pre-operative imaging, the intra-operative findings and the postoperative histology result of the 15 cases analysed. CONCLUSION The focused parathyroidectomy under SCB yielded a good result with concordant preoperative Sestamibi and ultrasound findings.
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Affiliation(s)
- I Bombil
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - L Louw
- Department of Nuclear Medicine, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - C Mitchell
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - F Mahlobo
- Department of Radiology, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - R A Muganza
- Department of Surgery, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
| | - N R Madima
- Department of Anesthesiology, Chris Hani Baragwanath Academic Hospital and the Faculty of Health sciences. University of the Witwatersrand, Johannesburg, South Africa
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Jenkin B, Mitchell C. CHROMOSOMAL MICROARRAY TESTING IN A DEVELOPMENTAL PAEDIATRICS SETTING. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Current guidelines recommend chromosomal microarray (CMA) testing as a first line etiologic investigation for developmental disorders such as intellectual disability or autism spectrum disorder (ASD). How often a copy number variation (CNV) is found, a definitive etiologic diagnosis is made and a change in clinical management occurs has not been well studied in a community setting.
OBJECTIVES
The study objective was to examine the real world use of CMA testing in a developmental paediatric setting: the prevalence of positive results and management decisions.
DESIGN/METHODS
This was a retrospective, descriptive study. The charts of 170 children seen by a single developmental paediatrician in a small city over a 7 year period (2010 - 2017) were reviewed. Referrals were received from both urban and rural communities. Information regarding reason for referral, clinical diagnosis, requests for CMA testing, test results and subsequent management decisions were extracted. The patient age ranged from 1 to 18 years (average 5.1 years). Children were referred for a wide variety of developmental and behavioural problems. Developmental delay, disruptive behavior, possible autism spectrum disorder or speech delay were the most common reasons for referral. Children were considered for CMA testing according to published guidelines. The most common clinical diagnoses in referred children were attention deficit hyperactivity disorder (ADHD), ASD and global developmental delay (GDD). Clinical management decisons were obtained from the medical chart and included follow-up visits.
RESULTS
CMA testing was recommended for 78 children, of which 65 had CMA testing completed (83%). Of these, 15 (23%) had an abnormal result and 6 (9%) were deemed pathogenic. The most common finding was a CNV at 2p16.3 in 2 children (3%). Of the children with pathogenic CNVs, 3 (50%) had more than one CNV. One child had a previously diagnosed trisomy X. One child with normal CMA had further testing, and a genetic diagnosis of atypical Rett Syndrome was made. The primary management decisions based on the CMA test results included parent education, genetic counselling and prognosis clarification.
CONCLUSION
In a developmental paediatrics setting, the use of CMA testing for first-line etiologic assessment in children with developmental disorders obtains positive results in close to 10% of tested children. This is similar to previously published results. Approximately 1/6 tested children had results of uncertain significance which require further study over time.
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Affiliation(s)
| | - Clare Mitchell
- Schulich School of Medicine and Dentistry, Western University
- Child and Parent Resource Institute
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Hoolohan C, Larkin A, McLachlan C, Falconer R, Soutar I, Suckling J, Varga L, Haltas I, Druckman A, Lumbroso D, Scott M, Gilmour D, Ledbetter R, McGrane S, Mitchell C, Yu D. Engaging stakeholders in research to address water-energy-food (WEF) nexus challenges. Sustain Sci 2018; 13:1415-1426. [PMID: 30220918 PMCID: PMC6132404 DOI: 10.1007/s11625-018-0552-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
The water-energy-food (WEF) nexus has become a popular, and potentially powerful, frame through which to analyse interactions and interdependencies between these three systems. Though the case for transdisciplinary research in this space has been made, the extent of stakeholder engagement in research remains limited with stakeholders most commonly incorporated in research as end-users. Yet, stakeholders interact with nexus issues in a variety of ways, consequently there is much that collaboration might offer to develop nexus research and enhance its application. This paper outlines four aspects of nexus research and considers the value and potential challenges for transdisciplinary research in each. We focus on assessing and visualising nexus systems; understanding governance and capacity building; the importance of scale; and the implications of future change. The paper then proceeds to describe a novel mixed-method study that deeply integrates stakeholder knowledge with insights from multiple disciplines. We argue that mixed-method research designs-in this case orientated around a number of cases studies-are best suited to understanding and addressing real-world nexus challenges, with their inevitable complex, non-linear system characteristics. Moreover, integrating multiple forms of knowledge in the manner described in this paper enables research to assess the potential for, and processes of, scaling-up innovations in the nexus space, to contribute insights to policy and decision making.
