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Macartney RA, Weaver E, Irwin R, Wylie MP, Burke GA, Lamprou DA. Co-delivery of VEGF and amoxicillin using LP-coated co-axial electrospun fibres for the potential treatment of diabetic wounds. Biomater Adv 2024; 158:213765. [PMID: 38242058 DOI: 10.1016/j.bioadv.2024.213765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
Diabetic complications present throughout a wide range of body tissues, however one of the most widely recognised complications remains to be chronic diabetic wounds. Current treatment options largely rely on standard wound treatment routines which provide no promotion of wound healing mechanisms at different physiological stages of repair. Recently materials produced using novel additive manufacturing techniques have been receiving attention for applications in wound care and tissue repair. Additive manufacturing techniques have recently been used in the interest of targeted drug delivery and production of novel materials resembling characteristics of native tissues. The potential to exploit these highly tailorable manufacturing techniques for the design of novel wound care remedies is highly desirable. In the present study two additive manufacturing techniques are combined to produce a scaffold for the treatment of diabetic wounds. The combination of microfluidic manufacturing of an antimicrobial liposome (LP) formulation and a coaxial electrospinning method incorporating both antimicrobial and proangiogenic factors allowed dual delivery of therapeutics to target both infection and lack of vascularisation at wound sites. The coaxial fibres comprised of a polyvinyl alcohol (PVA) core containing vascular endothelial growth factor (VEGF) and a poly (l-lactide-co-ε-caprolactone) (PLCL) shell blended with amoxicillin (Amox). Additionally, a liposomal formulation was produced to incorporate Amox and adhered to the surface of fibres loaded with Amox and VEGF. The liposomal loading provided the potential to deliver a much higher, more clinically relevant dose of Amox without detrimentally changing the mechanical properties of the material. The growth factor release was sustained up to 7-days in vitro. The therapeutic effect of the antibiotic loading was analysed using a disk diffusion method with a significant increase in zone diameter following LP adhesion, proving the full scaffold system had improved efficacy against both Gram-positive and Gram-negative strains. Additionally, the dual-loaded scaffolds show enhanced potential for supporting vascular growth in vitro, as demonstrated via a viability assay and tubule formation studies. Results showed a significant increase in the average total number of tubes from 10 in control samples to 77 in samples fully-loaded with Amox and VEGF.
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Affiliation(s)
- Robyn A Macartney
- Nanotechnology & Integrated Bioengineering Centre (NIBEC), School of Engineering, Ulster University, York Street, Belfast BT15 1ED, UK; School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
| | - Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Robyn Irwin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Matthew P Wylie
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - George A Burke
- Nanotechnology & Integrated Bioengineering Centre (NIBEC), School of Engineering, Ulster University, York Street, Belfast BT15 1ED, UK
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Weaver E, Macartney RA, Irwin R, Uddin S, Hooker A, Burke GA, Wylie MP, Lamprou DA. Liposomal encapsulation of amoxicillin via microfluidics with subsequent investigation of the significance of PEGylated therapeutics. Int J Pharm 2024; 650:123710. [PMID: 38097147 DOI: 10.1016/j.ijpharm.2023.123710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
With an increasing concern of global antimicrobial resistance, the efforts to improve the formulation of a narrowing library of therapeutic antibiotics must be confronted. The liposomal encapsulation of antibiotics using a novel and sustainable microfluidic method has been employed in this study to address this pressing issue, via a targeted, lower-dose medical approach. The study focusses upon microfluidic parameter optimisation, formulation stability, cytotoxicity, and future applications. Particle sizes of circa. 130 nm, with viable short-term (28-day) physical stability were obtained, using two different non-cytotoxic liposomal formulations, both of which displayed suitable antibacterial efficacy. The microfluidic method allowed for high encapsulation efficiencies (≈77 %) and the subsequent in vitro release profile suggested high limits of antibiotic dissociation from the nanovessels, achieving 90% release within 72 h. In addition to the experimental data, the growing use of poly(ethylene) glycol (PEG) within lipid-based formulations is discussed in relation to anti-PEG antibodies, highlighting the key pharmacological differences between PEGylated and non-PEGylated formulations and their respective advantages and drawbacks. It's surmised that in the case of the formulations used in this study, the addition of PEG upon the liposomal membrane would still be a beneficial feature to possess owing to beneficial features such as stability, antibiotic efficacy and the capacity to further modify the liposomal membrane.
