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Alexander D, Armen S. Adapt and overcome: next steps in validating military-civilian partnerships. Trauma Surg Acute Care Open 2024; 9:e001419. [PMID: 38440094 PMCID: PMC10910509 DOI: 10.1136/tsaco-2024-001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- David Alexander
- Department of Surgery, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- United States Army Reserve, Fort Liberty, North Carolina, USA
| | - Scott Armen
- Department of Surgery, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- United States Army Reserve, Fort Liberty, North Carolina, USA
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2
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Heilmann A, Rueda Z, Alexander D, Laupland KB, Keynan Y. Impact of climate change on amoeba and the bacteria they host. J Assoc Med Microbiol Infect Dis Can 2024; 9:1-5. [PMID: 38567368 PMCID: PMC10984314 DOI: 10.3138/jammi-2023-09-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Ashley Heilmann
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zulma Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Alexander
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Lab, Winnipeg, Manitoba, Canada
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Butterfield Street, Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Bosco A, Di Lorito C, Yang Y, Dunlop M, Booth A, Alexander D, Jones S, Briggs M, Todd C, Burns A. Caregiver experiences of hospice dementia care: a systematic review and meta-ethnography. Aging Ment Health 2024; 28:197-206. [PMID: 37667896 DOI: 10.1080/13607863.2023.2241027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/13/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Hospices are regarded as gold standard providers of end-of-life care. The term hospice, however, is broadly used, and can describe a type of care offered in a variety of health care services (e.g. nursing homes). It thus becomes complex for families to decide between services. We aimed to review the evidence around the experience of family carers of people with dementia accessing in-patient hospice settings for end-of-life care. METHOD We registered the review protocol on PROSPERO. We used PerSPE(C)TiF to systematically organise our search strategy. The evidence was reviewed across six databases: PubMed, EMBASE, PsycINFO, ASSIA, ISI Web, and CINAHL. We used meta-ethnography as per the eMERGe guidance for data interpretation. RESULTS Four studies were included. Two third-order constructs were generated through meta-ethnography: expectations of care and barriers to quality of care. We found that carers had expectations of care, and these could change over time. If discussion was not held with hospice staff early on, the carers could experience reduced care quality due to unmatched expectations. Unmatched expectations acted as barriers to care and these were found in terms of carers not feeling adequately supported, and/or having the person discharged from hospice, which would entail increased care responsibility for carers. CONCLUSION In view of an increase in new dementia cases over time and with hospice services being under pressure, integrating palliative care services within community-based models of care is key to reducing the risk of having inadequate and under resourced services for people with dementia.
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Affiliation(s)
- A Bosco
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration- Greater Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - C Di Lorito
- Department of Primary Care and Population Health, University College London, Centre for Ageing Population Studies, Royal Free Hospital, London, UK
| | - Y Yang
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration- Greater Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - M Dunlop
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - A Booth
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - D Alexander
- East Cheshire Hospice, Macclesfield, Cheshire, UK
| | - S Jones
- East Cheshire Hospice, Macclesfield, Cheshire, UK
| | - M Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - C Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration- Greater Manchester, Manchester, UK
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - A Burns
- Manchester Institute for Collaborative Research on Ageing, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
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Bosco A, Di Lorito C, Dunlop M, Booth A, Alexander D, Jones S, Underwood BR, Todd C, Burns A. Experiences of hospice dementia care: A qualitative study of bereaved carers and hospice clinicians. PLoS One 2023; 18:e0286493. [PMID: 37930977 PMCID: PMC10627455 DOI: 10.1371/journal.pone.0286493] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Nearly 50 million people worldwide have dementia and the increasing numbers requiring end-of-life and palliative care, has led to national efforts to define standards of care for this patient group. Little research, however, has been done to date about the experience of hospice care for people with dementia accessing these services. This study explores the views of hospice dementia care for bereaved carers of people with dementia and hospice clinicians. METHODS We used purposive sampling for participant recruitment. Semi-structured qualitative interviews were conducted with bereaved carers and hospice clinical staff. Interviews were audio recorded and the transcriptions were analysed through thematic analysis. A total of 12 participants were interviewed from one service in the Northwest region in the UK. All were female and white British. RESULTS Participants described their experience of hospice dementia care in three main themes: Pre-access to service, roles and responsibility within hospice care, ease and difficulty of last period of end-of-life care. CONCLUSION Rapid response teams delivering hospice home care could represent a better option to inpatient care and may be preferred by patients. This type of service, however, may require joined-up care with other community services, and this type of care needs to be considered and planned. Future studies should evaluate this type of community care.
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Affiliation(s)
- A. Bosco
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research, Applied Research Collaboration- Greater Manchester, Manchester, United Kingdom
| | - C. Di Lorito
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free Hospital, University College London, London, United Kingdom
| | - M. Dunlop
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - A. Booth
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - D. Alexander
- East Cheshire Hospice, Macclesfield, Cheshire, United Kingdom
| | - S. Jones
- East Cheshire Hospice, Macclesfield, Cheshire, United Kingdom
| | - B. R. Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Windsor Unit, Fulbourn Hospital, Cambridge, United Kingdom
| | - C. Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research, Applied Research Collaboration- Greater Manchester, Manchester, United Kingdom
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - A. Burns
- Manchester Institute for Collaborative Research on Ageing, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom
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Gill IS, Griffiths EJ, Dooley D, Cameron R, Savić Kallesøe S, John NS, Sehar A, Gosal G, Alexander D, Chapel M, Croxen MA, Delisle B, Di Tullio R, Gaston D, Duggan A, Guthrie JL, Horsman M, Joshi E, Kearny L, Knox N, Lau L, LeBlanc JJ, Li V, Lyons P, MacKenzie K, McArthur AG, Panousis EM, Palmer J, Prystajecky N, Smith KN, Tanner J, Townend C, Tyler A, Van Domselaar G, Hsiao WWL. The DataHarmonizer: a tool for faster data harmonization, validation, aggregation and analysis of pathogen genomics contextual information. Microb Genom 2023; 9:mgen000908. [PMID: 36748616 PMCID: PMC9973856 DOI: 10.1099/mgen.0.000908] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Pathogen genomics is a critical tool for public health surveillance, infection control, outbreak investigations as well as research. In order to make use of pathogen genomics data, they must be interpreted using contextual data (metadata). Contextual data include sample metadata, laboratory methods, patient demographics, clinical outcomes and epidemiological information. However, the variability in how contextual information is captured by different authorities and how it is encoded in different databases poses challenges for data interpretation, integration and their use/re-use. The DataHarmonizer is a template-driven spreadsheet application for harmonizing, validating and transforming genomics contextual data into submission-ready formats for public or private repositories. The tool's web browser-based JavaScript environment enables validation and its offline functionality and local installation increases data security. The DataHarmonizer was developed to address the data sharing needs that arose during the COVID-19 pandemic, and was used by members of the Canadian COVID Genomics Network (CanCOGeN) to harmonize SARS-CoV-2 contextual data for national surveillance and for public repository submission. In order to support coordination of international surveillance efforts, we have partnered with the Public Health Alliance for Genomic Epidemiology to also provide a template conforming to its SARS-CoV-2 contextual data specification for use worldwide. Templates are also being developed for One Health and foodborne pathogens. Overall, the DataHarmonizer tool improves the effectiveness and fidelity of contextual data capture as well as its subsequent usability. Harmonization of contextual information across authorities, platforms and systems globally improves interoperability and reusability of data for concerted public health and research initiatives to fight the current pandemic and future public health emergencies. While initially developed for the COVID-19 pandemic, its expansion to other data management applications and pathogens is already underway.
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Affiliation(s)
- Ivan S Gill
- University of British Columbia, Vancouver, BC, Canada
| | - Emma J Griffiths
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Damion Dooley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Rhiannon Cameron
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Nithu Sara John
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anoosha Sehar
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gurinder Gosal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Madison Chapel
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Matthew A Croxen
- Alberta Precision Labs, Edmonton, AB, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | | | - Daniel Gaston
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, NS, Canada
| | - Ana Duggan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | | | - Mark Horsman
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.,Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Esha Joshi
- Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Levon Kearny
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Natalie Knox
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Lynette Lau
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Jason J LeBlanc
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, NS, Canada
| | - Vincent Li
- Alberta Precision Labs, Edmonton, AB, Canada
| | - Pierre Lyons
- Public Health Agency of Canada, Moncton, NB, Canada
| | | | - Andrew G McArthur
- Michael G. DeGroote Institute for Infectious Disease Research & Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Emily M Panousis
- Michael G. DeGroote Institute for Infectious Disease Research & Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - John Palmer
- Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Natalie Prystajecky
- University of British Columbia, Vancouver, BC, Canada.,BCCDC Public Health Laboratory, Vancouver, BC, Canada
| | | | - Jennifer Tanner
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Christopher Townend
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Andrea Tyler
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Gary Van Domselaar
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - William W L Hsiao
- University of British Columbia, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Tsang RSW, Law DKS, Zhou J, Haldane D, Garceau R, Zahariadis G, Mead K, Alexander D. Characterization of invasive meningococcal disease case isolates in Atlantic Canada, 2014 to 2020: spatial-temporal variations of clones and predicted meningococcal B vaccine coverage. J Med Microbiol 2022; 71. [PMID: 36748536 DOI: 10.1099/jmm.0.001615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction. Invasive meningococcal disease (IMD) caused by Neisseria meningitidis may show temporal and geographical changes in both the epidemiology and the characteristics of the strains involved.Gap statement. A study that examined invasive N. meningitidis causing IMD in Atlantic Canada from 2009 to 2013 was published in 2014. Data from subsequent years have not been described.Aim. This study examined the molecular epidemiology of IMD in four Atlantic Provinces of Canada as well as potential serogroup B (MenB) vaccine coverage.Methods. Individual IMD case isolates recovered from 2014 to 2020 were analysed for serotype and serosubtype antigens as well as by whole-genome sequencing (WGS) for prediction of potential MenB vaccine coverage.Results. Of the 56 IMD isolates, 42, 8, 5 and 1 were MenB, serogroup Y, serogroup W (MenW) and serogroup C, respectively. Geographical differences in the distribution of MenB clones revealed concentration of sequence type (ST)-269 clonal complex (cc) and ST-60 cc in Newfoundland and Labrador, while ST-41/44 cc (particularly ST-154) was predominantly found in New Brunswick and Nova Scotia. Core genome multi-locus sequence typing (cgMLST) also separated the New Brunswick and Nova Scotia ST-154 isolates into two clusters, with differences in their nhba and penA alleles. Furthermore, cgMLST also separated the ST-269 cc isolates in Atlantic Canada into the ST-1611 and the ST-269/ST-8924 clusters, with the latter showing high similarity to the ST-269 that first emerged in the Province of Quebec. Genetic Meningococcal Antigen Typing System showed that 54.8 % of MenB were predicted to be covered by the MenB vaccine Bexsero, with a further 38.1 % potentially covered by virtue of the presence of genes that encoded factor H-binding protein variant 1 proteins. Meningococcal deduced vaccine antigen reactivity predicted from WGS data showed that 95.3 % of MenB were covered by Trumenba. Four cases of IMD due to MenW ST-11 cc were also identified, with the first case found in 2018.Conclusions. This study provided evidence concerning the dynamics of N. meningitidis strains causing IMD in Atlantic Canada, with both geographical and temporal differences found. MenB vaccine appeared to provide good coverage of MenB IMD, especially towards the predominant strain of ST-154.