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Affiliation(s)
- C. Hoolohan
- Tyndall Centre for Climate Change Research, University of Manchester, Manchester, UK
| | - A. Larkin
- Tyndall Centre for Climate Change Research, University of Manchester, Manchester, UK
| | - C. McLachlan
- Tyndall Centre for Climate Change Research, University of Manchester, Manchester, UK
| | | | | | | | - L. Varga
- Cranfield University, Cranfield, UK
| | | | | | | | - M. Scott
- University of Glasgow, Glasgow, UK
| | - D. Gilmour
- University of Abertay Dundee, Dundee, UK
| | | | | | | | - D. Yu
- Loughborough University, Loughborough, UK
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Zeldow B, Kim S, McSherry G, Cotton MF, Jean-Philippe P, Violari A, Bobat R, Nachman S, Mofenson LM, Madhi SA, Mitchell C. Use of antiretrovirals in HIV-infected children in a tuberculosis prevention trial: IMPAACT P1041. Int J Tuberc Lung Dis 2018; 21:38-45. [PMID: 28157463 DOI: 10.5588/ijtld.16.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
SETTING International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1041, a tuberculosis (TB) prevention trial conducted among children enrolled from 2004 to 2008 during South Africa's roll-out of combination antiretroviral therapy (ART). OBJECTIVE To estimate TB incidence and mortality and the effect of ART. DESIGN Children were pre-screened to exclude TB disease and exposure, actively screened 3-monthly for TB exposure and symptoms, and provided post-exposure isoniazid prophylaxis therapy (IPT). TB diagnoses were definite, probable, or possible, and mortality all-cause. Testing was at the 5% significance level. RESULTS In 539 children (aged 3-4 months) followed up for a median of 74 weeks (interquartile range [IQR] 48-116), incidence/100 person-years (py) was 10.67 (95%CI 8.47-13.26) for any TB and 2.89 (95%CI 1.85-4.31) for definite/probable TB. Any TB incidence was respectively 9.39, 13.59, and 9.83/100 py before, <180 days after, and 180 days after ART initiation. Adjusted analysis showed a non-significant increase in any TB (HR 1.32, 95%CI 0.71-2.52, P = 0.38) and a significant reduction in mortality (HR 0.39, 95%CI 0.17-0.82, P = 0.017) following ART initiation. CONCLUSIONS ART reduced mortality but not TB incidence in human immunodeficiency virus (HIV) infected children in IMPAACT P1041, possibly attributable to active screening for TB exposure and symptoms with post-exposure IPT. Research into this as a strategy for TB prevention in high HIV-TB burden settings may be warranted.
