1
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Musters AH, Broderick C, Prieto‐Merino D, Chiricozzi A, Damiani G, Peris K, Dhar S, De A, Freeman E, Arents BWM, Burton T, Bosma AL, Chi C, Fletcher G, Drucker AM, Kabashima K, de Monchy EF, Panda M, Wall D, Vestergaard C, Mahé E, Bonzano L, Kattach L, Napolitano M, Ordoñez‐Rubiano MF, Haufe E, Patruno C, Irvine AD, Spuls PI, Flohr C. The effects of systemic immunomodulatory treatments on COVID-19 outcomes in patients with atopic dermatitis: Results from the global SECURE-AD registry. J Eur Acad Dermatol Venereol 2022; 37:365-381. [PMID: 36169355 PMCID: PMC9537876 DOI: 10.1111/jdv.18613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Limited data are available on the effects of systemic immunomodulatory treatments on COVID-19 outcomes in patients with atopic dermatitis (AD). OBJECTIVE To investigate COVID-19 outcomes in patients with AD treated with or without systemic immunomodulatory treatments, using a global registry platform. METHODS Clinicians were encouraged to report cases of COVID-19 in their patients with AD in the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Atopic Dermatitis (SECURE-AD) registry. Data entered from 1 April 2020 to 31 October 2021 were analysed using multivariable logistic regression. The primary outcome was hospitalization from COVID-19, according to AD treatment groups. RESULTS 442 AD patients (mean age 35.9 years, 51.8% male) from 27 countries with strongly suspected or confirmed COVID-19 were included in analyses. 428 (96.8%) patients were treated with a single systemic therapy (n = 297 [67.2%]) or topical therapy only (n = 131 [29.6%]). Most patients treated with systemic therapies received dupilumab (n = 216). Fourteen patients (3.2%) received a combination of systemic therapies. Twenty-six patients (5.9%) were hospitalized. No deaths were reported. Patients treated with topical treatments had significantly higher odds of hospitalization, compared with those treated with dupilumab monotherapy (odds ratio (OR) 4.65 [95%CI 1.71-14.78]), including after adjustment for confounding variables (adjusted OR (aOR) 4.99 [95%CI 1.4-20.84]). Combination systemic therapy which did not include systemic corticosteroids was associated with increased odds of hospitalization, compared with single agent non-steroidal immunosuppressive systemic treatment (OR 8.09 [95%CI 0.4-59.96], aOR 37.57 [95%CI 1.05-871.11]). Hospitalization was most likely in patients treated with combination systemic therapy which included systemic corticosteroids (OR 40.43 [95%CI 8.16-207.49], aOR 45.75 [95%CI 4.54-616.22]). CONCLUSIONS Overall, the risk of COVID-19 complications appears low in patients with AD, even when treated with systemic immunomodulatory agents. Dupilumab monotherapy was associated with lower hospitalization than other therapies. Combination systemic treatment, particularly combinations including systemic corticosteroids, was associated with the highest risk of severe COVID-19.
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Affiliation(s)
- A. H. Musters
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - C. Broderick
- Unit for Population‐Based Dermatology Research, Guy’s and St Thomas’ NHS Foundation Trust and King’s College LondonLondonUK
| | - D. Prieto‐Merino
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical MedicineLondonUK
| | - A. Chiricozzi
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly,Dermatologia, Università Cattolica del Sacro CuoreRomeItaly
| | - G. Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161MilanItaly,Department of Biomedical, Surgical and Dental SciencesUniversity of MilanMilanItaly,PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological SciencesUniversity of PaduaPaduaItaly
| | - K. Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro CuoreRomeItaly,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli ‐ IRCCSRomeItaly
| | - S. Dhar
- Department of Pediatric DermatologyInstitute of Child HealthKolkataIndia
| | - A. De
- Department of DermatologyCalcutta National Medical CollegeKolkataIndia
| | - E. Freeman
- Department of Dermatology, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA,Medical Practice Evaluation CenterMongan Institute, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - B. W. M. Arents
- Dutch Association for People with Atopic Dermatitis (VMCE), NijkerkThe Netherlands
| | - T. Burton
- Patient Representative (independent), NottinghamUnited Kingdom
| | - A. L. Bosma
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - C.‐C. Chi
- Department of Dermatology, Chang Gung Memorial Hospital, LinkouTaoyuanTaiwan,College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - G. Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of DermatologyUniversity College DublinDublinIreland
| | - A. M. Drucker
- Department of MedicineUniversity of Toronto, Toronto, Canada; Women's College Research Institute, Women's College HospitalTorontoCanada
| | - K. Kabashima
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan,Singapore Immunology Network (SIgN) and Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), BiopolisSingapore
| | - E. F. de Monchy
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - M. Panda
- Department of DVLInstitute of Medical Sciences and SUM HospitalBhubaneswarOdishaIndia
| | - D. Wall
- National and International Skin Registry Solutions (NISR), Charles Institute of DermatologyUniversity College DublinDublinIreland,Hair Restoration BlackrockDublinIreland
| | - C. Vestergaard
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - E. Mahé
- Service de Dermatologie et Médecine VasculaireCentre Hospitalier Victor Dupouy, 69 rue du Lieutenant‐Colonel Prud'honArgenteuilCedexFrance
| | - L. Bonzano
- Dermatology Unit, Azienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - L. Kattach
- Guy's & St. Thomas' Hospitals NHS Foundation Trust
| | - M. Napolitano
- Department of Medicine and Health Sciences Vincenzo TiberioUniversity of MoliseCampobassoItaly
| | | | - E. Haufe
- Center for Evidence‐based Health Care (ZEGV), Medical Faculty Carl Gustav Carus, TU DresdenDresdenGermany
| | - C. Patruno
- Dermatology and Venereology, Department of Health SciencesUniversity Magna Graecia of CatanzaroItaly
| | | | - P. I. Spuls
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - C. Flohr
- Unit for Population‐Based Dermatology Research, Guy’s and St Thomas’ NHS Foundation Trust and King’s College LondonLondonUK
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Freeman E, Cheung W, Kavnoudias H, Majeed A, Kemp W, Roberts SK. Irreversible Electroporation For Hepatocellular Carcinoma: Longer-Term Outcomes At A Single Centre. Cardiovasc Intervent Radiol 2020; 44:247-253. [PMID: 33051707 DOI: 10.1007/s00270-020-02666-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Irreversible electroporation (IRE) is a non-thermal ablation technique for unresectable hepatocellular carcinoma (HCC) not amenable to standard thermal ablation. The aim of this study was to report our longer-term outcomes using this treatment modality. METHOD We identified all patients at our institution who underwent IRE for HCC between December 2008 and October 2019 as recommended after multi-disciplinary team review. Demographic, clinical, tumour response and survival data up until 1 March, 2020 were analysed. The primary outcome was local recurrence-free survival (LRFS) in patients who had a complete response (CR). Secondary outcomes included CR rates, procedure-related complications and the incidence of death or liver transplantation. RESULTS A total of 23 patients (78% males, median age 65.2 years) received IRE therapy to 33 HCC lesions during the study period with the median tumour size being 2.0 cm (range 1.0-5.0 cm). Twenty-nine (87.9%) lesions were successfully ablated after one (n = 26) or two (n = 3) procedures. The median follow-up time for these lesions was 20.4 months. The median overall LRFS was 34.5 (95% CI 24.8 -) months with a 6- and 12-month LRFS of 87.9% (95% CI 75.8-100) and 83.6% (95% CI 70.2-99.7), respectively. Tumours < 2 cm had a 12-month LRFS of 100% (95% CI 100-100). CONCLUSION IRE appears to be an efficacious local ablative method for early stage HCC not amenable to standard ablative techniques, with very good CR rates and longer-term LRFS, particularly for smaller lesions. Further studies comparing this technique to more widely accepted ablative methods such as radiofrequency and microwave ablation are warranted.
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Affiliation(s)
- E Freeman
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia
| | - W Cheung
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - H Kavnoudias
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - A Majeed
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - W Kemp
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - S K Roberts
- Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne, 3004, Australia. .,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
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Farina N, Ibnidris A, Alladi S, Comas-Herrera A, Albanese E, Docrat S, Ferri CP, Freeman E, Govia I, Jacobs R, Astudillo-Garcia CI, Musyimi C, Sani TP, Schneider M, Theresia I, Turana Y, Knapp M, Banerjee S. A systematic review and meta-analysis of dementia prevalence in seven developing countries: A STRiDE project. Glob Public Health 2020; 15:1878-1893. [PMID: 32658604 DOI: 10.1080/17441692.2020.1792527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The STRiDE project sets out to support the development of effective dementia policy in middle-income countries (Brazil, India, Indonesia, Jamaica, Kenya, Mexico, and South Africa). As part of this it will generate new data about the prevalence of dementia for a subset of these countries. This study aims to identify the current estimates of dementia prevalence in these countries and where the gaps lie in the current literature. A systematic review was completed on 30th April 2019 across electronic databases, identifying dementia prevalence literature originating from any of the seven countries. Four hundred and twenty-nine records were identified following de-duplication; 28 studies met the inclusion criteria and were included in the systematic review. Pooled estimates of dementia prevalence ranged from 2% to 9% based on DSM-IV criteria; these figures were generally higher in studies using other diagnostic criteria (e.g. the 10/66 algorithm). Available prevalence data varied between countries. Only Brazil, Mexico and India had data derived from studies judged as having a low risk of bias. Irrespective of country, studies often were not explicit in detailing the representativeness of their sample, or whether there was non-response bias. Further transparent and externally valid dementia prevalence research is needed across the STRiDE countries.