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Affiliation(s)
- Raymond S W Tsang
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Dennis K S Law
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Jianwei Zhou
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - David Haldane
- Nova Scotia Health Authority, Government of Nova Scotia, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhouse University, Halifax, Nova Scotia, Canada
| | - Richard Garceau
- Communicable Disease Control Unit, Department of Health, Government of New Brunswick, Fredericton, New Brunswick, Canada
| | - George Zahariadis
- Provincial Public Health Laboratory, Eastern Health Microbiology Services, Government of Newfoundland and Labrador, St. John's, Newfoundland, Canada.,Department of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Kristen Mead
- Department of Health, Government of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - David Alexander
- Cadham Provincial Labortory, Government of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
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Souza H, Castro S, Alexander D, Saturiano A. Perception of veterinarians on monitoring diabetic cats with emphasis on the flash glucose monitoring system. ARQ BRAS MED VET ZOO 2022. [DOI: 10.1590/1678-4162-12684] [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: 11/22/2022] Open
Abstract
ABSTRACT This study aimed to understand the perception of veterinarians regarding monitoring blood and interstitial glucose levels in cats with diabetes mellitus and/or diabetic ketoacidosis, with emphasis on the flash glucose monitoring system (FGMS) (FreeStyle Libre, Abbott, Brazil). This research consisted of two stages. In all, 516 response forms were obtained, and of these, 480 (93%) were considered valid. In total, 333 (69.4%) veterinarians did not use the FGMS, while 147 (30.6%) did. The cost of the FGMS (116, 78%) was the greatest deterrent to acceptability. Veterinarians who use the device consider it indispensable in the hospital monitoring of diabetic ketoacidosis and a facilitator in the accurate monitoring of measurements. In addition, the preferred location for application of the sensor is the cranial lateral wall of the chest and it is quite tolerable. Monitoring a diabetic cat requires commitment from the owner and the veterinary team to ensure feline-friendly management.
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Affiliation(s)
- H.J.M. Souza
- Universidade Federal Rural do Rio de Janeiro, Brazil
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Tolia S, Hussain S, Alexander D, Khan S, Soltys M, Kamba K, Brennan S, Adhikari S, Joshi A, Sciamanna C, Narang N, Pillarella J, Pauwaa S, Macaluso G, Cotts W, Andrade A. Cardiac Implantable Electronic Devices In Advanced Heart Failure Patients On Palliative Inotropes. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.148] [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: 11/24/2022]
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Henssler J, Alexander D, Schwarzer G, Bschor T, Baethge C. Combining Antidepressants vs Antidepressant Monotherapy for Treatment of Patients With Acute Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:300-312. [PMID: 35171215 PMCID: PMC8851370 DOI: 10.1001/jamapsychiatry.2021.4313] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [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: 01/08/2023]
Abstract
IMPORTANCE Combining antidepressants is frequently done in the treatment of acute depression, but studies have yielded conflicting results. OBJECTIVE To conduct a systematic review and meta-analysis assessing efficacy and tolerability of combination therapy. Combinations using presynaptic α2-autoreceptor antagonists or bupropion were investigated separately. DATA SOURCES MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials were systematically searched from each database inception through January 2020. STUDY SELECTION Randomized clinical trials (RCTs) comparing combinations of antidepressants with antidepressant monotherapy in adult patients with acute depression were included. DATA EXTRACTION AND SYNTHESIS Following guidelines from Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and recommendations from the Cochrane Handbook, 2 reviewers independently performed a literature search, study selection, data extraction, and evaluation of risk of bias. Data were pooled in random-effects analyses. MAIN OUTCOMES AND MEASURES Primary outcome was efficacy measured as standardized mean difference (SMD); secondary outcomes were response, remission, change from baseline in rating scale scores, number of dropouts, and number of dropouts due to adverse events. RESULTS Thirty-nine RCTs including 6751 patients were eligible. Combination treatment was statistically significantly associated with superior treatment outcomes relative to monotherapy (SMD = 0.31; 95% CI, 0.19-0.44). Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors was superior to other combinations (SMD = 0.37; 95% CI, 0.19-0.55). Bupropion combinations were not superior to monotherapy (SMD = 0.10; 95% CI, -0.07 to 0.27). Numbers of dropouts and dropouts due to adverse events did not differ between treatments. Studies were heterogeneous, and there was indication of publication bias (Egger test result was positive; P = .007, df = 36), but results remained robust across prespecified secondary outcomes and sensitivity and subgroup analyses, including analyses restricted to studies with low risk of bias. CONCLUSIONS AND RELEVANCE In this meta-analysis of RCTs comparing combinations of antidepressants with antidepressant monotherapy, combining antidepressants was associated with superior treatment outcomes but not with more patients dropping out of treatment. Combinations using an antagonist of presynaptic α2-autoreceptors may be preferable and may be applied as a first-line treatment in severe cases of depression and for patients considered nonresponders.
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Affiliation(s)
- Jonathan Henssler
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany,Charité University Medicine, St Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Berlin, Germany
| | - David Alexander
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, University Hospital of Dresden, Dresden, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
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Flynn C, Stoian RI, Weers BD, Mullet JE, Thomasson JA, Alexander D, Tkaczyk TS. Ruggedized, field-ready snapshot light-guide-based imaging spectrometer for environmental and remote sensing applications. Opt Express 2022; 30:10614-10632. [PMID: 35473024 DOI: 10.1364/oe.451624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
A field-ready, fiber-based high spatial sampling snapshot imaging spectrometer was developed for applications such as environmental monitoring and smart farming. The system achieves video rate frame transfer and exposure times down to a few hundred microseconds in typical daylight conditions with ∼63,000 spatial points and 32 spectral channels across the 470nm to 700nm wavelength range. We designed portable, ruggedized opto-mechanics to allow for imaging from an airborne platform. To ensure successful data collection prior to flight, imaging speed and signal-to-noise ratio was characterized for imaging a variety of land covers from the air. The system was validated by performing a series of observations including: Liriope Muscari plants under a range of water-stress conditions in a controlled laboratory experiment and field observations of sorghum plants in a variety of soil conditions. Finally, we collected data from a series of engineering flights and present reassembled images and spectral sampling of rural and urban landscapes.
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Tolia S, Khan M, Khan S, Alexander D, Soltys M, Kamba K, Brennan S, Adhikari S, Hussain S, Joshi A, Sciamanna C, Narang N, Pillarella J, Cotts W, Andrade A. Mortality and long-term outcomes of palliative inotropes in ischemic and non-ischemic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0915] [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: 11/12/2022] Open
Abstract
Abstract
Background
Palliative inotropes are frequently utilized for symptom management in patients with end stage heart failure who are unable to undergo durable advanced heart failure therapies. With the advent of improved medical management and early intervention, palliative inotropes may allow for improved patient outcomes than seen previously. In this study, we aim to investigate the survival and outcomes of palliative inotrope therapy and its impacts on ischemic versus non-ischemic cardiomyopathy.
Methods
We retrospectively analyzed 220 patients with American Heart Association Stage D heart failure who were discharged with palliative inotrope therapy after January 1, 2010. Patients who underwent mechanical circulatory support (MCS) or those who underwent heart transplant were excluded. Those with a history of coronary artery disease, myocardial infarction, history of percutaneous intervention, or coronary artery bypass grafting were assigned to ischemic cardiomyopathy (ICM), while patients without these findings were assigned to non-ischemic cardiomyopathy (NICM). Statistical analysis was completed using Chi-Square and Student's t-tests, wherein p<0.05 was considered statistically significant.
Results
Of the 220 patients, 87 had NICM as opposed to 133 with ICM. Mean age was found to be higher among patients with ICM (70 [62–79]) compared to NICM (65 [55–72], p-value <0.01). No significant difference was seen in total days on inotrope therapy (p=0.6). While more patients in both groups were placed on milrinone as opposed to dobutamine, there was no difference between patients with ischemic and NICM (p=0.66 and 0.51 respectively). Although a greater number of patients with NICM had been lost to follow up, admitted to hospice, or expired at 2 years (p<0.01), survival at 3 months, 1 year, and 2 years showed no difference between both groups. No difference was seen in number of hospitalizations or clinic visits in one year. Both groups had similar complication rates with intravenous-access related PICC line infections and new arrhythmias. (See Table).
Conclusion
Despite more frequent use of durable mechanical support devices, many patients who are deemed unsuitable for invasive measures are treated with palliative inotrope therapy. We have found that there is no significant difference in survival, complications, and outcomes of patients on palliative inotropes among ischemic and NICM. These findings show the versatility of palliative inotrope therapy in end stage heart failure. Further studies with larger populations need to be evaluated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Tolia
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - M Khan
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Khan
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - D Alexander
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - M Soltys
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - K Kamba
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Brennan
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Adhikari
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Hussain
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - A Joshi
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - C Sciamanna
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - N Narang
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - J Pillarella
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - W Cotts
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - A Andrade
- Advocate Christ Medical Center, Oak Lawn, United States of America
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Nashat H, Rocha L, Constantine A, Pires A, Patel R, Swan L, Alexander D, Gatzoulis MA, Johnson M, Dimopoulos K, Rafiq I. Cardiovascular outcomes in women with the highest classification of maternal cardiovascular risk in pregnancy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2903] [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
The modified world health organization (mWHO) classification of maternal risk is used to estimate morbidity and mortality in pregnant women with cardiovascular disease. Those in the highest risk category (mWHO Risk Class IV) are at greatest risk. Pregnancy is contraindicated in this patients.
Methods
This was a retrospective review of pregnant women classified as mWHO risk class IV, who were managed in a tertiary joint cardiac-obstetric pathway between 2008 and 2018.
Results
In total, there were 35 pregnancies in 30 women with the highest cardiovascular risk for adverse maternal outcomes. The mean maternal age at delivery was 29.3±5.2 years. Eleven (36%) patients were diagnosed with cardiovascular disease during pregnancy. Fourteen had a form of pulmonary arterial hypertension (46%), 6 (20%) had severe systemic ventricular dysfunction, 4 (13%) had severe mitral or aortic stenosis, 4 (13%) had aortic dilatation or inherited aortopathy, 1 (3%) had a history of peri-partum cardiomyopathy and 1 (3%) had severe native coarctation of the aorta. In the 30 pregnancies followed up in our centre, 29 (96%) were single foetus pregnancies and 1 (4%) was a twin pregnancy. There were 30 live births, 1 foetus was lost in the twin pregnancy. Of these 29 (96%) patients underwent elective caesarean section and 1 (4%) emergency caesarean section. Cardiovascular complications occurred in 18 (60%) women. Of these, 5 (28%) had atrial arrhythmias during pregnancy, 6 (33%) had worsening of pulmonary hypertension, 6 (33%) had decompensated heart failure. Three women had interventions during pregnancy: 1 had percutaneous intervention for coarctation of aorta due to foetal and maternal compromise, 1 had electrophysiological ablation for atrial arrhythmias to improve systemic ventricular function and 1 had an electrical cardioversion for atrial fibrillation. There were no deaths during pregnancy or in the peripartum period. One patient who presented at 34 weeks gestation with severe peripartum cardiomyopathy required early inotropic support followed by extracorporeal membrane oxygenation (ECMO) support post-delivery, died at 2 months post-partum.