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Affiliation(s)
- Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Robyn A Macartney
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Nanotechnology & Integrated Bioengineering Centre (NIBEC), School of Engineering, Ulster University, York Street, Belfast BT15 1ED, UK
| | - Robyn Irwin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Shahid Uddin
- Immunocore Ltd, 92 Park Dr, Milton, Abingdon OX14 4RY, UK
| | - Andrew Hooker
- Immunocore Ltd, 92 Park Dr, Milton, Abingdon OX14 4RY, UK
| | - George A Burke
- Nanotechnology & Integrated Bioengineering Centre (NIBEC), School of Engineering, Ulster University, York Street, Belfast BT15 1ED, UK
| | - Matthew P Wylie
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Frost J, Weaver E, Callaway L. Severe acute maternal morbidity reporting in Australia: Why is it so hard? Aust N Z J Obstet Gynaecol 2024. [PMID: 38214330 DOI: 10.1111/ajo.13787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
Adverse outcomes associated with pregnancy, including severe acute maternal morbidity (SAMM) and mortality, are internationally regarded as important indicators of quality of maternity services. Varied definitions and processes are barriers for SAMM recording, reporting and review. Identifying and documenting these cases of SAMM is a critical first step. Case reviews allow exploration of factors contributing to SAMM. Translation of the lessons learnt into practice improvement strategies and dissemination of this knowledge is essential for continual quality improvement. This review will outline the current status of SAMM review internationally and in Australia.
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Affiliation(s)
- Joanne Frost
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Queensland, Australia
| | - Leonie Callaway
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Weaver E, Sommonte F, Hooker A, Denora N, Uddin S, Lamprou DA. Microfluidic encapsulation of enzymes and steroids within solid lipid nanoparticles. Drug Deliv Transl Res 2024; 14:266-279. [PMID: 37505373 PMCID: PMC10746583 DOI: 10.1007/s13346-023-01398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
The production of solid lipid nanoparticles (SLNs) is challenging, especially when considering the incorporation of biologics. A novel in-house method of microfluidic production of biologic-encapsulated SLNs is proposed, using a variety of base materials for formulation to help overcome the barriers presented during manufacture and administration. Trypsin is used as a model drug for hydrophilic encapsulation whilst testosterone is employed as a positive non-biologic lipophilic control active pharmaceutical ingredient. Particle sizes obtained ranged from 160 to 320 nm, and a lead formulation has been identified from the combinations assayed, allowing for high encapsulation efficiencies (47-90%, respectively) of both the large hydrophilic and the small hydrophobic active pharmaceutical ingredients (APIs). Drug release profiles were analysed in vitro to provide useful insight into sustained kinetics, providing data towards future in vivo studies, which displayed a slow prolonged release for testosterone and a quicker burst release for trypsin. The study represents a large leap forward in the field of SLN production, especially in the field of difficult-to-encapsulate molecules, and the technique also benefits from being more environmentally sustainable due to the use of microfluidics.