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Affiliation(s)
- N Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - A Ibnidris
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - S Alladi
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - A Comas-Herrera
- London School of Economics and Political Science, London, UK
| | - E Albanese
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - S Docrat
- Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - C P Ferri
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - E Freeman
- London School of Economics and Political Science, London, UK
| | - I Govia
- Caribbean Institute for Health Research (CAIHR) - Epidemiology Research Unit, The University of the West Indies, Kingston, Jamaica
| | - R Jacobs
- Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - C Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - T P Sani
- Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - M Schneider
- Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - I Theresia
- Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Y Turana
- Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - M Knapp
- London School of Economics and Political Science, London, UK
| | - S Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK.,Faculty of Health, University of Plymouth, Plymouth, UK
| | -
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
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4
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Phillip CR, Mancera-Cuevas K, Leatherwood C, Chmiel JS, Erickson DL, Freeman E, Granville G, Dollear M, Walker K, McNeil R, Correia C, Canessa P, Ramsey-Goldman R, Feldman CH. Implementation and dissemination of an African American popular opinion model to improve lupus awareness: an academic-community partnership. Lupus 2019; 28:1441-1451. [PMID: 31594456 DOI: 10.1177/0961203319878803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/16/2022]
Abstract
OBJECTIVE Lupus is a chronic, autoimmune disease that disproportionately affects African Americans. We adapted the Centers for Disease Control and Prevention's Popular Opinion Leader model to implement an intervention tailored for African American individuals that leverages an academic-community partnership and community-based social networks to disseminate culturally appropriate lupus education. METHODS Academic rheumatologists, social scientists, and researchers in Boston, MA and Chicago, IL partnered with local lupus support groups, community organizations, and churches in neighborhoods with higher proportions of African Americans to develop curriculum and recruit community leaders with and without lupus (Popular Opinion Leaders; POLs). POLs attended four training sessions focused on lupus education, strategies to educate others, and a review of research methods. POLs disseminated information through their social networks and recorded their impact, which was mapped using a geographic information system framework. RESULTS We trained 18 POLs in greater Boston and 19 in greater Chicago: 97% were African American, 97% were female; and the mean age was 57 years. Fifty-nine percent of Boston POLs and 68% of Chicago POLs had lupus. POLs at both sites engaged members of their social networks and communities in conversations about lupus, health disparities, and the importance of care. Boston POLs documented 97 encounters with 547 community members reached. Chicago POLs documented 124 encounters with 4083 community members reached. CONCLUSIONS An adapted, community-based POL model can be used to disseminate lupus education and increase awareness in African American communities. Further research is needed to determine the degree to which this may begin to reduce disparities in access to care and outcomes.
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Affiliation(s)
- C R Phillip
- Division of Rheumatology, Immunology & Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - K Mancera-Cuevas
- Department of Medicine/Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - C Leatherwood
- Division of Rheumatology, Immunology & Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - J S Chmiel
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - D L Erickson
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | | | - M Dollear
- Lupus Society of Illinois, Chicago, IL
| | - K Walker
- Lupus Society of Illinois Support Group, Hazel Crest, IL
| | - R McNeil
- Lupus Society of Illinois, Trinity United Church of Christ Health Ministries, Chicago, IL
| | - C Correia
- Department of Medicine/Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - P Canessa
- Illinois Public Health Association, Springfield, IL
| | - R Ramsey-Goldman
- Department of Medicine/Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - C H Feldman
- Division of Rheumatology, Immunology & Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Oyesiku L, Regan S, Busakhala N, Asirwa F, Wenger M, Semeere A, Wools-Kaloustian K, Bassett I, Martin J, Freeman E. 217 Real-world chemotherapy adherence for Kaposi’s sarcoma in Sub-Saharan Africa. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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6
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Freeman M, Vera G, Escobar J, Rivas P, Vega S, Freeman E, Jaramillo J, Valencia E. Osseous healing followup after intraoral vertical ramus osteotomy. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.360] [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: 11/30/2022]
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7
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Vafaei A, Aubin M, Buhrmann R, Kergoat M, Aljied R, Freeman E. THE INTERACTION OF VISUAL ACUITY AND PERIPHERAL VASCULAR DISEASE WITH BALANCE: CANADIAN LONGITUDINAL STUDY ON AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1927] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | - M Kergoat
- Institut universitaire de gériatrie de Montréal
| | - R Aljied
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa
| | - E Freeman
- School of Epidemiology and Public Health, University of Ottawa
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8
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Seth D, Thomas C, Chelidze K, Chang A, Nolen M, Watson L, Maurer T, Keung C, Opondo J, Kiprono S, Freeman E. 339 Interdisciplinary dermatologic and wound care needs assessment in Western Kenya. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Freeman E, Busakhala N, Asirwa F, Regan S, Wenger M, Chelidze K, Semeere A, Seth D, Wools-Kaloustian K, Bassett I, Martin J. 325 Kaposis sarcoma severity, treatment and survival in a large community-based HIV health care network in Kenya. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.331] [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: 10/17/2022]
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10
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Singhal NK, Alkhayer K, Shelestak J, Clements R, Freeman E, McDonough J. Erythropoietin Upregulates Brain Hemoglobin Expression and Supports Neuronal Mitochondrial Activity. Mol Neurobiol 2018; 55:8051-8058. [PMID: 29498007 DOI: 10.1007/s12035-018-0971-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/19/2018] [Indexed: 01/09/2023]
Abstract
Multiple sclerosis (MS) is a neuro-inflammatory and demyelinating disease. Downregulation of neuronal mitochondrial gene expression and activity have been reported in several studies of MS. We have previously shown that hemoglobin-β (Hbb) signals to the nucleus of neurons and upregulates H3K4me3, a histone mark involved in regulating cellular metabolism and differentiation. The present study was undertaken to evaluate the effect of erythropoietin (EPO) on the upregulation of hemoglobin and mitochondrial-associated neuroprotection. We found that administering EPO (5000 IU/kg intraperitoneally) to mice upregulated brain Hbb expression, levels of H3K4me3, expression of mitochondrial complex III, complex V, and mitochondrial respiration. We also found that the neuronal mitochondrial metabolite N-acetylaspartate (NAA), a marker of neuronal mitochondrial activity, was increased with EPO treatment. Further, we measured the effects of EPO on preventing mitochondrial deficits in the cuprizone toxic demyelinating mouse model of MS. We found that EPO prevented cuprizone-mediated decreases in Hbb, complex III, and NAA. Our data suggest that EPO mediated regulation of Hbb supports neuronal energetics and may provide neuroprotection in MS and other neurodegenerative diseases where a dysfunction of mitochondria contributes to disease.
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Affiliation(s)
- N K Singhal
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA.
| | - K Alkhayer
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - J Shelestak
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - R Clements
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - E Freeman
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - J McDonough
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA.
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Singhal NK, Freeman E, Arning E, Wasek B, Clements R, Sheppard C, Blake P, Bottiglieri T, McDonough J. Dysregulation of methionine metabolism in multiple sclerosis. Neurochem Int 2017; 112:1-4. [PMID: 29080803 DOI: 10.1016/j.neuint.2017.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 06/21/2017] [Revised: 09/27/2017] [Accepted: 10/24/2017] [Indexed: 12/18/2022]
Abstract
We report a significant reduction in plasma methionine concentrations in relapse remitting multiple sclerosis (MS) patients compared to controls. In vivo studies demonstrate that changes in peripheral methionine levels in mice can regulate histone H3 methylation and expression of DNA methyltransferase 3A (DNMT3A) centrally, in the cerebral cortex. Therefore, we propose that decreases in circulating methionine represent one of the earliest manifestations of dysregulated methionine metabolism in MS with potential impacts on both histone H3 and DNA methylation in the central nervous system.