Conclusions
With appropriate pre-pregnancy optimization, antepartum surveillance individualised peripartum care plans and multidisciplinary care throughout pregnancy, women at the highest risk for cardiovascular outcomes can have successful pregnancies, although the risk of cardiovascular complications remains high.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Nashat
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - L Rocha
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - A Constantine
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - A Pires
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - R Patel
- Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - L Swan
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - D Alexander
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - M A Gatzoulis
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - M Johnson
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - I Rafiq
- Royal Brompton Hospital, Cardiology, London, United Kingdom
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Zheng D, Flynn C, Stoian RI, Lu J, Cao H, Alexander D, Tkaczyk TS. Radiometric and design model for the tunable light-guide image processing snapshot spectrometer (TuLIPSS). Opt Express 2021; 29:30174-30197. [PMID: 34614746 DOI: 10.1364/oe.435733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
The tunable light-guide image processing snapshot spectrometer (TuLIPSS) is a novel remote sensing instrument that can capture a spectral image cube in a single snapshot. The optical modelling application for the absolute signal intensity on a single pixel of the sensor in TuLIPSS has been developed through a numerical simulation of the integral performance of each optical element in the TuLIPSS system. The absolute spectral intensity of TuLIPSS can be determined either from the absolute irradiance of the observed surface or from the tabulated spectral reflectance of various land covers and by the application of a global irradiance approach. The model is validated through direct comparison of the simulated results with observations. Based on tabulated spectral reflectance, the deviation between the simulated results and the measured observations is less than 5% of the spectral light flux across most of the detection bandwidth for a Lambertian-like surface such as concrete. Additionally, the deviation between the simulated results and the measured observations using global irradiance information is less than 10% of the spectral light flux across most of the detection bandwidth for all surfaces tested. This optical modelling application of TuLIPSS can be used to assist the optimal design of the instrument and explore potential applications. The influence of the optical components on the light throughput is discussed with the optimal design being a compromise among the light throughput, spectral resolution, and cube size required by the specific application under consideration. The TuLIPSS modelling predicts that, for the current optimal low-cost configuration, the signal to noise ratio can exceed 10 at 10 ms exposure time, even for land covers with weak reflectance such as asphalt and water. Overall, this paper describes the process by which the optimal design is achieved for particular applications and directly connects the parameters of the optical components to the TuLIPSS performance.
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Pescaroli G, Galbusera L, Cardarilli M, Giannopoulos G, Alexander D. Linking healthcare and societal resilience during the Covid-19 pandemic. Saf Sci 2021; 140:105291. [PMID: 33897106 PMCID: PMC8054640 DOI: 10.1016/j.ssci.2021.105291] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/02/2021] [Indexed: 06/02/2023]
Abstract
Coronavirus disease 2019 (Covid-19) has highlighted the link between public healthcare and the broader context of operational response to complex crises. Data are needed to support the work of the emergency services and enhance governance. This study develops a Europe-wide analysis of perceptions, needs and priorities of the public affected by the Covid-19 emergency. An online multilingual survey was conducted from mid-May until mid-July 2020. The questionnaire investigates perceptions of public healthcare, emergency management and societal resilience. In total, N = 3029 valid answers were collected. They were analysed both as a whole and focusing on the most represented countries (Italy, Romania, Spain and the United Kingdom). Our findings highlight some perceived weaknesses in emergency management that are associated with the underlying vulnerability of the global interconnected society and public healthcare systems. The spreading of the epidemic in Italy represented a 'tipping point' for perceiving Covid-19 as an 'emergency' in the surveyed countries. The respondents uniformly suggested a preference for gradually restarting activities. We observed a tendency to ignore the cascading effects of Covid-19 and possible concurrence of threats. Our study highlights the need for practices designed to address the next phases of the Covid-19 crisis and prepare for future systemic shocks. Cascading effects that could compromise operational capacity need to be considered more carefully. We make the case for the reinforcement of cross-border coordination of public health initiatives, for standardization in business continuity management, and for dealing with the recovery at the European level.
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Affiliation(s)
- Gianluca Pescaroli
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Luca Galbusera
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | | | - David Alexander
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
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Bullard J, Funk D, Dust K, Garnett L, Tran K, Bello A, Strong JE, Lee SJ, Waruk J, Hedley A, Alexander D, Van Caeseele P, Loeppky C, Poliquin G. Comparaison de l’infectivité du coronavirus du syndrome respiratoire aigu sévère 2 chez les enfants et les adultes. CMAJ 2021; 193:E870-E877. [PMID: 34099475 PMCID: PMC8203260 DOI: 10.1503/cmaj.210263-f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/11/2022] Open
Abstract
CONTEXTE: Le rôle des enfants dans la propagation et la transmission communautaire du coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) est encore mal compris. Nous visons à quantifier l’infectivité du SRAS-CoV-2 d’échantillons nasopharyngés provenant d’enfants comparativement à ceux provenant d’adultes. MÉTHODES: Nous avons obtenu des écouvillons nasopharyngés de cas adultes et pédiatriques de la maladie à coronavirus 2019 (COVID-19) ainsi que de leurs contacts qui ont obtenu un résultat positif à la présence du SRAS-CoV-2 lors d’un test de dépistage au Manitoba entre les mois de mars et décembre 2020. Nous avons comparé la croissance virale en culture cellulaire, les valeurs de cycle seuil de test d’amplification en chaîne par polymérase couplé à une transcription inverse (RT-PCR) de l’enveloppe (E) du gène du SRAS-CoV-2 et de la dose infectieuse pour 50 % de la culture tissulaire (DICT50/mL) entre les adultes et les enfants. RÉSULTATS: Parmi les 305 échantillons positifs à la présence du SRAS-CoV-2 validés par RT-PCR, 97 échantillons provenaient d’enfants de 10 ans et moins, 78 échantillons d’enfants de 11–17 ans et 130 échantillons d’adultes (≥ 18 ans). On a observé une croissance virale en culture dans 31 % des échantillons, dont 18 (19 %) échantillons d’enfants de 10 ans et moins, 18 (23 %) d’enfants de 11–17 ans et 57 (44 %) d’adultes (enfants c. adultes, rapport de cotes 0,45; intervalle de confiance [IC] à 95 % 0,28–0,72). Le cycle seuil était de 25,1 (IC à 95 % 17,7–31,3) chez les enfants de 10 ans et moins, 22,2 (IC à 95 % 18,3–29,0) chez les enfants de 11–17 ans et 18,7 (IC à 95 % 17,9–30,4) chez les adultes (p < 0,001). La DICT50/mL médiane était considérablement plus faible chez les enfants de 11–17 ans (316, écart interquartile [EI] 178–2125) que chez les adultes (5620, EI 1171–17 800, p < 0,001). Le cycle seuil était un indicateur exact d’une culture positive chez les enfants et les adultes (aire sous la courbe de la fonction d’efficacité du récepteur, 0,87, IC à 95 % 0,81–0,93 c. 0,89, IC à 95 % 0,83–0,96, p = 0,6). INTERPRÉTATION: Comparés aux adultes, les enfants qui ont obtenu un résultat positif à un test de dépistage du SRAS-CoV-2 à l’aide d’un écouvillon nasopharyngé étaient moins susceptibles de présenter une croissance du virus en culture et obtenaient un cycle seuil plus élevé et une concentration virale moins élevée, indiquant que les enfants ne sont pas les principaux vecteurs de la transmission du SRAS-CoV-2.
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Affiliation(s)
- Jared Bullard
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man.
| | - Duane Funk
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Kerry Dust
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Lauren Garnett
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Kaylie Tran
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Alex Bello
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - James E Strong
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Santina J Lee
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Jillian Waruk
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Adam Hedley
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - David Alexander
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Paul Van Caeseele
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Carla Loeppky
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
| | - Guillaume Poliquin
- Laboratoire provincial Cadham (Bullard, Dust, Hedley, Alexander, Van Caeseele), Santé Manitoba, Département de pédiatrie et de santé de l'enfant (Bullard, Strong, Lee, Van Caeseele, Poliquin), Université du Manitoba; Laboratoire national de microbiologie (Funk, Garnett, Tran, Bello, Strong, Poliquin), Agence de la santé publique du Canada; Département d'anesthésiologie et de médecine (Funk), section des soins intensifs, Université du Manitoba; Département de microbiologie médicale et des maladies infectieuses (Garnett, Tran, Bello, Alexander), Université du Manitoba; Contrôle des maladies transmissibles, Santé publique (Lee), Santé Manitoba; Unité d'épidémiologie et de surveillance (Waruk, Loeppky), Santé Manitoba; Département des sciences en santé communautaire (Loeppky), University of Manitoba, Winnipeg, Man
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Marshall R, Alexander D, Fleming J, Grayson J, Peters G, Buczek E. Utility of intraoperative frozen sections of thyroid tissue in the age of molecular testing. Clin Otolaryngol 2021; 46:991-997. [PMID: 33811452 DOI: 10.1111/coa.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 12/17/2020] [Accepted: 03/14/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Our study aims to examine the correlation between preoperative ultrasound-guided fine-needle aspiration and intraoperative frozen section and examine the clinical benefit of frozen section in the context of the latest national guidelines on the management of differentiated thyroid cancer. STUDY DESIGN A retrospective review of thyroid frozen section from 2012 to2017 at one institution. SETTING Tertiary care centre. PARTICIPANTS/MAIN OUTCOME Patient demographics, fine-needle aspiration results, molecular testing results, frozen section diagnosis (classified as benign, indeterminate, or malignant), final pathologic diagnosis, initial planned surgery, actual surgery performed, need for additional surgery and complications were recorded. Complications included hematoma formation, hypocalcaemia (requiring readmission, symptomatic, or >24-hour stay post op) and recurrent or superior laryngeal nerve damage. RESULTS 728 total patients had an intraoperative frozen section performed. A Thy 4/Bethesda V USGFNA diagnosis (n = 55) significantly correlated with a clinically important intraoperative frozen section (n = 17, P < .01). Intraoperative management was changed by the frozen section 53 times (7.2%). Molecular testing was sent on 92 USGFNA specimens, 80 of which were deemed "suspicious." Of the 49 patients whose management was upstaged intraoperatively, 29 (59%) would not necessitate a completion thyroidectomy under the latest UK and ATA guidelines based on final pathology. CONCLUSION Intraoperative frozen sections rarely alter the pre-surgical plan and indeed may result in expanded surgery that could have been avoided based on latest UK and US guidelines. Molecular testing of indeterminate fine-needle aspiration results does not appear to predict meaningful intraoperative frozen section results.