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Affiliation(s)
- Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Federica Sommonte
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", 4 Orabona St., Bari, 70125, Italy
| | - Andrew Hooker
- Immunocore Ltd., 92 Park Dr, Milton, Abingdon, OX14 4RY, UK
| | - Nunzio Denora
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", 4 Orabona St., Bari, 70125, Italy
| | - Shahid Uddin
- Immunocore Ltd., 92 Park Dr, Milton, Abingdon, OX14 4RY, UK
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Jaradat E, Weaver E, Meziane A, Lamprou DA. Synthesis and Characterization of Paclitaxel-Loaded PEGylated Liposomes by the Microfluidics Method. Mol Pharm 2023; 20:6184-6196. [PMID: 37931072 DOI: 10.1021/acs.molpharmaceut.3c00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
For cancer therapy, paclitaxel (PX) possesses several limitations, including limited solubility and untargeted effects. Loading PX into nanoliposomes to enhance PX solubility and target their delivery as a drug delivery system has the potential to overcome these limitations. Over the other conventional method to prepare liposomes, a microfluidic system is used to formulate PX-loaded PEGylated liposomes. The impact of changing the flow rate ratio (FRR) between the aqueous and lipid phases on the particle size and polydispersity index (PDI) is investigated. Moreover, the effect of changing the polyethylene glycol (PEG) lipid ratio on the particle size, PDI, stability, encapsulation efficiency % (EE %), and release profile is studied. The physicochemical characteristics of the obtained formulation were analyzed by dynamic light scattering, FTIR spectroscopy, and AFM. This work aims to use microfluidic technology to produce PEGylated PX-loaded liposomes with a diameter of <200 nm, low PDI < 0.25 high homogeneity, and viable 28 day stability. The results show a significant impact of FRR and PEG lipid ratio on the empty liposomes' physicochemical characteristics. Among the prepared formulations, two formulations produce size-controlled, low PDI, and stable liposomes, which make them preferable for PX encapsulation. The average EE % was >90% for both formulations, and the variation in the PEG lipid ratio affected the EE % slightly; a high packing for PX was reported at different drug concentrations. A variation in the release profiles was notified for the different PEG lipid ratios.
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Affiliation(s)
- Eman Jaradat
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, BT9 7BL Belfast, U.K
| | - Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, BT9 7BL Belfast, U.K
| | | | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, BT9 7BL Belfast, U.K
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Liu ZJ, Yang M, Deng MZ, Abdelfattah MY, Baldwin M, Weaver E. Respiratory internal kinematics of the tongue base and soft palate in obese minipigs with obstructive sleep apnea. Res Sq 2023:rs.3.rs-3581408. [PMID: 38014298 PMCID: PMC10680925 DOI: 10.21203/rs.3.rs-3581408/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
It is largely unknown how the tongue base and soft palate deform to alter the configuration of the oropharyngeal airway during respiration. This study is to address this important gap. After live sleep monitoring of 5 Yucatan and 2 Panepinto minipigs to verify obstructive sleep apnea (OSA), 8 and 4 ultrasonic crystals were implanted into the tongue base and soft palate to circumscribe a cubic and square region, respectively. The 3D and 2D dimensional changes of the circumscribed regions were measured simultaneously with electromyographic activity (EMG) of the oropharyngeal muscles during spontaneous respiration under sedated sleep. The results indicated that both obese Yucatan and Panepinto minipigs presented spontaneous OSA, but not in 3 non-obese Yucatan minipigs. During inspiration, the tongue base showed elongation in both dorsal and ventral regions but thinning and thickening in the anterior and posterior regions respectively. The widths showed opposite directions, widening in the dorsal but narrowing in the ventral regions. The soft palate expanded in both length and width. Compared to normal controls, obese/OSA ones showed similar directions of dimensional changes, but the magnitude of change was two times larger in the tongue base and soft palate, and obese/OSA Panepinto minipigs presented 10 times larger changes in all dimensions of both the tongue base and the soft palate. The opposite direction of the respiratory spatial relationship between these two structures was seen in obese/OSA as compared to normal minipigs.