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Affiliation(s)
- N K Singhal
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH 44240, United States.
| | - E Freeman
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH 44240, United States
| | - E Arning
- Center of Metabolomics, Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX 75226, United States
| | - B Wasek
- Center of Metabolomics, Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX 75226, United States
| | - R Clements
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH 44240, United States
| | - C Sheppard
- Oak Clinic for Multiple Sclerosis, Uniontown, OH, 44685, United States
| | - P Blake
- Oak Clinic for Multiple Sclerosis, Uniontown, OH, 44685, United States
| | - T Bottiglieri
- Center of Metabolomics, Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX 75226, United States
| | - J McDonough
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH 44240, United States
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12
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Freeman E, Harper J, Goel N, Gilbert I, Unguris J, Schiff SJ, Tadigadapa S. Improving the magnetoelectric performance of Metglas/PZT laminates by annealing in a magnetic field. Smart Mater Struct 2017; 26:085038. [PMID: 28966478 PMCID: PMC5615411 DOI: 10.1088/1361-665x/aa770b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A comprehensive investigation of magnetostriction optimization in Metglas 2605SA1 ribbons is performed to enhance magnetoelectric performance. We explore a range of annealing conditions to relieve remnant stress and align the magnetic domains in the Metglas, while minimizing unwanted crystallization. The magnetostriction coefficient, magnetoelectric coefficient, and magnetic domain alignment are correlated to optimize magnetoelectric performance. We report on direct magnetostriction observed by in-plane Doppler vibrometer and domain imagining using scanning electron microscopy with polarization analysis for a range of annealing conditions. We find that annealing in an oxygen-free environment at 400 °C for 30 min yields an optimal magnetoelectric coefficient, magnetostriction and magnetostriction coefficient. The optimized ribbons had a magnetostriction of 50.6 ± 0.2 μm m-1 and magnetoelectric coefficient of 79.3 ± 1.5 μm m-1 mT-1. The optimized Metglas 2605SA1 ribbons and PZT-5A (d31 mode) sensor achieves a magnetic noise floor of approximately 600 pT Hz-1/2 at 100 Hz and a magnetoelectric coefficient of 6.1 ± 0.03 MV m-1 T-1.
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Affiliation(s)
- E Freeman
- Department of Electrical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - J Harper
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, United States of America
| | - N Goel
- Department of Electrical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - I Gilbert
- Center for Nanoscale Science and Technology, National Institute of Standards and Technology, Gaithersburg, MD, United States of America
| | - J Unguris
- Center for Nanoscale Science and Technology, National Institute of Standards and Technology, Gaithersburg, MD, United States of America
| | - S J Schiff
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, United States of America
- Departments of Neurosurgery and Physics, The Pennsylvania State University, University Park, PA, United States of America
| | - S Tadigadapa
- Department of Electrical Engineering, The Pennsylvania State University, University Park, PA, United States of America
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13
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Skinner LC, Primeau F, Freeman E, de la Fuente M, Goodwin PA, Gottschalk J, Huang E, McCave IN, Noble TL, Scrivner AE. Radiocarbon constraints on the glacial ocean circulation and its impact on atmospheric CO 2. Nat Commun 2017; 8:16010. [PMID: 28703126 PMCID: PMC5511348 DOI: 10.1038/ncomms16010] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/22/2017] [Indexed: 11/15/2022] Open
Abstract
While the ocean’s large-scale overturning circulation is thought to have been significantly different under the climatic conditions of the Last Glacial Maximum (LGM), the exact nature of the glacial circulation and its implications for global carbon cycling continue to be debated. Here we use a global array of ocean–atmosphere radiocarbon disequilibrium estimates to demonstrate a ∼689±53 14C-yr increase in the average residence time of carbon in the deep ocean at the LGM. A predominantly southern-sourced abyssal overturning limb that was more isolated from its shallower northern counterparts is interpreted to have extended from the Southern Ocean, producing a widespread radiocarbon age maximum at mid-depths and depriving the deep ocean of a fast escape route for accumulating respired carbon. While the exact magnitude of the resulting carbon cycle impacts remains to be confirmed, the radiocarbon data suggest an increase in the efficiency of the biological carbon pump that could have accounted for as much as half of the glacial–interglacial CO2 change. Establishing the efficiency of the biological carbon pump is needed to constrain the impact of ocean circulation on the carbon cycle. Here, the authors compile a global array of ocean–atmosphere radiocarbon disequilibrium estimates and evaluate the strength of the carbon pump over the last glacial maximum.
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Affiliation(s)
- L C Skinner
- Godwin Laboratory for Palaeoclimate Research, Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
| | - F Primeau
- Department of Earth System Science, University of California, Irvine, California 92697-3100, USA
| | - E Freeman
- Godwin Laboratory for Palaeoclimate Research, Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
| | - M de la Fuente
- Godwin Laboratory for Palaeoclimate Research, Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
| | - P A Goodwin
- National Oceanography Centre, University of Southampton, Southampton SO14 3ZH, UK
| | - J Gottschalk
- Godwin Laboratory for Palaeoclimate Research, Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK.,Oeschger Center for Climate Change Research Institute for Geology University of Bern Baltzerstr. 1-3, 3012 Bern, Switzerland
| | - E Huang
- MARUM-Center for Marine Environmental Sciences and Faculty of Geosciences, University of Bremen, Bremen D-28359, Germany
| | - I N McCave
- Godwin Laboratory for Palaeoclimate Research, Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
| | - T L Noble
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, Tasmania 7001, Australia
| | - A E Scrivner
- Godwin Laboratory for Palaeoclimate Research, Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
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Henson LH, Songsasen N, Waddell W, Wolf KN, Emmons L, Gonzalez S, Freeman E, Maldonado J. Characterization of genetic variation and basis of inflammatory bowel disease in the Toll-like receptor 5 gene of the red wolf and the maned wolf. ENDANGER SPECIES RES 2017. [DOI: 10.3354/esr00790] [Citation(s) in RCA: 4] [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: 11/23/2022] Open
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Mitchell C, Srinivasan S, Zhan X, Wu M, Reed S, Guthrie K, LaCroix A, Fiedler T, Munch M, Liu C, Hoffman N, Blair I, Newton K, Freeman E, Joffe H, Cohen L, Fredricks D. 1: Associations between serum estrogen, vaginal microbiota and vaginal glycogen in postmenopausal women. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Singhal NK, Huang H, Li S, Clements R, Gadd J, Daniels A, Kooijman EE, Bannerman P, Burns T, Guo F, Pleasure D, Freeman E, Shriver L, McDonough J. The neuronal metabolite NAA regulates histone H3 methylation in oligodendrocytes and myelin lipid composition. Exp Brain Res 2016; 235:279-292. [PMID: 27709268 DOI: 10.1007/s00221-016-4789-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/27/2016] [Indexed: 01/01/2023]
Abstract
The neuronal mitochondrial metabolite N-acetylaspartate (NAA) is decreased in the multiple sclerosis (MS) brain. NAA is synthesized in neurons by the enzyme N-acetyltransferase-8-like (NAT8L) and broken down in oligodendrocytes by aspartoacylase (ASPA) into acetate and aspartate. We have hypothesized that NAA links the metabolism of axons with oligodendrocytes to support myelination. To test this hypothesis, we performed lipidomic analyses using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and high-performance thin-layer chromatography (HPTLC) to identify changes in myelin lipid composition in postmortem MS brains and in NAT8L knockout (NAT8L-/-) mice which do not synthesize NAA. We found reduced levels of sphingomyelin in MS normal appearing white matter that mirrored decreased levels of NAA. We also discovered decreases in the amounts of sphingomyelin and sulfatide lipids in the brains of NAT8L-/- mice compared to controls. Metabolomic analysis of primary cultures of oligodendrocytes treated with NAA revealed increased levels of α-ketoglutarate, which has been reported to regulate histone demethylase activity. Consistent with this, NAA treatment resulted in alterations in the levels of histone H3 methylation, including H3K4me3, H3K9me2, and H3K9me3. The H3K4me3 histone mark regulates cellular energetics, metabolism, and growth, while H3K9me3 has been linked to alterations in transcriptional repression in developing oligodendrocytes. We also noted the NAA treatment was associated with increases in the expression of genes involved in sulfatide and sphingomyelin synthesis in cultured oligodendrocytes. This is the first report demonstrating that neuronal-derived NAA can signal to the oligodendrocyte nucleus. These data suggest that neuronal-derived NAA signals through epigenetic mechanisms in oligodendrocytes to support or maintain myelination.
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Affiliation(s)
- N K Singhal
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - H Huang
- Department of Chemistry and Biology, University of Akron, Akron, OH, 44325, USA
| | - S Li
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - R Clements
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - J Gadd
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - A Daniels
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - E E Kooijman
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - P Bannerman
- Department of Cell Biology and Human Anatomy, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - T Burns
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - F Guo
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - D Pleasure
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - E Freeman
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - L Shriver
- Department of Chemistry and Biology, University of Akron, Akron, OH, 44325, USA
| | - J McDonough
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA.