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Affiliation(s)
- B Zeldow
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA
| | - S Kim
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Biostatistics, Rutgers School of Public Health, Newark, New Jersey, USA
| | - G McSherry
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - M F Cotton
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - P Jean-Philippe
- Henry Jackson Foundation-National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - A Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - R Bobat
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - S Nachman
- State University of New York at Stony Brook, Stony Brook, New York, USA
| | - L M Mofenson
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA; Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, USA
| | - S A Madhi
- Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand, Johannesburg, South Africa
| | - C Mitchell
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Bombil I, Louw L, Mitchell C, Mahlobo F, Muganza RA, Madima NR. Sonar guided focused parathyroidectomy under cervical block. S AFR J SURG 2018. [DOI: 10.17159/2078-5151/2018/v56n2a2511] [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: 11/05/2022]
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Ona S, James K, Ananthakrishnan A, Long M, Martin C, Chen W, Mitchell C. Prevalence of vulvovaginal discomfort in a cohort of women with inflammatory bowel disease. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2017.08.038] [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: 10/18/2022]
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Eiser C, Stride CB, Vora A, Goulden N, Mitchell C, Buck G, Adams M, Jenney MEM. Prospective evaluation of quality of life in children treated in UKALL 2003 for acute lymphoblastic leukaemia: A cohort study. Pediatr Blood Cancer 2017; 64. [PMID: 28475268 DOI: 10.1002/pbc.26615] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) from diagnosis until end of treatment for children with acute lymphoblastic leukaemia was investigated, examining effects of age, gender, risk-stratified treatment regimen, and therapy intensity (one vs. two 'delayed intensifications' [DIs]). METHOD In a multi-centre prospective study, parents reported their child's generic and disease-specific HRQoL and their own care-giving burden at five time points. From 1,428 eligible patients, 874 parents completed questionnaires at least once during treatment. RESULTS At each time point, generic HRQoL was significantly lower than equivalent norm scores for healthy children. HRQoL decreased significantly at the start of treatment, before recovering gradually (but remained below pre-treatment levels). Parents reported that older children worried more about side effects and their appearance, but showed less procedural anxiety than younger children. Concern for appearance was greater among girls than boys. Compared to Regimen B (i.e. additional doxorubicin during induction and additional cyclophosphamide and cytarabine during consolidation chemotherapy), patients receiving Regimen A had fewer problems with pain and nausea. There were no statistically significant differences in HRQoL by number of DI blocks received. INTERPRETATION HRQoL is compromised at all stages of treatment, and is partly dependent on age. The findings increase understanding of the impact of therapy on children's HRQoL and parental care-giving burden, and will contribute to the design of future trials.
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Affiliation(s)
- C Eiser
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - C B Stride
- Department of statistics, Management School, Conduit Road, University of Sheffield, Sheffield, United Kingdom
| | - A Vora
- Department of Paediatric Haematology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom
| | - N Goulden
- Department of paediatric haematology, Great Ormond Street Hospital, London, United Kingdom
| | - C Mitchell
- Department of Paediatric Haematology/Oncology, John Radcliffe Hospital, Oxford, United Kingdom
| | - G Buck
- Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom
| | - M Adams
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | - M E M Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
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Blick C, Vinograd A, Mitchell C, Shin S, Chen A. 335 Procedural Competency in Ultrasound-Guided Peripheral Intravenous Catheter Insertion in a Pediatric Emergency Department. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chow S, Leach R, Mitchell C. Non-elective admissions in cancer care - A review of acute oncology services (AOS) implementation in a north-west region of England. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx375.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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FitzGerald W, Crowe B, Brennan P, Cassidy JP, Leahy M, McElroy MC, Casey M, Waller A, Mitchell C. Acute fatal haemorrhagic pneumonia caused by Streptococcus equi zooepidemicus in greyhounds in Ireland with subsequent typing of the isolates. Vet Rec 2017; 181:119. [PMID: 28600445 DOI: 10.1136/vr.104275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/03/2022]