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Fratini C, Weaver E, Moroni S, Irwin R, Dallal Bashi YH, Uddin S, Casettari L, Wylie MP, Lamprou DA. Combining microfluidics and coaxial 3D-bioprinting for the manufacturing of diabetic wound healing dressings. Biomater Adv 2023; 153:213557. [PMID: 37441958 DOI: 10.1016/j.bioadv.2023.213557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023]
Abstract
Diabetic foot ulcers (DFUs) are a crucial complication of diabetes, as in a diabetic wound, each step of the physiological healing process is affected. This entails a more easily infectable wound, and delayed tissue regeneration due to the inflammation that occurs, leading to a drastic decrease in the overall patient's quality of life. As a strategy to manage DFUs, skin alternatives and wound dressings are currently receiving a lot of attention as they keep the wound environment "under control", while providing bioactive compounds that help to manage infection and inflammation and promote tissue repair. This has been made possible thanks to the advent of emerging technologies such as 3D Bioprinting to produce skin resembling constructs or microfluidics (MFs) that allows the manufacture of nanoparticles (NPs) that act as drug carriers, in a prompt and less expensive way. In the present proof-of-concept study, the possibility of combining two novel and appealing techniques in the manufacturing of wound dressings has been demonstrated for first time. The novelty of this work consists in the combination of liposomes (LPs) encapsulating the active pharmaceutical ingredient (API) into a hydrogel that is further printed into a three-dimensional scaffold for wound dressing; to the knowledge of the authors this has never been done before. A grid-shaped scaffold has been produced through the coaxial 3D bioprinting technique which has allowed to combine, in one single filament, two different bioinks. The inner core of the filament is a nanocomposite hydrogel consisting of hydroxyethyl cellulose (HEC) and PEGylated LPs encapsulated with thyme oil (TO) manufactured via MFs for the first time. The outer shell of the filament, instead, is represented by a hybrid hydrogel composed of sodium alginate/cellulose nanocrystals (SA/CNC) and enriched with free TO. This provides a combination of two different release ratios of the API, a bulk release for the first 24 h thanks to the free TO in the shell of the filament and a sustained release for up to 10 days provided from the API inside the LPs. Confocal Microscopy verified the actual presence of the LPs inside the scaffold after printing and evaluation using the zone of inhibition test proved the antibacterial activity of the manufactured scaffolds against both Gram-positive and Gram-negative bacteria.
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Affiliation(s)
- Costanza Fratini
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom; Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom
| | - Sofia Moroni
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom; Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Robyn Irwin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom
| | - Yahya H Dallal Bashi
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom
| | - Shahid Uddin
- Immunocore Ltd., 92 Park Dr, Milton Park, Abingdon OX14 4RY, United Kingdom
| | - Luca Casettari
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Matthew P Wylie
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom.
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Ghodke J, Ekonomou SI, Weaver E, Lamprou D, Doran O, Stratakos AC. The Manufacturing and Characterisation of Eugenol-Enclosed Liposomes Produced by Microfluidic Method. Foods 2023; 12:2940. [PMID: 37569209 PMCID: PMC10418319 DOI: 10.3390/foods12152940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
In this study, liposomes enclosing eugenol were prepared using microfluidics. Two lipids-1,2-dimyristoyl-sn-glycero-3-phosphocholine, 18:0 (DSPC) and 2-dimyristoyl-sn-glycero-3-phosphocholine, 14:0 (DMPC)-and microfluidic chips with serpentine and Y-shaped micromixing designs were used for the liposomal formulation. Minimum bactericidal concentration (MBC) values indicated that eugenol was more effective against Gram-negative than Gram-positive bacteria. Four different flow-rate ratios (FRR 2:1, 3:1, 4:1, 5:1) were explored. All liposomes' encapsulation efficiency (EE) was determined: 94.34% for DSPC 3:1 and 78.63% for DMPC 5:1. The highest eugenol release of 99.86% was observed at pH 4, DMPC 3:1 (Y-shaped chip). Liposomes were physically stable at 4, 20 and 37 °C for 60 days as determined by their size, polydispersity index (PDI) and zeta potential (ZP). The most stable liposomes were observed at FRR 5:1 for DSPC. EE, stability, and eugenol release studies proved that the liposomal formulations produced can be used as delivery vehicles to increase food safety.