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Manibusan M, Touart L, Freeman E. Adequacy of current test methods to identify adverse effects caused by endocrine disruptors. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McNulty C, Bowen J, Foy C, Gunn K, Freeman E, Tompkins D, Brady A, Ejidokun T, Donald I, Smith G. Is there an opportunity to reduce urinary catheter-related infections? Exploring variation in catheterisation rates in care homes. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14690446060070010701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
rinary catheterisation in care homes is associated with increased morbidity, hospitalisation and mortality. The authors aimed to determine whether staffing, resident underlying illness or nursing band, or use of other toileting methods were responsible for the wide variation in urinary catheterisation rates found in English care homes. The authors approached randomly-selected registered care homes in three former health districts in England. A questionnaire survey was used to determine the number of residents in each nursing care band and with different medical conditions that were catheterised, and the home's management of residents' continence. The number of residents or staffing did not influence catheterisation rate. Higher catheterisation rate homes had a lower proportion of high band nursing residents and residents with incontinence, severe physical disability and dementia than the other homes. Only urinary retention (3 per cent of residents) was significantly more common in the higher catheterisation rate homes. There was no difference in continence care before inserting a catheter. The authors suggest that care culture and staff attitudes to catheterisation should be explored in greater depth using structured interviews or focus groups. This may allow the identification of key factors that can be targeted in order to reduce catheterisation rates and the associated morbidity.
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Affiliation(s)
- C.A.M. McNulty
- Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
| | - J. Bowen
- Health Protection Agency Primary Care Unit, (Now Medical Research Department, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN
| | - C. Foy
- Research and Development Support Unit, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
| | - K. Gunn
- Health Protection Agency Shropshire and Staffordshire Health Protection Unit, Mellor House, Corporation Street, Stafford ST15 3SR
| | - E. Freeman
- Gloucestershire Research and Development Support Unit, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
| | - D. Tompkins
- Health Protection Agency Yorkshire and the Humber, Bridle Path, York Road, Leeds LS15 7TR
| | - A. Brady
- Leeds Community and Mental Health Services Teaching NHS Trust, North Wing, St Mary's House, St Mary's Road, Leeds LS7 3JX
| | - T. Ejidokun
- Health Protection Agency Gloucestershire, Health Protection Team, Cheltenham and Tewkesbury Primary Care Trust, Unit 43 Central Way, Arle Road, Cheltenham GL51 8LX
| | - I. Donald
- Gloucestershire Hospitals NHS Trust, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
| | - G.E. Smith
- Health Protection Agency West Midlands, Second Floor, Lincoln House, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS
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Martens K, Jeong JW, Aetukuri N, Rettner C, Shukla N, Freeman E, Esfahani DN, Peeters FM, Topuria T, Rice PM, Volodin A, Douhard B, Vandervorst W, Samant MG, Datta S, Parkin SSP. Field Effect and Strongly Localized Carriers in the Metal-Insulator Transition Material VO(2). Phys Rev Lett 2015; 115:196401. [PMID: 26588400 DOI: 10.1103/physrevlett.115.196401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Indexed: 06/05/2023]
Abstract
The intrinsic field effect, the change in surface conductance with an applied transverse electric field, of prototypal strongly correlated VO(2) has remained elusive. Here we report its measurement enabled by epitaxial VO(2) and atomic layer deposited high-κ dielectrics. Oxygen migration, joule heating, and the linked field-induced phase transition are precluded. The field effect can be understood in terms of field-induced carriers with densities up to ∼5×10(13) cm(-2) which are trongly localized, as shown by their low, thermally activated mobility (∼1×10(-3) cm(2)/V s at 300 K). These carriers show behavior consistent with that of Holstein polarons and strongly impact the (opto)electronics of VO(2).
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Affiliation(s)
- K Martens
- IBM Research-Almaden, San Jose, California 95120, USA
- ESAT Department, KU Leuven, Leuven BE-3001, Belgium
- IMEC, Kapeldreef 75, Leuven BE-3001, Belgium
| | - J W Jeong
- IBM Research-Almaden, San Jose, California 95120, USA
| | - N Aetukuri
- IBM Research-Almaden, San Jose, California 95120, USA
| | - C Rettner
- IBM Research-Almaden, San Jose, California 95120, USA
| | - N Shukla
- Department of Electrical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - E Freeman
- Department of Electrical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - D N Esfahani
- Physics Department, University of Antwerp, Groenenborgerlaan 171 BE-2020, Antwerp BE-2020, Belgium
| | - F M Peeters
- Physics Department, University of Antwerp, Groenenborgerlaan 171 BE-2020, Antwerp BE-2020, Belgium
| | - T Topuria
- IBM Research-Almaden, San Jose, California 95120, USA
| | - P M Rice
- IBM Research-Almaden, San Jose, California 95120, USA
| | - A Volodin
- Department of Physics and Astronomy, KU Leuven, Leuven BE-3001, Belgium
| | - B Douhard
- IMEC, Kapeldreef 75, Leuven BE-3001, Belgium
| | - W Vandervorst
- IMEC, Kapeldreef 75, Leuven BE-3001, Belgium
- Department of Physics and Astronomy, KU Leuven, Leuven BE-3001, Belgium
| | - M G Samant
- IBM Research-Almaden, San Jose, California 95120, USA
| | - S Datta
- Department of Electrical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - S S P Parkin
- IBM Research-Almaden, San Jose, California 95120, USA
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Chan R, Freeman E. P-37 * OXYCODONE MISUSE. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu054.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Ntonia I, Freeman E. Nasal-Temporal Asymmetries in Suprathreshold Facial Expressions of Emotion. Iperception 2014. [DOI: 10.1068/ii36] [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: 10/23/2022] Open
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22
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Li S, Clements R, Sulak M, Gregory R, Freeman E, McDonough J. Decreased NAA in gray matter is correlated with decreased availability of acetate in white matter in postmortem multiple sclerosis cortex. Neurochem Res 2014; 38:2385-96. [PMID: 24078261 DOI: 10.1007/s11064-013-1151-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/02/2013] [Accepted: 09/05/2013] [Indexed: 01/31/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system (CNS) which leads to progressive neurological disability. Our previous studies have demonstrated mitochondrial involvement in MS cortical pathology and others have documented decreased levels of the neuronal mitochondrial metabolite N-acetyl aspartate (NAA) in the MS brain. While NAA is synthesized in neurons, it is broken down in oligodendrocytes into aspartate and acetate. The resulting acetate is incorporated into myelin lipids, linking neuronal mitochondrial function to oligodendrocyte-mediated elaboration of myelin lipids in the CNS. In the present study we show that treating human SH-SY5Y neuroblastoma cells with the electron transport chain inhibitor antimycin A decreased levels of NAA as measured by HPLC. To better understand the significance of the relationship between mitochondrial function and levels of NAA and its breakdown product acetate on MS pathology we then quantitated the levels of NAA and acetate in MS and control postmortem tissue blocks. Regardless of lesion status, we observed that levels of NAA were decreased 25 and 32 % in gray matter from parietal and motor cortex in MS, respectively, compared to controls. Acetate levels in adjacent white matter mirrored these decreases as evidenced by the 36 and 45 % reduction in acetate obtained from parietal and motor cortices. These data suggest a novel mechanism whereby mitochondrial dysfunction and reduced NAA levels in neurons may result in compromised myelination by oligodendrocytes due to decreased availability of acetate necessary for the synthesis of myelin lipids.
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Abstract
Research on HIV infection and sexual behaviour in sub-Saharan Africa typically focuses on individuals aged 15-49 years under the assumption that both become less relevant for older individuals. We test this assumption using data from rural Malawi to compare sexual behaviour and HIV infection for individuals aged 15-49 with individuals aged 50-64 and 65 and over years. Although general declines with age were observed, levels of sexual activity and HIV remained considerable: 26.7% and 73.8% of women and men aged 65+ reported having sex in the last year, respectively; men's average number of sexual partners remained above one; and HIV prevalence is significantly higher for men aged 50-64 (8.9%) than men aged 15-49 (4.1%). We conclude that older populations are relevant to studies of sexual behaviour and HIV risk. Their importance is likely to increase as access to antiretrovirals in Africa increases. We recommend inclusion of adults aged over 49 years in African HIV/AIDS research and prevention efforts.