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Affiliation(s)
- Ryan Marshall
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Alexander
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason Fleming
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica Grayson
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Glenn Peters
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bullard J, Funk D, Dust K, Garnett L, Tran K, Bello A, Strong JE, Lee SJ, Waruk J, Hedley A, Alexander D, Van Caeseele P, Loeppky C, Poliquin G. Infectivity of severe acute respiratory syndrome coronavirus 2 in children compared with adults. CMAJ 2021; 193:E601-E606. [PMID: 33837039 PMCID: PMC8101972 DOI: 10.1503/cmaj.210263] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND: The role of children in the transmission and community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. We aimed to quantify the infectivity of SARS-CoV-2 in nasopharyngeal samples from children compared with adults. METHODS: We obtained nasopharyngeal swabs from adult and pediatric cases of coronavirus disease 2019 (COVID-19) and from their contacts who tested positive for SARS-CoV-2 in Manitoba between March and December 2020. We compared viral growth in cell culture, cycle threshold values from the reverse transcription polymerase chain reaction (RT-PCR) of the SARS-CoV-2 envelope (E) gene and the 50% tissue culture infective dose (TCID50/mL) between adults and children. RESULTS: Among 305 samples positive for SARS-CoV-2 by RT-PCR, 97 samples were from children aged 10 years or younger, 78 were from children aged 11–17 years and 130 were from adults (≥ 18 yr). Viral growth in culture was present in 31% of samples, including 18 (19%) samples from children 10 years or younger, 18 (23%) from children aged 11–17 years and 57 (44%) from adults (children v. adults, odds ratio 0.45, 95% confidence interval [CI] 0.28–0.72). The cycle threshold was 25.1 (95% CI 17.7–31.3) in children 10 years or younger, 22.2 (95% CI 18.3–29.0) in children aged 11–17 years and 18.7 (95% CI 17.9–30.4) in adults (p < 0.001). The median TCID50/mL was significantly lower in children aged 11–17 years (316, interquartile range [IQR] 178–2125) than adults (5620, IQR 1171 to 17 800, p < 0.001). Cycle threshold was an accurate predictor of positive culture in both children and adults (area under the receiver-operator curve, 0.87, 95% CI 0.81–0.93 v. 0.89, 95% CI 0.83–0.96, p = 0.6). INTERPRETATION: Compared with adults, children with nasopharyngeal swabs that tested positive for SARS-CoV-2 were less likely to grow virus in culture, and had higher cycle thresholds and lower viral concentrations, suggesting that children are not the main drivers of SARS-CoV-2 transmission.
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Affiliation(s)
- Jared Bullard
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man.
| | - Duane Funk
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Kerry Dust
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Lauren Garnett
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Kaylie Tran
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Alex Bello
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - James E Strong
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Santina J Lee
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Jillian Waruk
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Adam Hedley
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - David Alexander
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Paul Van Caeseele
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Carla Loeppky
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
| | - Guillaume Poliquin
- Cadham Provincial Laboratory (Bullard, Dust, Hedley, Alexander, Van Caeseele), Manitoba Health; Department of Pediatrics & Child Health (Bullard, Strong, Lee, Van Caeseele, Poliquin), University of Manitoba; National Microbiology Laboratory (Funk, Garnett, Tran, Bello, Strong, Poliquin), Public Health Agency of Canada; Departments of Anesthesiology and Medicine (Funk), Section of Critical Care, University of Manitoba; Department of Medical Microbiology & Infectious Diseases (Garnett, Tran, Bello, Alexander), University of Manitoba; Communicable Disease Control, Public Health (Lee), Manitoba Health; Epidemiology and Surveillance Unit (Waruk, Loeppky), Manitoba Health; Department of Community Health Science (Loeppky), University of Manitoba. Winnipeg, Man
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Suppasri A, Kitamura M, Tsukuda H, Boret SP, Pescaroli G, Onoda Y, Imamura F, Alexander D, Leelawat N, Syamsidik. Perceptions of the COVID-19 pandemic in Japan with respect to cultural, information, disaster and social issues. Prog Disaster Sci 2021; 10:100158. [PMID: 34095808 PMCID: PMC7923862 DOI: 10.1016/j.pdisas.2021.100158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 04/01/2024]
Abstract
A questionnaire survey was distributed via the Internet to 600 respondents. Preliminary results revealed that most Japanese people regularly washed their hands and had low resistance to wearing masks even before the COVID-19 pandemic. Internet news was the most common source of information. Half of the respondents said they would "stay at home evacuation" if a disaster occurred during the COVID-19 pandemic, reflecting the strategy promoted to reduce crowding in evacuation shelters. If a state of emergency must be reinstated, one-third of respondents said they could bear it for a few months and another one-third for a few weeks.
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Affiliation(s)
- Anawat Suppasri
- International Research Institute of Disaster Science, Tohoku University, Japan
| | | | - Haruka Tsukuda
- Graduate School of Engineering, Tohoku University, Japan
| | - Sebastien P Boret
- International Research Institute of Disaster Science, Tohoku University, Japan
| | - Gianluca Pescaroli
- Institute for Risk and Disaster Reduction, University College London, United Kingdom
| | - Yasuaki Onoda
- Graduate School of Engineering, Tohoku University, Japan
| | - Fumihiko Imamura
- International Research Institute of Disaster Science, Tohoku University, Japan
| | | | - Natt Leelawat
- Disaster and Risk Management Information Systems Research Group, Department of Industrial Engineering, Faculty of Engineering, Chulalongkorn University, Thailand
| | - Syamsidik
- Tsunami Disaster Mitigation Research Center, Syiah Kuala University, Indonesia
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20
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Bullard J, Dust K, Funk D, Strong JE, Alexander D, Garnett L, Boodman C, Bello A, Hedley A, Schiffman Z, Doan K, Bastien N, Li Y, Van Caeseele PG, Poliquin G. Predicting Infectious Severe Acute Respiratory Syndrome Coronavirus 2 From Diagnostic Samples. Clin Infect Dis 2021; 71:2663-2666. [PMID: 32442256 PMCID: PMC7314198 DOI: 10.1093/cid/ciaa638] [Citation(s) in RCA: 870] [Impact Index Per Article: 290.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Reverse-transcription polymerase chain reaction (RT-PCR) has become the primary method to diagnose viral diseases, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RT-PCR detects RNA, not infectious virus; thus, its ability to determine duration of infectivity of patients is limited. Infectivity is a critical determinant in informing public health guidelines/interventions. Our goal was to determine the relationship between E gene SARS-CoV-2 RT-PCR cycle threshold (Ct) values from respiratory samples, symptom onset to test (STT), and infectivity in cell culture. METHODS In this retrospective cross-sectional study, we took SARS-CoV-2 RT-PCR-confirmed positive samples and determined their ability to infect Vero cell lines. RESULTS Ninety RT-PCR SARS-CoV-2-positive samples were incubated on Vero cells. Twenty-six samples (28.9%) demonstrated viral growth. Median tissue culture infectious dose/mL was 1780 (interquartile range, 282-8511). There was no growth in samples with a Ct > 24 or STT > 8 days. Multivariate logistic regression using positive viral culture as a binary predictor variable, STT, and Ct demonstrated an odds ratio (OR) for positive viral culture of 0.64 (95% confidence interval [CI], .49-.84; P < .001) for every 1-unit increase in Ct. Area under the receiver operating characteristic curve for Ct vs positive culture was OR, 0.91 (95% CI, .85-.97; P < .001), with 97% specificity obtained at a Ct of > 24. CONCLUSIONS SARS-CoV-2 Vero cell infectivity was only observed for RT-PCR Ct < 24 and STT < 8 days. Infectivity of patients with Ct > 24 and duration of symptoms > 8 days may be low. This information can inform public health policy and guide clinical, infection control, and occupational health decisions. Further studies of larger size are needed.
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Affiliation(s)
- Jared Bullard
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Kerry Dust
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Canada
| | - Duane Funk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Anaesthesiology and Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Canada
| | - James E Strong
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - David Alexander
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Lauren Garnett
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Carl Boodman
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Alexander Bello
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Adam Hedley
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Canada
| | - Zachary Schiffman
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Kaylie Doan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nathalie Bastien
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Yan Li
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Paul G Van Caeseele
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Guillaume Poliquin
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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21
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de Marvao A, Alexander D, Bucciarelli-Ducci C, Price S. Heart disease in women: a narrative review. Anaesthesia 2021; 76 Suppl 4:118-130. [PMID: 33682102 DOI: 10.1111/anae.15376] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease is the worldwide leading cause of death in women. Biological differences between the sexes, a result of genetic, epigenetic and sex hormone-mediated factors, are complex and incompletely understood. These differences are compounded by socio-cultural factors and together account for the variation in the prevalence, presentation and natural history of cardiovascular disease between men and women. Although there is growing recognition of sex-specific determinants of outcomes, women remain under-represented in clinical trials, and sex-disaggregated diagnostic and management strategies are not currently recommended in clinical guidelines. Women remain more likely to experience delays in diagnosis, to be treated less aggressively and to have worse outcomes. As a consequence, cardiovascular disease in women remains understudied, underdiagnosed and undertreated. This review will focus on female-specific characteristics of cardiovascular disease and how these may impact on anaesthetic and peri-operative risk assessment and care. We highlight significant differences between the sexes in the natural history of cardiovascular disease, including those disease entities that are more common in women, such as sudden coronary artery dissection or microvascular dysfunction. Given the rapidly rising incidence of maternal cardiovascular disease and associated complications, special consideration is given to the risk assessment and management of these conditions during pregnancy. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary heart team and ultimately improve the care provided to women.
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Affiliation(s)
- A de Marvao
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - D Alexander
- Department of Cardiac Anaesthesia, Royal Brompton Hospital, London, UK
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, UK
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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22
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Price LC, Martinez G, Brame A, Pickworth T, Samaranayake C, Alexander D, Garfield B, Aw TC, McCabe C, Mukherjee B, Harries C, Kempny A, Gatzoulis M, Marino P, Kiely DG, Condliffe R, Howard L, Davies R, Coghlan G, Schreiber BE, Lordan J, Taboada D, Gaine S, Johnson M, Church C, Kemp SV, Wong D, Curry A, Levett D, Price S, Ledot S, Reed A, Dimopoulos K, Wort SJ. Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement. Br J Anaesth 2021; 126:774-790. [PMID: 33612249 DOI: 10.1016/j.bja.2021.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. METHODS A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. RESULTS Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. CONCLUSIONS With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.