Affiliation(s)
- W FitzGerald
- Limerick Regional Veterinary Laboratory, Knockalisheen, Limerick, Ireland
| | - B Crowe
- Limerick Regional Veterinary Laboratory, Knockalisheen, Limerick, Ireland
| | - P Brennan
- Limerick Regional Veterinary Laboratory, Knockalisheen, Limerick, Ireland
| | - J P Cassidy
- Department of Veterinary Pathobiology, School of Veterinary Medicine, Belfield, Dublin 4, Ireland
| | - M Leahy
- Arra Veterinary Clinic, Tipperary, Co Tipperary, Ireland
| | - M C McElroy
- Central Veterinary Research Laboratory, Backweston, Celbridge, Co. Kildare, Ireland
| | - M Casey
- Central Veterinary Research Laboratory, Backweston, Celbridge, Co. Kildare, Ireland
| | - A Waller
- Department of Bacteriology, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK
| | - C Mitchell
- Department of Bacteriology, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK
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Cutler JA, Tahir R, Sreenivasamurthy SK, Mitchell C, Renuse S, Nirujogi RS, Patil AH, Heydarian M, Wong X, Wu X, Huang TC, Kim MS, Reddy KL, Pandey A. Differential signaling through p190 and p210 BCR-ABL fusion proteins revealed by interactome and phosphoproteome analysis. Leukemia 2017; 31:1513-1524. [DOI: 10.1038/leu.2017.61] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 12/15/2022]
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Beavers KN, Mitchell C. Uncommon castration complication: Penile amputation and sheath ablation following an iatrogenic phallectomy. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K. N. Beavers
- School of Veterinary Medicine; Louisiana State University; Baton Rouge USA
| | - C. Mitchell
- School of Veterinary Medicine; Louisiana State University; Baton Rouge USA
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Laubscher M, Mitchell C, Timms A, Goodier D, Calder P. Intramedullary femoral lengthening with an 'unstable' hip without prior stabilisation: preliminary results of a case series. SA orthop j 2017. [DOI: 10.17159/2309-8309/2017/v16n4a7] [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: 11/05/2022] Open
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Mitchell C, Srinivasan S, Zhan X, Wu M, Reed S, Guthrie K, LaCroix A, Fiedler T, Munch M, Liu C, Hoffman N, Blair I, Newton K, Freeman E, Joffe H, Cohen L, Fredricks D. 1: Associations between serum estrogen, vaginal microbiota and vaginal glycogen in postmenopausal women. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Khoja L, Horsley L, Heesters A, Machin JD, Mitchell C, Clamp AR, Jayson GC, Hasan J. Does clinical trial participation improve outcomes in patients with ovarian cancer? ESMO Open 2016; 1:e000057. [PMID: 27843621 PMCID: PMC5070238 DOI: 10.1136/esmoopen-2016-000057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/29/2016] [Accepted: 04/08/2016] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Treatment on a clinical trial is considered to be beneficial to oncology patients. However, supportive evidence for this is scarce. Trial effect describes the phenomenon of improved health outcomes in patients treated with standard of care (SOC) on trial compared to those receiving SOC outside of a clinical trial. We evaluated trial effect in patients with ovarian cancer treated at our tertiary cancer centre. METHODS We performed a retrospective cohort study of patients with ovarian cancer treated at The Christie National Health Service Foundation Trust. Patients treated on one of three first-line clinical trials: (SCOTROC-4, ICON-5, ICON-7) were matched (for age, International Federation of Gynaecology and Obstetrics stage, surgical status and performance status) with individuals receiving the same SOC off trial. Survival was calculated using Kaplan-Meier methodology. RESULTS 60 patients were evaluated; 30 on trial and 30 on SOC off trial. The median progression-free survival (PFS) was 21.8 months (control group) and 25.9 months (trial group), median overall survival (OS) was 64.3 months (control group) and 68.9 months (trial group). There was no difference in PFS (log-rank test: HR 0.87 (95% CI 0.48 to 1.54), p=0.6) or OS (log-rank test: HR 0.87 (95% CI 0.46 to 1.64), p=0.7) between groups. CONCLUSIONS Patient survival was similar regardless if treated on trial or as SOC. Our findings do not support trial effect, at least in a tertiary cancer centre. Clinical trial participation in specialised cancer centres promotes best practice to the benefit of all patients. These findings may impact discussions round consent of patients to trials and organisation of oncology services.