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Affiliation(s)
- E Freeman
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
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Freeman E, Hayward I, Frydman G. Can people with lifestyle related chronic disease BEAT IT through physical activity and education? J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.123] [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: 12/01/2022]
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Affiliation(s)
- S Shah
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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Shih CS, Ekoma S, Ho C, Pradhan K, Hwang E, Jakacki R, Fisher M, Kilburn L, Horn M, Vezina G, Rood B, Packer R, Mittal R, Omar S, Khalifa N, Bedir R, Avery R, Hwang E, Acosta M, Hutcheson K, Santos D, Zand D, Kilburn L, Rosenbaum K, Rood B, Packer R, Kalin-Hajdu E, Ospina L, Carret AS, Marzouki M, Decarie JC, Freeman E, Hershon L, Warmuth-Metz M, Zurakowski D, Bison B, Falkenstein F, Gnekow A, Ehrstedt C, Laurencikas E, Bjorklund AC, Stromberg B, Hedborg F, Pfeifer S, Bertin D, Packer RJ, Vallero S, Basso ME, Romano E, Peretta P, Morra I, D'Alonzo G, Fagioli F, Toledano H, Laviv Y, Dratviman-Storobinsky O, Michowiz S, Yaniv I, Cohen IJ, Goldenberg-Cohen N, Muller K, Gnekow A, Warmuth-Metz M, Pietsch T, Zwiener I, Falkenstein F, Meyer FM, Micke O, Hoffmann W, Kortmann RD, Shofty B, Ben-Sira L, Roth J, Constantini S, Shofty B, Weizmann L, Joskowicz L, Kesler A, Ben-Bashat D, Yalon M, Dvir R, Freedman S, Roth J, Ben-Sira L, Constantini S, Bandopadhayay P, Dagi L, Robison N, Goumnerova L, Ullrich N, Opocher E, De Salvo GL, De Paoli A, Simmons I, Sehested A, Walker DA, Picton SV, Gnekow A, Grill J, Driever PH, Azizi AA, Viscardi E, Perilongo G, Cappellano AM, Bouffet E, Silva F, Paiva P, Cavalheiro S, Seixas MT, Silva NS, Antony R, Fraser K, Lin J, Falkenstein F, Kwiecien R, Mirow C, Thieme B, von Hornstein S, Pietsch T, Faldum A, Warmuth-Metz M, Kortmann RD, Gnekow AK, Shofty B, Bokshtein F, Kesler A, Ben-Sira L, Freedman S, Constantini S, Panandiker AP, Klimo P, Thompson C, Armstrong G, Kun L, Boop F, Sanford A, Orge F, Laschinger K, Gold D, Bangert B, Stearns D, Cappellano AM, Senerchia A, Paiva P, Cavalheiro S, Silva F, Silva NS, Gnekow AK, Falkenstein F, Walker D, Perilongo G, Picton S, Grill J, Kortmann RD, Stokland T, van Meeteren AS, Slavc I, Faldum A, de Salvo GL, Fernandez KS, Antony R, Lulla RR, Flores M, Benavides VC, Mitchell C, AlKofide A, Hassonah M, Khafagh Y, Ayas MA, AlFawaz I, Anas M, Barria M, Siddiqui K, Al-Shail E, Fisher MJ, Ullrich NJ, Ferner RE, Gutmann DH, Listernick R, Packer RJ, Tabori U, Hoffman RO, Ardern-Holmes SL, Hummel TR, Hargrave DR, Charrow J, Loguidice M, Balcer LJ, Liu GT, Fisher MJ, Listernick R, Gutmann DH, Ferner RE, Packer RJ, Ullrich NJ, Tabori U, Hoffman RO, Ardern-Holmes SL, Hummel TR, Hargrave DR, Loguidice M, Balcer LJ, Liu GT, Jeeva I, Nelson O, Guy D, Damani A, Gogi D, Picton S, Simmons I, Jeeva I, Picton S, Guy D, Nelson O, Dewsbery S, Gogi D, Simmons I, Sievert AJ, Lang SS, Boucher K, Slaunwhite E, Brewington D, Madsen P, Storm PB, Resnick AC, Hemenway M, Madden J, Macy M, Foreman N, Rush S, Mascelli S, Raso A, Barla A, Nozza P, Biassoni R, Pignatelli S, Cama A, Verri A, Capra V, Garre M, Bergthold G, Piette C, Raquin MA, Dufour C, Varlet P, Dhermain F, Puget S, Sainte-Rose C, Abely M, Canale S, Grill J, Terashima K, Chow K, Jones J, Ahern C, Jo E, Ellezam B, Paulino A, Okcu MF, Su J, Adesina A, Mahajan A, Dauser R, Whitehead W, Lau C, Chintagumpala M, Kebudi R, Tuncer S, Cakir FB, Gorgun O, Agaoglu FY, Ayan I, Darendeliler E, Wolf D, Cohen K, Jeyapalan JN, Morley ICF, Hill AA, Tatevossian RG, Qaddoumi I, Ellison DW, Sheer D, Donson A, Barton V, Birks D, Kleinschmidt-DeMasters BK, Hemenway M, Handler M, Foreman N, Rush S, Tatevossian R, Qaddoumi I, Tang B, Dalton J, Shurtleff S, Punchihewa C, Orisme W, Neale G, Gajjar A, Baker S, Sheer D, Ellison D, Gilheeney S, Jamzadeh A, Winchester M, Yataghene K, De Braganca K, Khakoo Y, Lyden D, Dunkel I, Terasaki M, Eto T, Morioka M, Ho CY, Bar E, Giannini C, Karajannis MA, Zagzag D, Eberhart CG, Rodriguez FJ, Lee Y, Bartels U, Tabori U, Huang A, Bouffet E, Zaky W, Bluml S, Grimm J, Wong K, McComb G, Gilles F, Finlay J, Dhall G, Chen HH, Chen YW, Chang FC, Lin SC, Chang KP, Ho DM, Wong TT, Lee CC, Azizi AA, Fox R, Grill J, Mirow C, Gnekow A, Walker D, Perilongo G, Opocher E, Wheatley K, van Meeteren AYS, Phuakpet K, Tabori U, Bartels U, Huang A, Kulkarni A, Laperriere N, Bouffet E, Epari S, Nair V, Gupta T, Patil P, Moiyadi A, Shetty P, Kane S, Jalali R, Dorris K, Nadi M, Sutton M, Wang L, Stogner K, Li D, Hurwitz B, Stevenson C, Miles L, Kim MO, Fuller C, Hawkins C, Bouffet E, Jones B, Drake J, Fouladi M, Fontebasso AM, Shirinian M, Jones DTW, Quang DAK, Jacob K, Cin H, Witt H, Gerges N, Montpetit A, Brunet S, Lepage P, Klekner A, Lambert S, Kwan T, Hawkins C, Tabori U, Collins VP, Albrecht S, Pfister SM, Jabado N, Arrington D, Manley P, Kieran M, Chi S, Robison N, Chordas C, Ullrich N. LOW GRADE GLIOMAS. Neuro Oncol 2012; 14:i69-i81. [PMCID: PMC3483338 DOI: 10.1093/neuonc/nos092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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Shah S, Murthy S, Wolf V, Freeman E, Lotze T. Intracranial Optic Nerve Enlargement in Infantile Krabbe's Disease (P02.175). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lukes A, Freeman E, Van Drie D, Baker J, Adomako T. Safety of tranexamic acid in women with heavy menstrual bleeding: an open-label extension study. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Senapati S, Lin H, Pien G, Schwab R, Freeman E, Gracia C. Hormone variations associated with quantitative fat measures in the menopausal transition. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Riley G, Laidlaw J, Pugh D, Freeman E. The responses of professional groups to the use of Section 136 of the Mental Health Act (1983, as amended by the 2007 Act) in Gloucestershire. Med Sci Law 2011; 51:36-42. [PMID: 21595420 DOI: 10.1258/msl.2010.010072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Section 136 (S136) of the Mental Health Act (1983, as amended by the 2007 Act) empowers the police to detain those suspected of being mentally disordered in a public place and to convey them to a place of safety (POS) for further assessment. Gloucestershire has not had a specialist facility for S136 detentions and individuals were taken to the police cells or occasionally A&E departments for assessment. AIMS This paper forms one part of three aspects under investigation. Two companion papers by the authors describe the use of S136 using anonymised audit data and the experiences of detainees. The objectives of this paper have been to assess the responses of the different professional groups involved in the process of S136. METHOD An anonymous postal questionnaire was distributed to eight groups of professionals who were identified as having the potential to be involved in part of the process of a S136 detention. Results were collated and analysed, and formed the basis for a series of follow-up focus groups within groups to explore themes that warranted further investigation. RESULTS An overall response rate of 59% was achieved. Seventy-four per cent of participants thought that there should be an alternative POS to the police station. A&E was thought to be an unsuitable alternative POS, with a psychiatric hospital being the first choice for 58%. CONCLUSIONS There is a gap in the expectations of the different agencies involved in the S136 process, which have the potential to be divisive if interagency pathways and agreements are not in place.
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Affiliation(s)
- G Riley
- 2gether NHS Foundation Trust, Trust Headquarters, Rikenel, Montpellier, Gloucester GL1 1LY, UK.