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Affiliation(s)
- Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Guillermo Martinez
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - Aimee Brame
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | | | | | - David Alexander
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Benjamin Garfield
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Tuan-Chen Aw
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Bhashkar Mukherjee
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Carl Harries
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Gatzoulis
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Philip Marino
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - David G Kiely
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Rachel Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free Hospital, London, UK
| | | | - James Lordan
- National Pulmonary Hypertension Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - Dolores Taboada
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Samuel V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Davina Wong
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Andrew Curry
- Cardiothoracic Anaesthesia, University Hospital Southampton, Southampton, Hampshire, UK
| | - Denny Levett
- Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Anna Reed
- National Heart and Lung Institute, Imperial College London, London, UK; Respiratory and Lung Transplantation, Harefield Hospital, Uxbridge, UK
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephen John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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Kain JJ, Johns JD, Alexander D, Carroll WR, Grayson JW, Buczek EJ. Improving Head and Neck Microvascular Reconstructive Care with a Novel Perioperative Checklist. Laryngoscope 2021; 131:E2251-E2256. [PMID: 33434315 DOI: 10.1002/lary.29401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/08/2020] [Accepted: 01/03/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS To appraise the utility of a novel EMR-based checklist for complex head and neck microvascular free-tissue reconstruction. STUDY DESIGN A prospectively collected retrospective matched cohort study from a single tertiary care academic institution. METHODS A retrospective matched cohort study from an academic tertiary care center with 76 total patients analyzed for disease-specific and quality outcomes before and after implementation of an EMR-based checklist tailored to complex head and neck care. The intervention group consisted of 38 consecutive patients undergoing microvascular free tissue reconstruction after implementation of the EMR-based checklist strategy. A historic cohort of 38 patients was derived by matching patients meticulously for disease-specific and surgical characteristics. Primary outcomes included post-operative medical and surgical complications, intensive care requirements, 30-day reoperation rates, hospital length of stay, and completion of preoperative metastatic evaluations. Secondary outcomes included patterns of antibiotic administration, ultimate discharge dispositions, flap survival, and recognition of preoperative hypothyroidism in previously radiated patients. RESULTS Implementation of the perioperative checklist yielded an overall reduction in major medical complications (10.5% vs. 29.0%, P < .05*), post-operative antibiotic administration (17.4% vs. 44.7%, P < .05*), hospital length of stay (median (IQR) days 6 (1) versus 7 (3.25), P < .05*), and improved metastatic evaluation completion (92.1% vs. 63.2%, P < .05*). There was an improved discharge disposition (92.1% vs. 73.7%, P < .05*). No difference was observed in major wound complications (50.0% vs. 57.9%, P = .49), 30-day re-operation rates (31.5% vs. 34.2%, P = .81), 30-day readmission rates (21.1% vs. 21.1%, P > .99), escalations to intensive-care (13.2% vs. 21.1%, P = .36), or flap survival (97.4% vs. 89.5%, P = .17). CONCLUSIONS Use of our EMR-based perioperative checklist reduced major medical complications, post-operative antibiotic administration, hospital length of stay, and improved discharge outcomes for patients undergoing microvascular free-tissue reconstruction. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2251-E2256, 2021.
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Affiliation(s)
- Joshua J Kain
- Department of Otolaryngology Head and Neck Surgery, University of California at Davis, Sacramento, California, U.S.A
| | - James D Johns
- University of Alabama Birmingham School of Medicine, Birmingham, Alabama, U.S.A
| | - David Alexander
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - William R Carroll
- University of Alabama Birmingham School of Medicine, Birmingham, Alabama, U.S.A
| | - Jessica W Grayson
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Erin J Buczek
- University of Alabama Birmingham School of Medicine, Birmingham, Alabama, U.S.A
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Alexander D, Gaillard JC, Kelman I, Marincioni F, Penning-Rowsell E, van Niekerk D, Vinnell LJ. Academic publishing in disaster risk reduction: past, present, and future. Disasters 2021; 45:5-18. [PMID: 32034801 DOI: 10.1111/disa.12432] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nowadays there are approximately 80 Anglophone journals that deal primarily with disaster risk reduction (DRR) and allied fields. This large array signals a sustained, if uneven, growth in DRR scholarship but also competition between the offerings of different publishers and institutions. The purpose of this article is first to summarise the development of academic publishing on DRR from its early beginnings to the present day. The paper then evaluates the current state of publishing in this field and discusses possible future trends. Next, it identifies some possible opportunities, challenges, expectations, and commitments for journal editors both within DRR and academia more broadly, including those that refer to changes in the use of terminology, the relentless increase in the number of papers submitted, the expansion and dangers of predatory journals, different peer review models, open access versus paywalls, citations and bibliography metrics, academic social networks, and copyright and distribution issues.
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Affiliation(s)
- David Alexander
- Professor of Risk and Disaster Reduction at University College London, United Kingdom
| | - J C Gaillard
- Professor of Geography at the University of Auckland, New Zealand, and is Extraordinary Professor in the Unit for Environmental Sciences and Management at North West University, South Africa
| | - Ilan Kelman
- Professor of Disasters and Health at University College London, United Kingdom, and is Professor II at the University of Agder, Norway
| | | | | | - Dewald van Niekerk
- Professor and Director of the African Centre for Disaster Studies at North West University, South Africa
| | - Lauren J Vinnell
- Researcher at the Joint Centre for Disaster Research at Massey University, New Zealand, and is a PhD student at the Victoria University of Wellington, New Zealand
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25
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Mebrate Y, Phillips S, Field D, Mumuni I, Josse P, Alexander D, Das-Gupta R, Trimlett R, Polkey MI. Modification of a domiciliary ventilator to increase FiO 2: an off-label modification which may be of value in COVID-19. Thorax 2021; 76:83-85. [PMID: 33077616 PMCID: PMC7569708 DOI: 10.1136/thoraxjnl-2020-215487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022]
Abstract
Although nasal continuous positive airway pressure or non-invasive ventilation is used to manage some patients with acute lung injury due to COVID-19, such patients also demonstrate increased minute ventilation which makes it hard, if the device is used in line with the manufacturer's instructions, to achieve adequate oxygen delivery. In addition, if a hospital contains many such patients, then it is possible that the oxygen requirements will exceed infrastructure capacity. Here we describe a simple modification of two exemplar ventilators normally used for domiciliary ventilation, which substantially increased the fraction of inspired oxygen (FiO2) delivered.
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Affiliation(s)
- Yoseph Mebrate
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Steven Phillips
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Debbie Field
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ivy Mumuni
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Paul Josse
- Department of Design, Brunel University College of Engineering Design and Physical Sciences, Uxbridge, Hillingdon, UK
| | - David Alexander
- Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rishi Das-Gupta
- Department of Innovation and Technology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Richard Trimlett
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Michael I Polkey
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Thoracic Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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26
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Peterson SW, Martin I, Demczuk W, Barairo N, Naidu P, Lefebvre B, Allen V, Hoang L, Hatchette TF, Alexander D, Tomas K, Trubnikov M, Wong T, Mulvey MR. Multiplex real-time PCR assays for the prediction of cephalosporin, ciprofloxacin and azithromycin antimicrobial susceptibility of positive Neisseria gonorrhoeae nucleic acid amplification test samples. J Antimicrob Chemother 2020; 75:3485-3490. [PMID: 32830242 DOI: 10.1093/jac/dkaa360] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The incidence of antimicrobial-resistant Neisseria gonorrhoeae (GC) is rising in Canada; however, antimicrobial resistance (AMR) surveillance data are unavailable for infections diagnosed directly from clinical specimens by nucleic acid amplification tests (NAATs), representing over 80% of diagnoses. We developed a set of 10 improved molecular assays for surveillance of GC-AMR and prediction of susceptibilities in NAAT specimens. METHODS Multiplex real-time PCR (RT-PCR) assays were developed to detect SNPs associated with cephalosporin (ponA, porB, mtrR -35delA, penA A311V, penA A501, N513Y, G545S), ciprofloxacin (gyrA S91, parC D86/S87/S88) and azithromycin [23S (A2059G, C2611T), mtrR meningitidis-like promoter] resistance. The assays were validated on 127 gonococcal isolates, 51 non-gonococcal isolates and 50 NAATs with matched culture isolates. SNPs determined from the assay were compared with SNPs determined from in silico analysis of WGS data. MICs were determined for culture isolates using the agar dilution method. RESULTS SNP analysis of the 50 NAAT specimens had 96% agreement with the matched culture RT-PCR analysis. When compared with MICs, presence of penA A311V or penA A501 and two or more other SNPs correlated with decreased susceptibility and presence of three or more other SNPs correlated with intermediate susceptibility to cephalosporins; presence of any associated SNP correlated with ciprofloxacin or azithromycin resistance. NAAT-AMR predictions correlated with matched-culture cephalosporin, ciprofloxacin and azithromycin MICs at 94%, 100% and 98%, respectively. CONCLUSIONS We expanded molecular tests for N. gonorrhoeae AMR prediction by adding new loci and multiplexing reactions to improve surveillance where culture isolates are unavailable.
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Affiliation(s)
- S W Peterson
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - I Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - W Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - N Barairo
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - P Naidu
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | - B Lefebvre
- Laboratoire de santé publique du Québec, Ste-Anne-de-Bellevue, Québec, Canada
| | - V Allen
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | - L Hoang
- British Columbia Centres for Disease Control Public Health Microbiology & Reference Laboratory, Vancouver, British Columbia, Canada
| | - T F Hatchette
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - D Alexander
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
| | - K Tomas
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - M Trubnikov
- First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, Ontario, Canada
| | - T Wong
- First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, Ontario, Canada
| | - M R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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Kimpton JA, Batalle D, Barnett ML, Hughes EJ, Chew ATM, Falconer S, Tournier JD, Alexander D, Zhang H, Edwards AD, Counsell SJ. Diffusion magnetic resonance imaging assessment of regional white matter maturation in preterm neonates. Neuroradiology 2020; 63:573-583. [PMID: 33123752 PMCID: PMC7966229 DOI: 10.1007/s00234-020-02584-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Abstract
Purpose Diffusion magnetic resonance imaging (dMRI) studies report altered white matter (WM) development in preterm infants. Neurite orientation dispersion and density imaging (NODDI) metrics provide more realistic estimations of neurite architecture in vivo compared with standard diffusion tensor imaging (DTI) metrics. This study investigated microstructural maturation of WM in preterm neonates scanned between 25 and 45 weeks postmenstrual age (PMA) with normal neurodevelopmental outcomes at 2 years using DTI and NODDI metrics. Methods Thirty-one neonates (n = 17 male) with median (range) gestational age (GA) 32+1 weeks (24+2–36+4) underwent 3 T brain MRI at median (range) post menstrual age (PMA) 35+2 weeks (25+3–43+1). WM tracts (cingulum, fornix, corticospinal tract (CST), inferior longitudinal fasciculus (ILF), optic radiations) were delineated using constrained spherical deconvolution and probabilistic tractography in MRtrix3. DTI and NODDI metrics were extracted for the whole tract and cross-sections along each tract to assess regional development. Results PMA at scan positively correlated with fractional anisotropy (FA) in the CST, fornix and optic radiations and neurite density index (NDI) in the cingulum, CST and fornix and negatively correlated with mean diffusivity (MD) in all tracts. A multilinear regression model demonstrated PMA at scan influenced all diffusion measures, GA and GAxPMA at scan influenced FA, MD and NDI and gender affected NDI. Cross-sectional analyses revealed asynchronous WM maturation within and between WM tracts.). Conclusion We describe normal WM maturation in preterm neonates with normal neurodevelopmental outcomes. NODDI can enhance our understanding of WM maturation compared with standard DTI metrics alone. Supplementary Information The online version of this article (10.1007/s00234-020-02584-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J A Kimpton
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - D Batalle
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK.,Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M L Barnett
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - E J Hughes
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - A T M Chew
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - S Falconer
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - J D Tournier
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - D Alexander
- Department of Computer Science and Centre for Medical Imaging Computing, University College London, London, UK
| | - H Zhang
- Department of Computer Science and Centre for Medical Imaging Computing, University College London, London, UK
| | - A D Edwards
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - S J Counsell
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK.