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Affiliation(s)
- L Khoja
- The Christie NHS Foundation Trust , Manchester , UK
| | - L Horsley
- The Christie NHS Foundation Trust , Manchester , UK
| | - A Heesters
- University Health Network 550 University Avenue , Toronto, Ontario , Canada
| | - J D Machin
- The Christie NHS Foundation Trust , Manchester , UK
| | - C Mitchell
- The Christie NHS Foundation Trust , Manchester , UK
| | - A R Clamp
- The Christie NHS Foundation Trust , Manchester , UK
| | - G C Jayson
- The Christie NHS Foundation Trust , Manchester , UK
| | - J Hasan
- The Christie NHS Foundation Trust , Manchester , UK
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Abstract
Aims Patients undergoing femoral lengthening by external fixation tolerate treatment less well when compared to tibial lengthening. Lengthening of the femur with an intramedullary device may have advantages. Patients and Methods We reviewed all cases of simple femoral lengthening performed at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities, congenital limb deficiencies and lengthening with an unstable hip were excluded, leaving 33 cases (in 22 patients; 11 patients had bilateral procedures) for review. Healing index, implant tolerance and complications were compared. Results In 20 cases (15 patients) the Precice lengthening nail was used and in 13 cases (seven patients) the LRS external fixator system. The desired length was achieved in all cases in the Precice group and in 12 of 13 cases in the LRS group. The mean healing index was 31.3 days/cm in the Precice and 47.1 days/cm in the LRS group (p < 0.001). This was associated with an earlier ability to bear full weight without aids in the Precice group. There were more complications with LRS lengthening, including pin site infections and regenerate deformity. Implant tolerance and the patients’ perception of the cosmetic result were better with the Precice treatment. Conclusion Femoral lengthening with the Precice femoral nail achieved excellent functional results with fewer complications and greater patient satisfaction when compared with the LRS system in our patients. Cite this article: Bone Joint J 2016;98-B:1382–8.
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Affiliation(s)
- M. Laubscher
- H49 OMB Groote Schuur Hospital, University
of Cape Town, Cape Town, 7925, South Africa
| | - C. Mitchell
- The Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - A. Timms
- The Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - D. Goodier
- The Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - P. Calder
- The Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7 4LP, UK
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Hansen W, Mitchell C, Ayutyanont N, Bremer Z, Bhattarai B, Stowell J. 360 Perception of Point-of-Care Ultrasound Performed by Emergency Physicians. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.377] [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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Beneri CA, Aaron L, Kim S, Jean-Philippe P, Madhi S, Violari A, Cotton MF, Mitchell C, Nachman S. Understanding NIH clinical case definitions for pediatric intrathoracic TB by applying them to a clinical trial. Int J Tuberc Lung Dis 2016; 20:93-100. [PMID: 26688534 DOI: 10.5588/ijtld.14.0848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Standardized clinical case definitions represent the best option for pediatric tuberculosis (TB) disease diagnosis and classification. OBJECTIVE To apply published guidelines for intrathoracic TB classification for use in reporting diagnostic studies with passive case finding to presumed TB patients from International Maternal Pediatric Adolescent AIDS Clinical Trials P1041, a trial of isoniazid prophylaxis in healthy human immunodeficiency virus exposed, bacille Calmette-Guérin vaccinated infants which employed active surveillance to assess a novel application of these guidelines in this setting. METHODS P1041 presumed TB patients were retrospectively cross-classified by protocol-defined and National Institutes of Health (NIH) classifications, and agreement was assessed. RESULTS Of 219 TB suspects, 166 had signs/symptoms, with 158 considered TB (21 confirmed, 92 probable, 45 possible) and 8 not TB (6 TB unlikely, 2 alternative diagnoses). Weight loss and failure to thrive represented the majority of the observed signs/symptoms. Among those with signs/symptoms, agreement between definitions was poor. Furthermore, 53 TB presumptives were without signs/symptoms, including 33 classified by the P1041 protocol as TB. CONCLUSION Poor agreement between P1041 and NIH classifications reflects cases identified through active vs. passive surveillance, the latter reflecting the intended use of NIH definitions. Given the interest in standardized definitions for broader application, future efforts could focus on expanding TB disease classification to presumed TB patients identified through active surveillance.