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Verghese P, Freeman E. Segmentation counteracts masking. J Vis 2010. [DOI: 10.1167/6.6.809] [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] Open
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Su H, Su H, Sammel M, Springer E, Freeman E, DeMichele A, DeMichele A, Mao J, Mao J. Weight Gain Is Associated with Increased Risk of Hot Flashes in Breast Cancer Survivors on Aromatase Inhibitors. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Hot flashes in breast cancer survivors (BCS) receiving adjuvant aromatase inhibitor (AI) therapy are common, but risk factors for these symptoms are not well-defined. This study tested if body size is associated with hot flashes in BCS on AI therapy.Materials and methods: We performed a cross-sectional analysis of a cohort of postmenopausal women with Stages 0-III breast cancer receiving adjuvant AI therapy at a university hospital-based outpatient breast oncology clinic. Subjects provided patient-reported outcomes on hot flashes, current and pre-breast cancer weight and height, and additional demographic and treatment data.The primary outcome was occurrence of hot flashes. Secondary outcomes included hot flash severity and frequency. The exposures of interest were 1) current weight and 2) weight change since breast cancer diagnosis, categorized as weight loss (lost 10 pounds or more), maintenance (+/- 10 pounds), or gain (gained 10 pounds or more). Multivariable logistic regression models examined the independent association between hot flash outcomes and current weight or weight change while controlling for confounders.Results: 300 participants were enrolled at a mean age of 61 years (range 33-86) after mean duration of AI exposure of 23 months (range 1 month-9 years). 177 (59%) reported hot flashes overall, 96 (32%) reported moderate to very severe hot flashes, and 60 (20%) had at least 4 hot flashes daily. 182 (61%) experienced weight maintenance, while 81 (27%) had weight gain and 34 (11%) had weight loss. In a multivariable model, weight gain was independently associated with hot flash occurrence (OR 2.1, 95% CI 1.1-4.4) and hot flash severity (OR 2.4, 95% CI 1.4-4.9), but not hot flash frequency, after adjusting for current weight and height, age, smoking, race, prior chemotherapy and prior tamoxifen therapy. Hot flash occurrence was also significantly associated with current smoking (OR 5.1, 95% CI 1.1-24.0) and age (OR for each additional year of age 0.93, 95% CI 0.90-0.97). Current weight, alcohol use, AI type, and AI duration were not associated with any of the three outcomes.Conclusions: In an outpatient BCS population on AI therapy, weight gain is a risk factor for both hot flash occurrence and severity. Women who gained at least ten pounds since breast cancer diagnosis were two times more likely to have hot flashes than women who maintained or lost weight. These results support the thermoregulatory model of hot flashes and argue against a protective effect of body fat in this population.Support: ACS MRSG-08-110-01-CCE, ACS CCDA#-08-107-01, Pennsylvania Department of Aging
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1059.
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Affiliation(s)
- H. Su
- 1University of Pennsylvania, PA,
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- 2University of Pennsylvania, PA,
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- 2University of Pennsylvania, PA,
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- 5University of Pennsylvania, PA,
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Towrie M, Botchway SW, Clark A, Freeman E, Halsall R, Parker AW, Prydderch M, Turchetta R, Ward AD, Pollard MR. Dynamic position and force measurement for multiple optically trapped particles using a high-speed active pixel sensor. Rev Sci Instrum 2009; 80:103704. [PMID: 19895067 DOI: 10.1063/1.3202381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A high frame rate active pixel sensor designed to track the position of up to six optically trapped objects simultaneously within the field of view of a microscope is described. The sensor comprises 520 x 520 pixels from which a flexible arrangement of six independent regions of interest is accessed at a rate of up to 20 kHz, providing the capability to measure motion in multiple micron scale objects to nanometer accuracy. The combined control of both the sensor and optical traps is performed using unique, dedicated electronics (a field programmable gate array). The ability of the sensor to measure the dynamic position and the forces between six optically trapped spheres, down to femtonewton level, is demonstrated paving the way for application in the physical and life sciences.
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Affiliation(s)
- M Towrie
- Department of Photon Science, Lasers for Science Facility, Rutherford Appleton Laboratory, Science and Technology Facilities Council, Didcot OX11 0QX, United Kingdom.
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McNulty CAM, Freeman E, Oliver I, Ford-Young W, Randall S. Strategies used to increase chlamydia screening in general practice: a qualitative study. Public Health 2008; 122:845-56. [PMID: 18620715 DOI: 10.1016/j.puhe.2007.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 08/01/2007] [Accepted: 10/26/2007] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore strategies used by chlamydia screening co-ordinators and practice staff to implement genital chlamydia screening within general practices. METHODS Qualitative phenomenological study using individual semi-structured telephone interviews. Screening co-ordinators were selected purposively in Phase 1 and 2 areas of the Department of Health National Chlamydia Screening Programme in England, where there was significant screening in general practice. Open questions were asked about: the factors that determined high chlamydia screening rates; maintaining motivation for screening; and strategies to increase screening in general practices. RESULTS Co-ordinators reported that successful screening practices had a champion who drove the screening process forward. These practices had normalized screening, so all at-risk patients were offered opportunistic screening whenever they attended. This was facilitated by a variety of time-saving methods including computer prompts, test kits in the reception area, youth clinics and receptionist involvement. Chlamydia screening was sustained through frequent reminders, newsletters containing chlamydia screening rates, and advertising to the 'at-risk' population from the screening team. Co-ordinators' enthusiasm and project management skills were as important as sexual health experience. Co-ordinators reported that to facilitate chlamydia screening across all practices, screening could be included in the General Medical Services (GMS) contract, and a higher national profile was needed amongst health professionals and the public. CONCLUSIONS All practice staff need to be encouraged to become champions of the chlamydia screening programme through education, especially aimed at older clinicians and receptionists. The National Health Service should consider including chlamydia screening in the GMS contract. Increased public awareness will allow screening to be undertaken more quickly and by non-medical staff.
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Affiliation(s)
- C A M McNulty
- Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
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Shah N, Freeman E, Martinez A, Mellerio J, Smith VV, Lindley KJ, Sebire NJ. Histopathological features of gastrointestinal mucosal biopsy specimens in children with epidermolysis bullosa. J Clin Pathol 2006; 60:843-4. [PMID: 17046847 PMCID: PMC1995778 DOI: 10.1136/jcp.2005.035766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- N Shah
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
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McNulty CAM, Richards J, Livermore DM, Little P, Charlett A, Freeman E, Harvey I, Thomas M. Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care. J Antimicrob Chemother 2006; 58:1000-8. [PMID: 16998209 DOI: 10.1093/jac/dkl368] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolate. PATIENTS AND METHODS This was a prospective cohort study of clinical outcome. We enrolled 497 women (>or=18-70 years) presenting to general practitioner surgeries in Norwich and Gloucester with at least two symptoms of acute (<7 days) uncomplicated UTI. Significant bacteriuria was defined as >or=10(4) cfu/mL from a mid-stream urine (MSU). RESULTS Of enrolled patients 75% (334/448) had significant bacteriuria, and trimethoprim resistance was present in 13.9% (44/317) of isolates. Patients with resistant isolates had a longer median time to symptom resolution (7 versus 4 days, P=0.0002), greater reconsultation to the practice (39% versus 6% in first week, P<0.0001), more subsequent antibiotics (36% versus 4% in first week, P<0.0001) and higher rates of significant bacteriuria at 1 month (42% versus 20% with susceptible isolate, P=0.04). Half of patients reconsulting in the first week had a resistant organism. CONCLUSIONS Patients with uncomplicated UTI caused by trimethoprim-resistant organisms had significantly worse clinical outcomes than those with trimethoprim-susceptible organisms. Nevertheless, trimethoprim resistance was rarer than predicted from routine laboratory submissions and we calculate that 23 women require microbiological investigation to prevent one reconsultation arising from resistance-based treatment failure. We therefore suggest empirical antibiotic treatment in acute, uncomplicated UTIs. If patients reconsult in the first week, we suggest a change of antibiotic treatment with urine culture and susceptibility testing then done. More generally, laboratory resources should concentrate on resistance surveillance to inform empirical antibiotic choice.