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Affiliation(s)
- Andrew Walkty
- Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health, Winnipeg, Manitoba, Canada
- Correspondence: Andrew Walkty, MD, MS673B Microbiology, Health Sciences Centre, 820 Sherbrook St., Winnipeg, Manitoba, R3A 1R9, Canada ()
| | - David Alexander
- Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
| | - John Embil
- Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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29
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Sudo H, Tsuji AB, Sugyo A, Kurosawa G, Kurosawa Y, Alexander D, Tsuda H, Saga T, Higashi T. Radiolabeled Human Monoclonal Antibody 067-213 has the Potential for Noninvasive Quantification of CD73 Expression. Int J Mol Sci 2020; 21:E2304. [PMID: 32225110 PMCID: PMC7177856 DOI: 10.3390/ijms21072304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND CD73 is an ectonucleotidase regulating extracellular adenosine concentration and plays an important role in adenosine-mediated immunosuppressive pathways. The efficacy of CD73-targeted therapy depends on the expression levels of CD73; therefore, monitoring CD73 status in cancer patients would provide helpful information for selection of patients who would benefit from CD73-targeted therapy. Here, we evaluated the ability of 111In-labeled antibody 067-213, which has high affinity for human CD73, to act as a noninvasive imaging probe. METHODS Cell binding and competitive inhibition assays for 111In-labeled 067-213 were conducted using MIAPaCa-2 (high CD73 expression) and A431 (low CD73 expression) cells. For in vivo assessments, biodistribution and SPECT/CT studies were conducted in MIAPaCa-2 and A431 tumor-bearing mice. To estimate the absorbed dose in humans, biodistribution and SPECT/CT studies were conducted in healthy rats. RESULTS 111In-labeled 067-213 bound to MIAPaCa-2 and A431 cells in a CD73-dependent manner and the affinity loss after 111In-labeling was limited. Biodistribution and SPECT/CT studies with 111In-labeled 067-213 in mice showed high uptake in MIAPaCa-2 tumors and lower uptake in A431 tumors. In rats, the probe did not show high uptake in normal organs, including endogenously CD73-expressing organs. The estimated absorbed doses in humans were reasonably low. CONCLUSIONS 111In-labeled 067-213 showed CD73-expression-dependent tumor uptake and low uptake in normal organs and tissues. Radiolabeled 067-213 holds promise as an imaging probe for noninvasive evaluation of CD73 expression levels in patients. Our data encourage further clinical studies to clarify a role for CD73 monitoring in patients receiving CD73-targeted immune therapy.
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Affiliation(s)
- Hitomi Sudo
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology (QST-NIRS), Inage, Chiba 263-8555, Japan; (H.S.); (A.S.)
| | - Atsushi B. Tsuji
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology (QST-NIRS), Inage, Chiba 263-8555, Japan; (H.S.); (A.S.)
| | - Aya Sugyo
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology (QST-NIRS), Inage, Chiba 263-8555, Japan; (H.S.); (A.S.)
| | - Gene Kurosawa
- International Center for Cell and Gene Therapy, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan;
| | - Yoshikazu Kurosawa
- Department of Innovation Center for Advanced Medicine, Research Promotion Support Center, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan;
| | - David Alexander
- Nanotoxicology Project, Nagoya City University, 3-1 Tanabe-dohri, Mizuho-ku, Nagoya 466-8603, Japan; (D.A.); (H.T.)
| | - Hiroyuki Tsuda
- Nanotoxicology Project, Nagoya City University, 3-1 Tanabe-dohri, Mizuho-ku, Nagoya 466-8603, Japan; (D.A.); (H.T.)
| | - Tsuneo Saga
- Department of Advanced Medical Imaging Research, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan;
| | - Tatsuya Higashi
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology (QST-NIRS), Inage, Chiba 263-8555, Japan; (H.S.); (A.S.)
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30
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Dasari TW, Patel B, Wayangankar SA, Alexander D, Zhao YD, Schlegel J, Leung C, Lozano P, Latif F, Thadani U. Prognostic Value of 6-Minute Walk Distance in Patients Undergoing Percutaneous Coronary Intervention: a Veterans Affairs Prospective Study. Tex Heart Inst J 2020; 47:10-14. [PMID: 32148446 DOI: 10.14503/thij-17-6471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The 6-minute walk distance (6MWD) test is a useful prognostic tool in chronic heart failure. Its usefulness after percutaneous coronary intervention is unknown. In a prospective observational study, patients underwent a 6MWD test within 2 weeks after percutaneous coronary intervention. The primary endpoint was major adverse cardiovascular events (MACE) (death, acute coronary syndrome, and heart failure admission) at one year. Receiver operating characteristic curves and area under the curve were used to determine the 6MWD test's predictive power, and the Youden index was used to measure its effectiveness. A total of 212 patients were enrolled (98% men; mean age, 65 ± 9 yr). Major comorbidities were hypertension in 187 patients (88%), dyslipidemia in 186 (88%), and diabetes mellitus in 95 (45%). Among the 176 patients (83%) who completed the 6MWD test, the incidence of MACE at one year was 22% (acute coronary syndrome in 17%; heart failure admission in 4%; and death in 3%). The area under the curve for MACE was 0.59, and 6MWD was shorter for patients with MACE than for those without (290 vs 326 m; P=0.03). For 39 patients with previous heart failure who completed the 6MWD test, the area under the curve was 0.64 for MACE and 0.78 for heart failure admission. The 6MWD test predicted reasonably well the incidence of MACE one year after percutaneous coronary intervention. In a subgroup of patients with previous heart failure, it fared even better in predicting heart failure admission. Larger studies are needed to confirm these findings.
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McDougall DL, Soutar CD, Perry BJ, Brown C, Alexander D, Yost CK, Stavrinides J. Isolation and Characterization of vB_PagP-SK1, a T7-Like Phage Infecting Pantoea agglomerans. ACTA ACUST UNITED AC 2020; 1:45-56. [DOI: 10.1089/phage.2019.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Craig D. Soutar
- Department of Biology, University of Regina, Regina, Saskatchewan, Canada
| | - Benjamin J. Perry
- Department of Microbiology and Immunology, University of Otago, North Dunedin, New Zealand
| | - Cheryl Brown
- Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
| | | | | | - John Stavrinides
- Department of Biology, University of Regina, Regina, Saskatchewan, Canada
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Jansen DEMC, Visser A, Vervoort JPM, Kocken P, Reijneveld SA, Blair M, Alexander D, Rigby M, Michaud PA. Organization and content of primary care for adolescents – comparison of actual and desired situation. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.191] [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: 11/14/2022] Open
Abstract
Abstract
To successfully navigate increasing autonomy, independence and health behaviors in adolescence, accessible adolescent health care services (AHS) are essential. AHS comprise all services in primary care that are aimed at the specific needs of adolescents and can be provided in various settings such as public services, private services, schools and hospitals. In the MOCHA project (Models of Child Health Appraised) we assessed the structure and content of AHS in 30 European countries against the standards in the field of adolescent health services: accessibility, staff attitude, communication, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community. The results revealed that although half of the 30 countries did adopt adolescent-specific policies, many countries did not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care is limited. In addition, one third of the countries do not have a formal policy which guarantees the confidentiality of a consult and the possibility to consult a physician without parents knowing. Finally, around half of the countries do not have specialized centers in adolescent health care in order to tackle comprehensive health issues. Access to adolescent health care services needs to be improved for vulnerable adolescents such as migrant adolescents. Schools, ambulatory settings and hospitals should offer accessible, comprehensive health care and a culturally appropriate approach, particularly given the number of migrant adolescents living in EU and EEA countries. Finally, the health care systems should improve their communication strategies, to assist young people in understanding their rights and responsibility in the domain of health, and how and where to access to adequate care.
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Affiliation(s)
- D E M C Jansen
- Health Sciences, University Medical Center Groningen, Groningen, Netherlands
| | - A Visser
- Health Sciences, University Medical Center Groningen, Groningen, Netherlands
| | - J P M Vervoort
- Health Sciences, University Medical Center Groningen, Groningen, Netherlands
| | - P Kocken
- TNO Department Child Health, Leiden University Medical Centre, Leiden, Netherlands
| | - S A Reijneveld
- Health Sciences, University Medical Center Groningen, Groningen, Netherlands
| | - M Blair
- Imperial College, London, UK
| | | | - M Rigby
- Imperial College, London, UK
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Alexander D, Yoneda J, Bhat S, Oleksyn T, Chen J, Andrew C. 1828. Bedaquiline Resistance in Mycobacterium intracellulare Is Mediated by the Transcriptional Repressor MmpT5. Open Forum Infect Dis 2019. [PMCID: PMC6808869 DOI: 10.1093/ofid/ofz359.090] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bedaquiline (BDQ) is an FDA approved antibiotic with antimycobacterial activity. BDQ resistance has been observed in several Mycobacterium species. High-level resistance is due to mutations in ATP synthase. Low -level resistance is attributed to drug efflux. Previously, we suggested that the MmpSL5 efflux system mediates BDQ resistance in M. intracellulare. Here, we examine the role of MmpT5 in transcriptional regulation of mmpSL5 and BDQ resistance.
Methods
In this study, mmpSL5-mmpT5 genes were cloned from 2 pre-treatment (wild-type mmpT5) and 2 relapse (mutant mmpT5) isolates of M. intracellulare and transformed into M. smegmatis. BDQ MICs were determined as well as cell survival after 24 hours exposure to an inhibitory concentration (0.07 µg/mL) of BDQ. Transcription of the M. intracellulare mmpT5 and mmpSL5 promoters was monitored with luciferase reporter gene fusions in the presence of wild-type and mutant alleles of mmpT5. Single and multigene constructs were created using the MoClo system, and transformed into E. coli DH5α. Constructs containing the M. tuberculosis rv0678 gene, which mediates low-level BDQ resistance in M. tuberculosis, were also examined.
Results
The BDQ MIC for the M. smegmatis control strain, and all strains containing mmpSL5-mmpT5 constructs, was 0.007 µg/mL. Even so, strains containing mutant mmpT5 alleles showed enhanced survival after 24 hours exposure to 0.007 µg/mL BDQ. Bacterial colonies associated with mutant mmpT5 alleles exhibited altered morphology relative to wild-type strains. Transcription of mmpSL5 was repressed by wild-type mmpT5, but neither mutant mmpT5 nor rv0678 repressed transcription. The mmpT5 luciferase reporter was not active.
Conclusion
MmpT5 represses transcription of mmpSL5 whereas the operon is dysregulated by mmpT5 mutations. Although Rv0678 regulates mmpSL expression in M. tuberculosis, it cannot repress the M. intracellulare mmpSL5 genes. The mmpSL5-mmpT5 genes have no impact on the BDQ MIC for M. smegmatis, but constructs containing mutant mmpT5 alleles do enhance bacterial survival. The altered morphology of these colonies suggests that BDQ resistance is mediated by cell wall changes in combination with drug efflux.