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Affiliation(s)
- Jessica Ghodke
- College of Health, Science and Society, University of the West of England, Coldharbour Ln, Bristol BS16 1QY, UK; (J.G.); (S.I.E.); (O.D.)
| | - Sotirios I. Ekonomou
- College of Health, Science and Society, University of the West of England, Coldharbour Ln, Bristol BS16 1QY, UK; (J.G.); (S.I.E.); (O.D.)
| | - Edward Weaver
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (E.W.); (D.L.)
| | - Dimitrios Lamprou
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (E.W.); (D.L.)
| | - Olena Doran
- College of Health, Science and Society, University of the West of England, Coldharbour Ln, Bristol BS16 1QY, UK; (J.G.); (S.I.E.); (O.D.)
| | - Alexandros Ch. Stratakos
- College of Health, Science and Society, University of the West of England, Coldharbour Ln, Bristol BS16 1QY, UK; (J.G.); (S.I.E.); (O.D.)
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Dedeloudi A, Weaver E, Lamprou DA. Machine learning in additive manufacturing & Microfluidics for smarter and safer drug delivery systems. Int J Pharm 2023; 636:122818. [PMID: 36907280 DOI: 10.1016/j.ijpharm.2023.122818] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
A new technological passage has emerged in the pharmaceutical field, concerning the management, application, and transfer of knowledge from humans to machines, as well as the implementation of advanced manufacturing and product optimisation processes. Machine Learning (ML) methods have been introduced to Additive Manufacturing (AM) and Microfluidics (MFs) to predict and generate learning patterns for precise fabrication of tailor-made pharmaceutical treatments. Moreover, regarding the diversity and complexity of personalised medicine, ML has been part of quality by design strategy, targeting towards the development of safe and effective drug delivery systems. The utilisation of different and novel ML techniques along with Internet of Things sensors in AM and MFs, have shown promising aspects regarding the development of well-defined automated procedures towards the production of sustainable and quality-based therapeutic systems. Thus, the effective data utilisation, prospects on a flexible and broader production of "on demand" treatments. In this study, a thorough overview has been achieved, concerning scientific achievements of the past decade, which aims to trigger the research interest on incorporating different types of ML in AM and MFs, as essential techniques for the enhancement of quality standards of customised medicinal applications, as well as the reduction of variability potency, throughout a pharmaceutical process.
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Affiliation(s)
- Aikaterini Dedeloudi
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Weaver E, Mathew E, Caldwell J, Hooker A, Uddin S, Lamprou DA. The manufacturing of 3D-printed microfluidic chips to analyse the effect upon particle size during the synthesis of lipid nanoparticles. J Pharm Pharmacol 2023; 75:245-252. [PMID: 36453867 DOI: 10.1093/jpp/rgac085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES The process of 3D printing to produce microfluidic chips is becoming commonplace, due to its quality, versatility and newfound availability. In this study, a UV liquid crystal display (LCD) printer has been implemented to produce a progression of microfluidic chips for the purpose of liposomal synthesis. The emphasis of this research is to test the limitations of UV LCD printing in terms of resolution and print speed optimisation for the production of microfluidic chips. KEY FINDINGS By varying individual channel parameters such as channel length and internal geometries, the essential channel properties for optimal liposomal formulation are being investigated to act as a basis for future experimentation including the encapsulation of active pharmaceutical ingredients. Using the uniquely designed chips, liposomes of ≈120 nm, with polydispersity index values of ≤0.12 are able to be reproducibly synthesised. CONCLUSIONS The influence of total flow rates and lipid choice is investigated in depth, to provide further clarification on how a microfluidic setup should be optimised. In-depth explanations of the importance of each channel parameter are also explained throughout, with reference to their importance for the properties of a successful liposome.
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Affiliation(s)
- Edward Weaver
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | - Jay Caldwell
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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Meurk C, Roberts S, Lam M, Wittenhagen L, Callaway L, Moss K, Lucke J, Barker R, Waterson E, Rawlinson C, Malmstrom N, Weaver E, Hoehn E, Bosley E, Watson S, Heffernan E. Suicide crises among women and mothers during and around the time of pregnancy: Prevalence and timing of initial contact with first responders and health services. Aust N Z J Psychiatry 2023; 57:291-301. [PMID: 35652302 DOI: 10.1177/00048674221101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child's development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy. METHODS Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported. RESULTS The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]). CONCLUSION Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life.