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Affiliation(s)
- C A M McNulty
- Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester, and Microbiology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
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Khoe W, Freeman E, Woldorff MG, Mangun GR. Interactions between attention and perceptual grouping in human visual cortex. Brain Res 2006; 1078:101-11. [PMID: 16500628 DOI: 10.1016/j.brainres.2005.12.083] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 05/05/2005] [Revised: 12/15/2005] [Accepted: 12/16/2005] [Indexed: 11/28/2022]
Abstract
Freeman et al. demonstrated that detection sensitivity for a low contrast Gabor stimulus improved in the presence of flanking, collinearly oriented grating stimuli, but only when observers attended to them. By recording visual event-related potentials (ERPs) elicited by a Gabor stimulus, we investigated whether this contextual cueing effect involves changes in the short-latency afferent visual signal from V1 that have a stimulus onset latency between 60 and 80 ms and/or longer-latency changes from visual cortex. Under dual-task conditions, the subjects performed contrast discrimination for a central Gabor and an orientation judgment for a pre-specified subset of the flanking Gabors. On random trials, the central Gabor could be collinearly or orthogonally oriented with respect to the attended flankers. Subjects showed improvements in discriminating the contrast of the central grating when it was oriented collinearly with the attended flankers. The ERP difference between attending to collinear versus orthogonal flankers manifested as a positive polarity response at occipital electrodes with a latency of 180-250 ms after stimulus onset. No shorter-latency contextual cueing differences were observed in the ERPs. The ERP latency profile of the contextual cueing effect argues against the hypothesis that short-latency afferent activity from V1 is the stage of processing at which attention can influence neuronal lateral interactions. However, the scalp voltage distribution of the longer-latency contextual cueing effect is similar to the one generated by the early phasic stimulus onset activity from V1. These findings leave open the possibility that V1 is involved in the attentional modulation of lateral interactions but that this has a longer time course, likely being mediated by re-afferent inputs from later stages of the visual pathway.
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Affiliation(s)
- W Khoe
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093-0608, USA.
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McNulty CAM, Bowen J, Foy C, Gunn K, Freeman E, Tompkins D, Ejidokun T, Donald I, Smith GE. Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff. J Hosp Infect 2005; 62:29-36. [PMID: 16309782 DOI: 10.1016/j.jhin.2005.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 11/24/2004] [Accepted: 03/17/2005] [Indexed: 11/25/2022]
Abstract
A self-administered questionnaire was used to determine care home staff's reported knowledge of the urinary catheter care standards published by the National Institute for Clinical Excellence (NICE) and the Association of Continence Care, and to see whether this differed in homes with higher catheterization rates. Seven hundred and fifty out of 1438 (52%) nursing and care staff from 37 randomly selected care homes with high, medium and low catheterization rates responded. There was no difference in reported practice in care homes in the three health districts sampled or those with differing catheterization rates. Eighty-three percent of the nursing staff and 40% of the other care staff received formal catheter care training. However, at least 10% of all staff reported not washing their hands before handling a catheter, and delaying emptying a urine bag until it was full, rather than three-quarters full. Only 45% of nursing staff and 40% of other care staff encouraged residents to empty their own catheter bags. Routine use of catheter maintenance solutions or bladder washouts was reported by 50% of all staff. Nursing staff (29%) and other care staff (54%) took urine specimens from the catheter bag tap. Compliance with standards has improved greatly since an audit in 1998. However, some non-compliance remains. There is a need for ongoing local audit and formal training in urinary catheter care, particularly for non-qualified care staff. Education is needed to ensure local implementation of NICE guidance.
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Affiliation(s)
- C A M McNulty
- Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK.
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Abstract
BACKGROUND Although serology is the main Helicobacter pylori test used by general practitioners in the UK, there is no information available on variation in requesting rates. AIM To explore the reasons for any variation in H. pylori serology testing by general practices in the UK using qualitative methods. METHODS Serology requesting rates were determined using laboratory and population data. Staff from randomly selected practices in the lowest and highest quintiles of testing attended focus groups to discuss the management of H. pylori and dyspepsia. Transcribed data were analysed using an interpretative phenomenological approach. RESULTS Serology submission varied 600-fold (0.1-59/1000 population/year) and H. pylori positivity rate 17-100%. Low-testing practices were less aware of the benefits of H. pylori testing and had shorter endoscopy waiting times. They preferred endoscopy diagnosis over serology test. Three high-testing practices had a high non-white population with high H. pylori positivity. Most staff knew little about the predictive value of serology, the availability of urea breath test on prescription or the existence of a stool test. CONCLUSIONS Seroprevalence of H. pylori is still high in dyspeptics, especially in non-white populations. Laboratories and primary care trusts should audit H. pylori requests and endoscopy referrals, target education at high endoscopy referrers and low H. pylori testers and inform clinicians of the more accurate H. pylori tests and NICE dyspepsia guidance.
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Affiliation(s)
- C A M McNulty
- Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK.
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Khoe W, Freeman E, Woldorff MG, Mangun GR. Electrophysiological correlates of lateral interactions in human visual cortex. Vision Res 2004; 44:1659-73. [PMID: 15136002 DOI: 10.1016/j.visres.2004.02.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 08/04/2003] [Revised: 02/04/2004] [Indexed: 11/25/2022]
Abstract
Detection thresholds for visually presented targets can be influenced by the nature of information in adjacent regions of the visual field. For example, detection thresholds for low-contrast Gabor patches decrease when flanked by patches that are oriented collinearly rather than orthogonally with the target. Such results are consistent with the known microanatomy of primary visual cortex, where long-range horizontal connections link cortical columns with common orientation preferences. To investigate the neural bases of collinearity effects, we recorded event-related brain potentials (ERPs) together with psychophysical measures for targets flanked by collinear vs. orthogonal gratings. Human volunteers performed a contrast discrimination task on a target grating presented at a perifoveal location. For targets flanked by collinear stimuli, we observed an increased positive polarity voltage deflection in the occipital scalp-recorded ERPs between 80 to 140 ms after stimulus onset. Such a midline occipital scalp voltage distribution of this ERP collinearity effect is consistent with a generator in primary visual cortex. Two later negative voltage ERP deflections (latencies of 245-295 and 300-350 ms) were focused at lateral occipital scalp sites, a pattern consistent with activity in extrastriate visual cortex. These ERP effects were correlated with improved contrast discrimination for central targets presented with collinear flanks. These results demonstrate that the integration of local flanking elements with a central stimulus can occur as early as 80 ms in human visual cortex, but this includes processes occurring at longer latencies and appears to involve both striate and extrastriate visual areas.
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Affiliation(s)
- W Khoe
- Center for Cognitive Research, Duke University, Durham, NC 27708, USA.
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McNulty CAM, Freeman E, Bowen J, Shefras J, Fenton KA. Diagnosis of genital chlamydia in primary care: an explanation of reasons for variation in chlamydia testing. Sex Transm Infect 2004; 80:207-11. [PMID: 15170005 PMCID: PMC1744849 DOI: 10.1136/sti.2003.006767] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the reasons for the 40-fold variation in diagnostic testing for genital Chlamydia trachomatis by general practices. METHODS A qualitative study with focus groups. We randomly selected urban and rural high and low testing practices served by Bristol, Hereford, and Gloucester microbiology laboratories. Open questions were asked about the investigation of C trachomatis in men and women in different clinical contexts. RESULTS The high and low testing practices did not differ in their age/sex make-up or by deprivation indices. There were major differences between high and low chlamydia testing practices. Low testing practices knew very little about the epidemiology and presentation of genital chlamydia infection and did not consider it in their differential diagnosis of genitourinary symptoms until patients had consulted several times. Low testers were less aware that chlamydia was usually asymptomatic, thought it was an inner city problem, and had poor knowledge of how to take diagnostic specimens. High testing practices either had a general practitioner with an interest in sexual health or a practice nurse who had completed specialist training in family planning. High testing practices were more cognizant of the symptoms and signs of chlamydia and always considered it in their differential diagnosis of genitourinary symptoms, including patients attending family planning clinics. CONCLUSIONS Any programme to increase chlamydia testing in primary care must be accompanied by an education and awareness programme especially targeted at low testing practices. This will need to include information about the benefits of testing and who, when, and how to test.
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Affiliation(s)
- C A M McNulty
- Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
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Abstract
A postal questionnaire survey was undertaken in registered nursing homes in three different health districts in England: Gloucestershire, North Staffordshire and Leeds. Nursing homes may be registered as general nursing or mental health homes. If homes also have provision for residential beds these are defined as dual registered homes. Overall, 9% (438/4900) of residents, with an equal male:female split, had urinary catheters. There was no significant difference in the overall urinary catheterization rate in the three districts (P=0.9). There was a wide range of urinary catheterization prevalence between homes, with some homes of all three categories having no catheterized residents and several with a prevalence of over 40%. The wide range of prevalence may be due to differences in residents' underlying medical conditions or to differences in attitudes towards urinary catheterization by nursing home staff. Almost all homes (114/124, 92%) stated they had an infection control policy, but 31% (38/124) did not have a written policy on urinary catheter care. In view of the potential for morbidity, infection control policies should include a section on the care of urinary catheters and this should form part of the continuing training of nursing home staff.