Disclosures
All Authors: No reported Disclosures.
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Tendler I, Bruza P, Hachadorian R, Alexander D, Jermyn M, Williams B, Jarvis L, Pogue B, Gladstone D. Scintillator Target Imaging: A Novel Surface Dosimetry Method. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gaiss S, Amarasiriwardena D, Alexander D, Wu F. Tissue level distribution of toxic and essential elements during the germination stage of corn seeds (Zea mays, L.) using LA-ICP-MS. Environ Pollut 2019; 252:657-665. [PMID: 31185354 DOI: 10.1016/j.envpol.2019.05.129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/05/2018] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 06/09/2023]
Abstract
Both essential and toxic metal contaminants impact agricultural crops by bioaccumulation in plants. The goal of this study was to evaluate the tissue-level spatial distribution of metal(loids) in corn seeds (Zea mays, L.) from contaminated corn fields near the Xikuangshan (XKS) antimony mine in Hunan, China, and compared them with corn (Zea mays everta L., popcorn) grown in a farm in Amherst, MA that practices sustainable farming as a control. How toxic and essential metals translocate through the roots and shoots during early stages of germination was also investigated. The cleaned corn seed samples were mounted in resin blocks and longitudinally dissected into thin sections. The laser ablation parameters were optimized, and the instrument was calibrated using tomato leaf standard reference material (NIST SRM 1573a) in a pellet form. Tissue level distributions of metal(loid)s As, Cd, Hg, Sb and Zn in corn seeds collected were determined using (LA-ICP-MS). Seeds from the control farm were germinated and their roots and shoots were analyzed to determine tissue level concentrations and their spatial distributions. It was found that seeds from the XKS mine region in China had higher overall concentration of all elements analyzed due to metal(loids) absorbed from contaminated mine soils. Metal(loids) concentrations were highest in the embryo (∼360 mg/kg) and pericarp (∼0.48 mg/kg) compared with the endosperm of corn seeds. Essential element Zn was found in the embryo and emerging coleoptile and radicle. Finally, in both roots and shoots, element concentrations were highest proximally to the tip cap compared to distal concentrations and later translocated to distal tissue regions. This study offers unique insights of metal(loid) bioaccumulation and translocation in corn and thus is better able to track metal(loids) contaminants trafficking in our food systems.
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Affiliation(s)
- Shelby Gaiss
- School of Natural Sciences, Hampshire College, Amherst, MA, USA
| | | | - David Alexander
- School of Natural Sciences, Hampshire College, Amherst, MA, USA
| | - Fengchang Wu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, China
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Abstract
Cascades have emerged as a new paradigm in disaster studies. The high level of dependency of modern populations on critical infrastructure and networks allows the impact of disasters to propagate through socio-economic systems. Where vulnerabilities overlap and interact, escalation points are created that can create secondary effects with greater impact than the primary event. This article explains how complexity can be categorised and analysed in order to find those weak points in society that enable cascading impacts to develop. Scenarios can be used to identify critical dependencies and guide measures designed to increase resilience. Experience suggests that many potential impacts of cascading disasters remain uninvestigated, which provides ample scope for escalation of impacts into complex forms of crisis.
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Wang Y, Pawlowski ME, Cheng S, Dwight JG, Stoian RI, Lu J, Alexander D, Tkaczyk TS. Light-guide snapshot imaging spectrometer for remote sensing applications. Opt Express 2019; 27:15701-15725. [PMID: 31163763 DOI: 10.1364/oe.27.015701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/26/2019] [Indexed: 06/09/2023]
Abstract
A fiber-based snapshot imaging spectrometer was developed with a maximum of 31853 (~188 x 170) spatial sampling and 61 spectral channels in the 450nm-750nm range. A compact, custom-fabricated fiber bundle was used to sample the object image at the input and create void spaces between rows at the output for dispersion. The bundle was built using multicore 6x6 fiber block ribbons. To avoid overlap between the cores in the direction of dispersion, we selected a subset of cores using two alternative approaches; a lenslet array and a photomask. To calibrate the >30000 spatial samples of the system, a rapid spatial calibration method was developed based on phase-shifting interferometry (PSI). System crosstalk and spectral resolution were also characterized. Preliminary hyperspectral imaging results of the Rice University campus landscape, obtained with the spectrometer, are presented to demonstrate the system's spectral imaging capability for distant scenes. The spectrum of different plant species with different health conditions, obtained with the spectrometer, was in accordance with reference instrument measurements. We also imaged Houston traffic to demonstrate the system's snapshot hyperspectral imaging capability. Potential applications of the system include terrestrial monitoring, land use, air pollution, water resources, and lightning spectroscopy. The fiber-based system design potentially allows tuning between spatial and spectral sampling to meet specific imaging requirements.
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Makowski MS, Norcross JR, Alexander D, Sanders RW, Conkin J, Young M. Carbon Monoxide Levels in the Extravehicular Mobility Unit by Modeling and Operational Testing. Aerosp Med Hum Perform 2019; 90:84-91. [PMID: 30670117 DOI: 10.3357/amhp.5220.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Carbon monoxide (CO) is a toxic gas with potential for detriment to spaceflight operations. An analytical model was developed to investigate if a maximum CO contamination of 1 ppm in the oxygen (O₂) supply reached dangerous levels during extravehicular activity (EVA). Occupational monitoring pre- and postsuited exposures provided supplementary data for review.METHODS: The analytical model estimated O₂ and CO concentrations in the extravehicular mobility unit (EMU) based on O₂ and CO flow rates into and out of the system. The model was based on 3 h of prebreathe at 15.2 psia, 8 h of EVA at 4.3 psia, and 1 h at 15.2 psia for suit doffing. The Coburn-Forster-Kane equation was used to calculate crewmember carboxyhemoglobin saturation (COHb%) as a function of time. Monitoring of hemoglobin CO saturation (Spco) with a CO-oximeter was conducted pre- and post-EVA during operations on the International Space Station and in ground-based analog environments.RESULTS: The model predicted a maximum PCO in the EMU of 0.061 mmHg and a maximum crewmember COHb% of 2.1%. Operational Spco measurements in mean ± SD during ground-based analog testing were 0.7% ± 1.8% pretest and 0.5% ± 1.5% posttest. Spco values on the ISS were 1.5% ± 0.7% pre-EVA and 1.1% ± 0.3% post-EVA.DISCUSSION: The model predicted that astronauts are not exposed to toxic levels of CO during EVA and operational measurements did not show significant differences between Spco levels between pre- and post-EVA.Makowski MS, Norcross JR, Alexander D, Sanders RW, Conkin J, Young M. Carbon monoxide levels in the extravehicular mobility unit by modeling and operational testing. Aerosp Med Hum Perform. 2019; 90(2):84-91.
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Alexander D, Thrasher M, Hughley B, Woodworth BA, Carroll W, Willig JH, Cho DY. Gamification as a tool for resident education in otolaryngology: A pilot study. Laryngoscope 2018; 129:358-361. [PMID: 30421431 DOI: 10.1002/lary.27286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 11/09/2022]
Affiliation(s)
- David Alexander
- Department of Otolaryngology-Head and Neck Surgery, Birmingham, Alabama, U.S.A
| | - Michelle Thrasher
- Department of Otolaryngology-Head and Neck Surgery, Birmingham, Alabama, U.S.A
| | - Brian Hughley
- Department of Otolaryngology-Head and Neck Surgery, Birmingham, Alabama, U.S.A
| | | | - William Carroll
- Department of Otolaryngology-Head and Neck Surgery, Birmingham, Alabama, U.S.A
| | - James H Willig
- Division of Infectious Disease, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Do-Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, Birmingham, Alabama, U.S.A
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Blair M, Rigby M, Alexander D. Critical Factors for Child Primary: Child-Centricity, Core Principles and Context Sensitivity. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky213.084] [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: 11/13/2022] Open
Affiliation(s)
- M Blair
- Imperial College London, London, UK
| | - M Rigby
- Imperial College London, London, UK
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Pescaroli G, Alexander D. Understanding Compound, Interconnected, Interacting, and Cascading Risks: A Holistic Framework. Risk Anal 2018; 38:2245-2257. [PMID: 29906307 DOI: 10.1111/risa.13128] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 05/04/2023]
Abstract
In recent years, there has been a gradual increase in research literature on the challenges of interconnected, compound, interacting, and cascading risks. These concepts are becoming ever more central to the resilience debate. They aggregate elements of climate change adaptation, critical infrastructure protection, and societal resilience in the face of complex, high-impact events. However, despite the potential of these concepts to link together diverse disciplines, scholars and practitioners need to avoid treating them in a superficial or ambiguous manner. Overlapping uses and definitions could generate confusion and lead to the duplication of research effort. This article gives an overview of the state of the art regarding compound, interconnected, interacting, and cascading risks. It is intended to help build a coherent basis for the implementation of the Sendai Framework for Disaster Risk Reduction (SFDRR). The main objective is to propose a holistic framework that highlights the complementarities of the four kinds of complex risk in a manner that is designed to support the work of researchers and policymakers. This article suggests how compound, interconnected, interacting, and cascading risks could be used, with little or no redundancy, as inputs to new analyses and decisional tools designed to support the implementation of the SFDRR. The findings can be used to improve policy recommendations and support tools for emergency and crisis management, such as scenario building and impact trees, thus contributing to the achievement of a system-wide approach to resilience.
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Affiliation(s)
- Gianluca Pescaroli
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - David Alexander
- Institute for Risk and Disaster Reduction, University College London, London, UK
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Abdelgied M, El-Gazzar A, Alexander D, Alexander W, Numano T, Iigo M, Naiki A, Abdelhamid M, Takase H, Hirose A, Taquahashi Y, Kanno J, Takahashi S, Tsuda H. Potassium octatitanate fibers are possibly carcinogenic in male Fischer 344 rats. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.901] [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: 10/28/2022]
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O’Rourke SM, Byrne G, Tatsuno G, Wright M, Yu B, Mesa KA, Doran RC, Alexander D, Berman PW. Robotic selection for the rapid development of stable CHO cell lines for HIV vaccine production. PLoS One 2018; 13:e0197656. [PMID: 30071025 PMCID: PMC6071959 DOI: 10.1371/journal.pone.0197656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/04/2018] [Accepted: 07/12/2018] [Indexed: 01/13/2023] Open
Abstract
The production of envelope glycoproteins (Envs) for use as HIV vaccines is challenging. The yield of Envs expressed in stable Chinese Hamster Ovary (CHO) cell lines is typically 10-100 fold lower than other glycoproteins of pharmaceutical interest. Moreover, Envs produced in CHO cells are typically enriched for sialic acid containing glycans compared to virus associated Envs that possess mainly high-mannose carbohydrates. This difference alters the net charge and biophysical properties of Envs and impacts their antigenic structure. Here we employ a novel robotic cell line selection strategy to address the problems of low expression. Additionally, we employed a novel gene-edited CHO cell line (MGAT1- CHO) to address the problems of high sialic acid content, and poor antigenic structure. We demonstrate that stable cell lines expressing high levels of gp120, potentially suitable for biopharmaceutical production can be created using the MGAT1- CHO cell line. Finally, we describe a MGAT1- CHO cell line expressing A244-rgp120 that exhibits improved binding of three major families of bN-mAbs compared to Envs produced in normal CHO cells. The new strategy described has the potential to eliminate the bottleneck in HIV vaccine development that has limited the field for more than 25 years.