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Affiliation(s)
- Carla Meurk
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Susan Roberts
- Lavender Mother and Baby Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Michael Lam
- Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Lisa Wittenhagen
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Leonie Callaway
- Royal Brisbane Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Katherine Moss
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Jayne Lucke
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Ruth Barker
- Queensland Children's Hospital, Queensland Health, Brisbane, QLD, Australia.,Queensland Injury Surveillance Unit, Jamieson Trauma Institute, Brisbane, QLD, Australia
| | - Elissa Waterson
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Catherine Rawlinson
- Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | | | - Edward Weaver
- Department of Obstetrics and Gynaecology/Women's and Children's, Griffith University School of Medicine and Dentistry, Sunshine Coast, QLD, Australia
| | - Elisabeth Hoehn
- Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Emma Bosley
- Information Support, Research and Evaluation, Office of the Medical Director, Queensland Ambulance Service, Kedron, QLD, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Shelby Watson
- State Domestic, Family Violence and Vulnerable Persons Unit, Vulnerable Persons Group, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, QLD, Australia
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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12
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Seed E, Kearney L, Weaver E, Ryan EG, Nugent R. A prospective cohort study comparing neonatal outcomes of waterbirth and land birth in an Australian tertiary maternity unit. Aust N Z J Obstet Gynaecol 2023; 63:59-65. [PMID: 35796252 DOI: 10.1111/ajo.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. AIM The aim was to investigate maternal and neonatal outcomes after WWI and/or waterbirth compared with land birth. MATERIALS AND METHODS A prospective cohort study was conducted in an Australian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied. Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth. RESULTS NNU admissions for a suspected infectious condition were significantly higher in the land birth group (P = 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission (P = 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0%; P = 0.007); obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58%; P = <0.001). There was one cord avulsion in the waterbirth group (0.41%). CONCLUSION Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.
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Affiliation(s)
- Emma Seed
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Lauren Kearney
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia.,University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Elizabeth G Ryan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.,University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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13
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Sommonte F, Weaver E, Mathew E, Denora N, Lamprou DA. In-House Innovative "Diamond Shaped" 3D Printed Microfluidic Devices for Lysozyme-Loaded Liposomes. Pharmaceutics 2022; 14:pharmaceutics14112484. [PMID: 36432675 PMCID: PMC9699034 DOI: 10.3390/pharmaceutics14112484] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Nanotechnology applications have emerged as one of the most actively researched areas in recent years. As a result, substantial study into nanoparticulate lipidic systems and liposomes (LPs) has been conducted. Regardless of the advantages, various challenges involving traditional manufacturing processes have hampered their expansion. Here, the combination of microfluidic technology (MF) and 3D printing (3DP) digital light processing (DLP) was fruitfully investigated in the creation of novel, previously unexplored "diamond shaped" devices suitable for the production of LPs carrying lysozyme as model drug. Computer-aided design (CAD) software was used designing several MF devices with significantly multiple and diverse geometries. These were printed using a high-performance DLP 3DP, resulting in extremely high-resolution chips that were tested to optimize the experimental condition of MF-based LPs. Monodisperse narrow-sized lysozyme-loaded PEGylated LPs were produced using in-house devices. The developed formulations succumbed to stability tests to determine their consistency, and then an encapsulation efficacy (EE) study was performed, yielding good findings. The in vitro release study indicated that lysozyme-loaded LPs could release up to 93% of the encapsulated cargo within 72 h. Therefore, the proficiency of the association between MF and 3DP was demonstrated, revealing a potential growing synergy.
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Affiliation(s)
- Federica Sommonte
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, Orabona Street, 4, 70125 Bari, Italy
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - Edward Weaver
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - Essyrose Mathew
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - Nunzio Denora
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, Orabona Street, 4, 70125 Bari, Italy
- Correspondence: (N.D.); (D.A.L.); Tel.: +39-080-544-2767 (N.D.); +44-(0)28-9097-2617 (D.A.L.)
| | - Dimitrios A. Lamprou
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK
- Correspondence: (N.D.); (D.A.L.); Tel.: +39-080-544-2767 (N.D.); +44-(0)28-9097-2617 (D.A.L.)