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Affiliation(s)
- C McNulty
- Health Protection Agency Primary Care Research Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
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McNulty C, Freeman E, Nichols T, Kalima P. Laboratory diagnosis of urinary symptoms in primary care--a qualitative study. Commun Dis Public Health 2003; 6:44-50. [PMID: 12736972] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The use of the microbiology laboratory for the investigation of urinary symptoms and the test positivity rate for the urine specimens varies considerably. We used qualitative methods to explore how and why primary care staff make diagnostic and management decisions in patients presenting with urinary symptoms. Stratified random sampling was used to include general practitioner (GP) practices that were heavy and light users of the microbiology service. The data were analysed using a modified grounded theory approach utilising the constant comparative method. Frequent users of the laboratory, with low specimen positivity, did not use near patient tests (NPTs) and sent urines from most patients with urinary symptoms to confirm their clinical diagnosis. Frequent users with high positivity advise patients with negative NPTs and send all specimens with positive NPTs for antibiotic susceptibility testing. Infrequent users did not value the laboratory for diagnosis, made great use of NPTs, and tended to prescribe empirical antibiotic treatment even in patients with minimal symptoms. Guidance on the management of urinary symptoms, the use of near patient tests and laboratory culture should form part of the ongoing education of primary care staff.
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Affiliation(s)
- C McNulty
- Public Health Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN.
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Abstract
BACKGROUND Functional breathing disorders may complicate asthma and impair quality of life. This study aimed to determine the effectiveness of physiotherapy based breathing retraining for patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing. METHODS 33 adult patients aged 17-65 with diagnosed and currently treated asthma and Nijmegen questionnaire scores > or =23 were recruited to a randomised controlled trial comparing short physiotherapy breathing retraining and an asthma nurse education control. The main outcome measures were asthma specific health status (Asthma Quality of Life questionnaire) and Nijmegen questionnaire scores RESULTS Of the 33 who entered the study, data were available on 31 after 1 month and 28 at 6 months. The median (interquartile range) changes in overall asthma quality of life score at 1 month were 0.6 (0.05-1.12) and 0.09 (-0.25-0.26) for the breathing retraining and education groups, respectively (p=0.018), 0.42 (0.11-1.17) and 0.09 (-0.58-0.5) for the symptoms domain (p=0.042), 0.52 (0.09-1.25) and 0 (-0.45-0.45) for the activities domain (p=0.007), and 0.50 (0-1.50) and -0.25 (-0.75-0.75) for the environment domain (p=0.018). Only the change in the activities domain remained significant at 6 months (0.83 (-0.10-1.71) and -0.05 (-0.74-0.34), p=0.018), although trends to improvement were seen in the overall score (p=0.065), the symptoms domain (p=0.059), and the environment domain (p=0.065). There was a correlation between changes in quality of life scores and Nijmegen questionnaire scores at 1 month and at 6 months. The number needed to treat to produce a clinically important improvement in health status was 1.96 and 3.57 at 1 and 6 months. CONCLUSION Over half the patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing show a clinically relevant improvement in quality of life following a brief physiotherapy intervention. This improvement is maintained in over 25% 6 months after the intervention.
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Affiliation(s)
- M Thomas
- Department of Primary Care, University of Aberdeen, Aberdeen, UK.
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Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R. Parents' perspectives on the MMR immunisation: a focus group study. Br J Gen Pract 2001; 51:904-10. [PMID: 11761204 PMCID: PMC1314147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The uptake of the combined measles, mumps and rubella immunisation (MMR) in Britain has fallen since 1998, when a link was hypothesised with the development of bowel disorders and childhood autism. Despite reassurances about the safety of MMR, uptake levels remain lower than optimal. We need to understand what influences parents' decisions on whether to accept MMR or not so that health professionals can provide a service responsive to their needs. AIM To investigate what influences parents' decisions on whether to accept or refuse the primary MMR immunisation and the impact of the recent controversy over its safety. DESIGN Qualitative study using focus group discussions. SETTING Forty-eight parents, whose youngest child was between 14 months and three years old, attended groups at community halls in six localities in Avon and Gloucestershire. METHODS Purposive sampling strategy was used to include parents from a variety of socioeconomic backgrounds. Three groups comprised parents who had accepted MMR and three groups comprised parents who had refused MMR. Data analysis used modified grounded theory techniques incorporating the constant comparative method. RESULTS All parents felt that the decision about MMR was difficult and stressful, and experienced unwelcome pressure from health professionals to comply. Parents were not convinced by Department of Health reassurances that MMR was the safest and best option for their children and many had accepted MMR unwillingly. Four key factors influenced parents' decisions: (a) beliefs about the risks and benefits of MMR compared with contracting the diseases, (b) information from the media and other sources about the safety of MMR, (c) confidence and trust in the advice of health professionals and attitudes towards compliance with this advice, and (d) views on the importance of individual choice within Government policy on immunisation. CONCLUSIONS Parents wanted up-to-date information about the risks and benefits of MMR to be available in advance of their immunisation appointment. Many parents did not have confidence in the recommendations of health professionals because they were aware that GPs needed to reach immunisation targets. Most parents would, however, welcome more open discussion about immunisation with health professionals.
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Affiliation(s)
- M Evans
- Division of Primary Health Care, University of Bristol.
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Freeman E, Sagi D, Driver J. Lateral interactions between targets and flankers in low-level vision depend on attention to the flankers. Nat Neurosci 2001; 4:1032-6. [PMID: 11559851 DOI: 10.1038/nn728] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [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: 06/21/2001] [Accepted: 08/28/2001] [Indexed: 11/09/2022]
Abstract
Detection of an oriented visual target can be facilitated by collinear visual flankers. Such lateral interactions are thought to reflect integrative processes in low-level vision. In past studies, the flankers were task-irrelevant, and were typically assumed to be unattended. Here we manipulated attention to the flankers directly, by requiring observers to judge the relative alignment of two flankers while ignoring a second flanker-pair. Under identical stimulus conditions, attended flankers produced typical lateral interactions, but ignored flankers did not. These data show that lateral interactions can depend on attention to the flanking context, revealing the functional consequences of attentional modulation in low-level vision.
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Affiliation(s)
- E Freeman
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AR, UK.
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Abstract
Unilateral spatial neglect is one of the most common symptoms of stroke. It has important implications for occupational therapy because of its clinical manifestations, which include problems with activities of daily living, mobility, and reading. This article reviews neurophysiological theories pertaining to unilateral spatial neglect and focuses on two new treatment approaches with potential application to occupational therapy practice. Both approaches--constraint-induced therapy and partial visual occlusion--involve a form of restraint of the less affected side. These approaches are discussed in the context of current neurophysiological theories and the application to occupational therapy treatment for neglect.
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Abstract
Issues concerning selective attention provoke new questions about visual segmentation, and vice-versa. We illustrate this by describing our recent work on grouping under conditions of inattention, on change blindness for background events and the residual processing of undetected background changes, on modal versus amodal completion in visual search, and the differential effects of these two forms of completion on attentional processes, and on attentional modulation of lateral interactions thought to arise in early visual cortex. Many of these results indicate that segmentation processes substantially constrain attentional processes, but the reverse influence is also apparent, suggesting an interactive architecture. We discuss how the 'proto-objects' revealed by studies of segmentation and attention (i.e. the segmented perceptual units which constrain selectivity) may relate to other object-based notions in cognitive science, and we wrestle with their relation to phenomenal visual awareness.
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Affiliation(s)
- J Driver
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AR, UK.
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Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. BMJ 2001; 322:1098-100. [PMID: 11337441 PMCID: PMC31263 DOI: 10.1136/bmj.322.7294.1098] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2001] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To estimate the prevalence of dysfunctional breathing in adults with asthma treated in the community. DESIGN Postal questionnaire survey using Nijmegen questionnaire. SETTING One general practice with 7033 patients. PARTICIPANTS All adult patients aged 17-65 with diagnosed asthma who were receiving treatment. MAIN OUTCOME MEASURE Score >/=23 on Nijmegen questionnaire. RESULTS 227/307 patients returned completed questionnaires; 219 (71.3%) questionnaires were suitable for analysis. 63 participants scored >/=23. Those scoring >/=23 were more likely to be female than male (46/132 (35%) v 17/87 (20%), P=0.016) and were younger (mean (SD) age 44.8 (14.7) v 49.0 (13.8, (P=0.05). Patients at different treatment steps of the British Thoracic Society asthma guidelines were affected equally. CONCLUSIONS About a third of women and a fifth of men had scores suggestive of dysfunctional breathing. Although further studies are needed to confirm the validity of this screening tool and these findings, these prevalences suggest scope for therapeutic intervention and may explain the anecdotal success of the Buteyko method of treating asthma.
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Affiliation(s)
- M Thomas
- Surgery, Minchinhampton, Stroud, Gloucestershire GL6 9JF.
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