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Affiliation(s)
- Sara M. O’Rourke
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Gabriel Byrne
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Gwen Tatsuno
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Meredith Wright
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Bin Yu
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Kathryn A. Mesa
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Rachel C. Doran
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - David Alexander
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
| | - Phillip W. Berman
- Department of Biomolecular Engineering, The University of California at Santa Cruz, Santa Cruz, California, United States of America
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Herson MR, Hamilton K, White J, Alexander D, Poniatowski S, O'Connor AJ, Werkmeister JA. Interaction of preservation methods and radiation sterilization in human skin processing, with particular insight on the impact of the final water content and collagen disruption. Part I: process validation, water activity and collagen changes in tissues cryopreserved or processed using 50, 85 or 98% glycerol solutions. Cell Tissue Bank 2018; 19:215-227. [PMID: 29696490 DOI: 10.1007/s10561-018-9694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
Current regulatory requirements demand an in-depth understanding and validation of protocols used in tissue banking. The aim of this work was to characterize the quality of split thickness skin allografts cryopreserved or manufactured using highly concentrated solutions of glycerol (50, 85 or 98%), where tissue water activity (aw), histology and birefringence changes were chosen as parameters. Consistent aw outcomes validated the proposed processing protocols. While no significant changes in tissue quality were observed under bright-field microscopy or in collagen birefringence, in-process findings can be harnessed to fine-tune and optimize manufacturing outcomes in particular when further radiation sterilization is considered. Furthermore, exposing the tissues to 85% glycerol seems to derive the most efficient outcomes as far as aw and control of microbiological growth.
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Affiliation(s)
- M R Herson
- Department of Surgery - Central Medical School, Monash University, Melbourne, Australia.
| | - K Hamilton
- Donor Tissue Bank of Victoria - Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - J White
- CSIRO - Manufacturing, Clayton, Australia
| | | | - S Poniatowski
- Donor Tissue Bank of Victoria - Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - A J O'Connor
- Department of Chemical and Biomolecular Engineering, University of Melbourne, Melbourne, Australia
| | - J A Werkmeister
- Hudson Institute of Medical Research, Monash University, Clayton, Australia
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Dewar I, Eagles J, Klein S, Gray N, Alexander D. Psychiatric trainees' experiences of, and reactions to, patient suicide. Psychiatr bull 2018. [DOI: 10.1192/pb.24.1.20] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThis survey is the first UK study of trainee psychiatrists' experiences of patient suicide. One hundred and three senior and specialist registrars in psychiatry working in Scotland completed the questionnaire, representing an 81% response rate.ResultsAlmost half (47%) had experienced suicide of a patient in their care or otherwise known to them (e.g. through on-call experiences). Although only 28% recalled previous training on issues to consider following a suicide, all of these doctors found this to be of value. Many reported that patient suicide had a deleterious impact on their personal and professional lives. The most valuable supports were informal, and the trainees' consultants appeared particularly well placed to offer support and advice.Clinical ImplicationsMany trainee psychiatrists experience the suicide of a patient. Such experiences have potential for adverse effects on doctors' professional practice and personal life. Greater availability of training in this area would allow trainees to be better prepared for such an event. Trainees' consultants have a pivotal role to play in providing appropriate advice and support after a patient suicide.
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Law J, Young M, Alexander D, Mason SS, Wear ML, Méndez CM, Stanley D, Ryder VM, Van Baalen M. Carbon Dioxide Physiological Training at NASA. Aerosp Med Hum Perform 2017; 88:897-902. [PMID: 28923137 DOI: 10.3357/amhp.4552.2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Astronauts undergo CO2 exposure training to recognize their symptoms that can arise acutely both on the ground and in spaceflight. This article describes acute CO2 exposure training at NASA and examines the symptoms reported by astronauts during training. METHODS In a controlled training environment, astronauts are exposed to up to 8% CO2 (60 mmHg) by a rebreathing apparatus. Symptoms are reported using a standard form. RESULTS Symptom documentation forms between April 1994 and February 2012 were obtained for 130 astronauts. The number of symptoms reported per session out of the possible 24 was related to age and sex, with those older slightly more likely to report symptoms. Women reported more symptoms on average than men (men: 3.7, women: 4.7). Respiratory symptoms (90%), flushing sensation/sweating (56%), and dizziness/feeling faint/lightheadedness (43%) were the top symptoms. Only headache reached statistical significance in differences between men (13%) and women (37%) after adjustment for multiple testing. Among those with multiple training sessions, respiratory symptoms were the most consistently reported. DISCUSSION CO2 exposure training is an important tool to educate astronauts about their potential acute CO2 symptoms. Wide interindividual and temporal variations were observed in symptoms reported during astronaut CO2 exposure training. Headache could not be relied on as a marker of acute exposure during testing since fewer than half the subjects reported it. Our results support periodic refresher training since symptoms may change over time. Further study is needed to determine the optimal interval of training to maximize symptom recognition and inform operational decisions.Law J, Young M, Alexander D, Mason SS, Wear ML, Méndez CM, Stanley D, Meyers Ryder V, Van Baalen M. Carbon dioxide physiological training at NASA. Aerosp Med Hum Perform. 2017; 88(10):897-902.
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Alexander D, Allardice GM, Moug SJ, Morrison DS. A retrospective cohort study of the influence of lifestyle factors on the survival of patients undergoing surgery for colorectal cancer. Colorectal Dis 2017; 19:544-550. [PMID: 28027419 DOI: 10.1111/codi.13594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
Abstract
AIM Several modifiable and nonmodifiable health-related behaviours are associated with the incidence of colorectal cancer (CRC), but there is little research on their association with survival. This work aimed to investigate possible relationships between modifiable behavioural factors and outcomes on a study cohort of CRC patients undergoing potentially curative surgery. METHOD A retrospective cohort study was carried out of patients diagnosed with nonmetastatic CRC residing in the NHS Greater Glasgow and Clyde area, UK and undergoing elective curative surgery (January 2011 to December 2012). Data were obtained from the Scottish Cancer Registry, National Scottish Death Records. Preoperative assessment of smoking, alcohol consumption, nurse-measured body mass index (BMI) and exercise levels were recorded, and patients were followed until death or censorship. Survival analysis was carried out and proportional hazards assumptions were assessed graphically using plots and were then formally tested using the PHTEST procedure in stata. RESULT Of the initial 527 patients, 181 (34%) satisfied the inclusion criteria. The total duration of follow-up was 480 person-years. At the preoperative assessment, 75% of patients were overweight or obese, 10.6% were current smokers, 13.1% recorded excess alcohol consumption and 8.5% had physical difficulty climbing stairs. Age, BMI, histopathological stage and physical capacity all independently affected survival (P < 0.05). Overweight patients [hazard ratio (HR) 2.81] and those who had difficulty climbing stairs (HR 3.31) had a significantly poorer survival. CONCLUSION This study found evidence that preoperative exercise capacity and BMI are important independent prognostic factors of survival in patients undergoing curative surgery for CRC.
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Affiliation(s)
| | - G M Allardice
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - D S Morrison
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
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Abstract
BACKGROUND A defunctioning loop ileostomy mitigates the consequences of anastomotic leak from low rectal anastomosis but it is associated with significant morbidity. In this study, the outcome of early reversal of defunctioning ileostomy during the same admission with the primary operation was assessed. METHODS This randomized study was carried out at York Teaching Hospital during the period 2003-2007. All patients with defunctioning ileostomy were considered for an early second operation if they had an uneventful recovery and were in good general condition. Patients on steroids, at high cardiorespiratory risk and those experiencing any postoperative complication were excluded. Eligible patients with satisfactory gastrografin enema on postoperative day 6 were randomized to early versus late reversal at 6-8 weeks. Outcome measures were ease of closure as assessed by a visual analog scale by the operating surgeon, all postoperative complications, duration of the operation, total length of hospital stay and associated costs. RESULTS Thirty-nine consecutive patients were assessed for eligibility and finally 26 were included in the study. Sixteen patients underwent early reversal. The median(interquartile range (IQR)) age was 62(22) years. Early reversal was significantly superior in terms of ease of abdominal wall closure, ease of reversal (p < 0.01 each), duration of the operation (median(IQR) 20(13) vs. 40(9) min, p < 0.01) and costs of stoma care (median(IQR) 27(9) vs. 311(108) £, p < 0.01). There were no major (grade III/IV) complications in either group. Total length of hospital stay was similar between groups. CONCLUSION In carefully selected patients, early reversal of defunctioning ileostomy is feasible, technically easier and has shorter operative time which can also lead to significant cost savings.
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Affiliation(s)
- Konstantinos Lasithiotakis
- Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, North Yorkshire, YO31 8HE, UK.
| | - Assad Aghahoseini
- Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, North Yorkshire, YO31 8HE, UK
| | - David Alexander
- Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, North Yorkshire, YO31 8HE, UK
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Casimir-Whittington R, Gorham S, Alexander D, Lane C, Moore-Lewis L, Sumbry J, Whittington R, Adams A. Serological and haematological values in geriatric broad-breasted white turkeys. Br Poult Sci 2016; 58:107-109. [PMID: 27845556 DOI: 10.1080/00071668.2016.1250248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Blood samples from 1-, 5- and 10-year-old broad-breasted white turkeys were used to determine haematological and serum values. There were 8 turkeys in each age group. Mean haematocrit, haemoglobin and creatinine values were higher in the 1-year-old than in 10-year-old turkeys. Mean alanine aminotransferase was greater in 1 year old than in 10 year olds and greater in 5 year olds than in 10 year olds. Aspartate aminotransferase values were significantly different between all age groups. Mean alkaline phosphatase was less in 1-year-old than in 10-year-old turkeys. There were no significant differences between the three groups for cholesterol, glucose, total protein, albumin, globulin, calcium and bilirubin. All male turkeys had higher haemoglobin and haematocrit values than age-matched females. These data will help establish basic background references values in geriatric turkeys used in research.
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Affiliation(s)
- R Casimir-Whittington
- a Department of Pathobiology , Tuskegee University, School of Veterinary Medicine , Tuskegee , AL , USA
| | - S Gorham
- a Department of Pathobiology , Tuskegee University, School of Veterinary Medicine , Tuskegee , AL , USA
| | - D Alexander
- a Department of Pathobiology , Tuskegee University, School of Veterinary Medicine , Tuskegee , AL , USA
| | - C Lane
- a Department of Pathobiology , Tuskegee University, School of Veterinary Medicine , Tuskegee , AL , USA
| | | | - J Sumbry
- c SPHV Relief USDA, FSIS , Augusta , GA , USA
| | - R Whittington
- d Department of Biology , Tuskegee University , Tuskegee , AL , USA
| | - A Adams
- a Department of Pathobiology , Tuskegee University, School of Veterinary Medicine , Tuskegee , AL , USA
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