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14
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Weaver E, Uddin S, Lamprou DA. Emerging technologies for combating pandemics. Expert Rev Med Devices 2022; 19:533-538. [PMID: 35983986 DOI: 10.1080/17434440.2022.2115355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Covid-19, alongside previous pandemics, has highlighted the need for the continued development of technologies that are at our disposal. Emerging technologies are those that show true promise in achieving such a goal and have begun to form sturdy independent research areas. Technological advances in healthcare must continually develop to ensure that the world is prepared for any future diseases that may ensue. As such, a strategic review into 39 manuscripts since 2019 has been conducted to determine the prominence of emerging technologies since the beginning of the Covid-19 pandemic. AREAS COVERED Relating to their use in a pandemic state, additive manufacturing (AM), biofabrication, microfluidics, biomedical microelectromechanical systems (BioMEMS), and artificial intelligence (AI) are described. Applications over the past 2-3 years, as well as future developments, are considered throughout. EXPERT OPINION All the technologies mentioned in this review are sure to develop further, having shown their importance and value during the covid-19 pandemic. As research continues within the area, their efficacy will increase to the point where it likely will become gold standard for pandemic control. Combining certain technologies mentioned has also proved to have had great success in improving the final results obtained.
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Affiliation(s)
- Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Shahid Uddin
- Immunocore, 92 Park Drive, Milton, Abingdon, OX14 4RY, UK
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
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15
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Abstract
INTRODUCTION Sustainability within the pharmaceutical industry is becoming a focal point for many companies, to improve the longevity and social perception of the industry. Both additive manufacturing (AM) and microfluidics (MFs) are continuously progressing, so are far from their optimization in terms of sustainability; hence, it is the aim of this review to highlight potential gaps alongside their beneficial features. Discussed throughout this review also will be an in-depth discussion on the environmental, legal, economic, and social particulars relating to these emerging technologies. AREAS COVERED Additive manufacturing (AM) and microfluidics (MFs) are discussed in depth within this review, drawing from up-to-date literature relating to sustainability and circular economies. This applies to both technologies being utilized for therapeutic and analytical purposes within the pharmaceutical industry. EXPERT OPINION It is the role of emerging technologies to be at the forefront of promoting a sustainable message by delivering plausible environmental standards whilst maintaining efficacy and economic viability. AM processes are highly customizable, allowing for their optimization in terms of sustainability, from reducing printing time to reducing material usage by removing supports. MFs too are supporting sustainability via reduced material wastage and providing a sustainable means for point of care analysis.
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Affiliation(s)
- Edward Weaver
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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16
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Ekonomou S, Akshay Thanekar P, Lamprou DA, Weaver E, Doran O, Stratakos AC. Development of Geraniol-Loaded Liposomal Nanoformulations against Salmonella Colonization in the Pig Gut. J Agric Food Chem 2022; 70:7004-7014. [PMID: 35653283 PMCID: PMC9204824 DOI: 10.1021/acs.jafc.2c00910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Salmonella is a global health threat, with pig production being one of the main sources of human salmonellosis. The current study investigated the antivirulence properties of geraniol for inhibiting the in vitro colonization of Salmonella. The minimum inhibitory (MIC) and bactericidal concentrations (MBC) of geraniol against Salmonella typhimurium followed by the sub-MIC of geraniol were determined. Results provided clear evidence that geraniol at 1/8 MIC can be used as an effective, non-toxic antivirulence compound to inhibit virulence factors (motility, adhesion, and invasiveness) affecting the colonization of S. typhimurium on IPEC-J2 cells. Additionally, the findings signified that microfluidics is an emerging technology suitable for the preparation of stable liposomes with a small size (<200 nm) and high encapsulation efficiency (EE) of up to 92.53%, which can act as effective carriers of geraniol into the pig gastrointestinal tract (GIT), targeting Salmonella, preventing colonization, and thus increasing the safety of the food supply chain.