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Affiliation(s)
- C A Beneri
- Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, New York, New York, USA
| | - L Aaron
- Harvard School of Public Heath, Boston, Massachusetts, USA
| | - S Kim
- Rutgers New Jersey Medical School, The State University of New Jersey, Newark, New Jersey, USA
| | - P Jean-Philippe
- Division of AIDS, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - S Madhi
- Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, Faculty of Health Sciences, USA; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - A Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - M F Cotton
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - C Mitchell
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - S Nachman
- Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, New York, New York, USA
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Mitchell C, Ploem MC, Hennekam RCM, Kaye J. A Duty To Warn Relatives in Clinical Genetics: Arguably 'Fair just and reasonable' in English Law? Tottels J Prof Neglig 2016; 32:120-136. [PMID: 27478488 PMCID: PMC4962911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of 'next-generation' genetic sequencing technology that allows the sequencing of large parts, or even the entirety, of a patient's genome is advancing rapidly in the UK and around the world. This is set to greatly increase the level of health information that will be of relevance to relatives and the latest medical guidance advises that there is a professional duty to consider warning a patient's relatives of a serious genetic risk in limited circumstances. However, the High Court in ABC v St George's Healthcare NHS Trust [2015] EWHC 1394 (QB), recently found that a legal duty on the part of doctors to warn a patient's daughter of a genetic risk of Huntington's Disease without the patient's consent, was not even 'reasonably arguable' and would not be 'fair, just and reasonable'. This article considers the courts' approach to a duty of care towards 'third parties' in this context and concludes that some form of a duty of care to genetic relatives in clinical genetics is at very least arguably 'fair, just and reasonable'.
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Affiliation(s)
- C Mitchell
- Researcher in Law, Centre for Health, Law and Emerging Technologies
(HeLEX), Nuffield Department of Population Health, University of Oxford, Ewert
House, Ewert Place, Oxford OX2 7DD
| | - M C Ploem
- Academic Legal Researcher, Department of Public Health,
Academic Medical Centre, University of Amsterdam, PO Box 22660, Amsterdam,
Netherlands
| | - R C M Hennekam
- Professor of Paediatrics and Translational Genetics,
Department of Paediatrics, Academic Medical Centre, University of Amsterdam, PO Box
22660, Amsterdam, Netherlands
| | - J Kaye
- Professor of Health Law and Policy, Centre for Health, Law and
Emerging Technologies (HeLEX), Nuffield Department of Population Health, University
of Oxford, Ewert House, Ewert Place, Oxford OX2 7DD. JK is funded under Wellcome
Trust Award 096599/2/11/Z. The views expressed in this publication are those of the
authors and not those of any supporting institutions
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Haworth A, Reynolds H, DiFranco M, Sun Y, Wraith D, Williams S, Parameswaran B, Mitchell C, Ebert M. OC-0061: Focal brachytherapy: what dose to what volume? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Donald KJ, Clarke HV, Mitchell C, Cornwell RM, Hubbard SF, Karley AJ. Protection of Pea Aphids Associated with Coinfecting Bacterial Symbionts Persists During Superparasitism by a Braconid Wasp. Microb Ecol 2016; 71:1-4. [PMID: 26520831 DOI: 10.1007/s00248-015-0690-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/12/2015] [Indexed: 06/05/2023]
Abstract
Bacterial endosymbionts that associate facultatively with insect herbivores can influence insect fitness and trophic interactions. The pea aphid, Acyrthosiphon pisum, can be protected from parasitism by the braconid wasp Aphidius ervi when harbouring particular symbiotic bacteria, with specific endosymbiont coinfections providing almost complete protection. However, studies often quantify aphid mummification with no control over parasitoid oviposition per aphid; thus, if mummy production fails or is low, the causes are often unclear. Here, we show that the high level of protection associated with the coinfecting endosymbionts Hamiltonella defensa and X-type is maintained even when pea aphids are superparasitised. This contrasts strongly with the protection provided by H. defensa alone, which has been shown by others to be overcome by superparasitism. By dissecting aphids exposed to two parasitoid attacks, we reveal that A. ervi deposits eggs equally freely in endosymbiont-infected and uninfected nymphs, and lack of mummification in endosymbiont-protected nymphs arises from failure of the wasp eggs to hatch or emerging larvae to develop.
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Affiliation(s)
- K J Donald
- The James Hutton Institute, Dundee, DD2 5DA, UK
| | - H V Clarke
- The James Hutton Institute, Dundee, DD2 5DA, UK
| | - C Mitchell
- The James Hutton Institute, Dundee, DD2 5DA, UK
| | | | - S F Hubbard
- School of the Environment, University of Dundee, Dundee, DD1 4HN, UK
| | - A J Karley
- The James Hutton Institute, Dundee, DD2 5DA, UK.
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