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Affiliation(s)
- Sotirios
I. Ekonomou
- Faculty
of Health and Applied Sciences (HAS), University
of the West of, Coldharbour Ln, Bristol BS16 1QY, England
| | - Pooja Akshay Thanekar
- Faculty
of Health and Applied Sciences (HAS), University
of the West of, Coldharbour Ln, Bristol BS16 1QY, England
| | - Dimitrios A. Lamprou
- School
of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Edward Weaver
- School
of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Olena Doran
- Faculty
of Health and Applied Sciences (HAS), University
of the West of, Coldharbour Ln, Bristol BS16 1QY, England
| | - Alexandros Ch. Stratakos
- Faculty
of Health and Applied Sciences (HAS), University
of the West of, Coldharbour Ln, Bristol BS16 1QY, England
- . Tel: (0044) 01173284743
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17
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Ikeda A, Weaver E. 0795 Association of Nasal and Sleep Apnea Clinical Measures. Sleep 2022. [DOI: 10.1093/sleep/zsac079.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The association between nasal measures and polygsomnography measures is modest. However, nasal treatment can improve sleep quality in people without sleep apnea. The association of nasal and sleep apnea clinical measures in patients with sleep apnea is unknown. Our primary hypothesis is that the subjective nasal obstruction is associated with reduced sleep apnea-specific quality of life at baseline and with sleep apnea treatment after 6 months.
Methods
This prospective cohort study included patients with newly diagnosed sleep apnea who were prescribed CPAP. Data were collected before CPAP and 6 months later, including the validated Nasal Obstruction Symptom Evaluation (NOSE, range 0-100, higher worse) scale and validated Symptoms of Nocturnal Obstruction & Related Events (SNORE-25, range 0-5, higher worse) quality of life instrument. Additional nasal measures, sleep apnea clinical measures, and covariates were collected. We tested the association between nasal and sleep apnea clinical measures with multivariate linear regression, adjusting for important confounding variables.
Results
The cohort (N=242) was middle-aged (47+/-12 years), included both sexes (65% men), and had severe sleep apnea (apnea-hypopnea index 33+/-24 events/hour). The baseline NOSE was strongly associated with SNORE-25, independent of demographics, comorbidity, and sleep apnea severity: beta 18, 95% CI 15-22, p<0.001, meaning for every unit of SNORE-25 increase there was an adjusted increase in NOSE score of 18. The 6-month changes in NOSE and SNORE-25 were strongly associated, independent of demographics, comorbidity, sleep apnea severity, and CPAP use: beta 17, 95%CI 13-22, p<0.001. Secondary nasal and sleep apnea clinical measures were associated, but nasal and polysomnography measures were not associated.
Conclusion
Nasal clinical measures are associated with sleep apnea clinical measures at baseline and with sleep apnea treatment, while the nasal measures are not associated with polysomnography measure. These data support the importance of the nasal airway on sleep apnea clinical outcomes.
Support (If Any)
R01 HL084139 (Weaver), T32 DC000018 (Stone), Seattle Veterans Affairs Medical Center
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18
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Ikeda A, McShay C, Marsh R, Saini S, Weaver E. 0794 Understanding Barriers and Communication Behaviors Impacting Referral to Sleep Surgery: Qualitative Patient Perspectives. Sleep 2022. [DOI: 10.1093/sleep/zsac079.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Shared decision-making is a process when patients, families, and clinicians work together to make optimal, personalized medical choices in the face of more than one reasonable treatment option. These interactions can influence the joint decision and may have lasting impressions for future healthcare encounters. Considering the American Academy of Sleep Medicine’s recent clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation, we aimed to understand patient experiences, in terms of barriers and communication behaviors in the referral process to sleep surgery consultation.
Methods
We performed a qualitative study consisting of in-depth semi-structured virtual interviews with adult patients (aged ≥18 years) with OSA (apnea-hypopnea index ≥5 events per hour of sleep, scored by AASM-accredited standards) and who were recommended for sleep surgery at a tertiary Sleep Surgery Clinic. Open ended questions focused on patient experiences during healthcare encounters from diagnosis, trials with noninvasive management options and ultimate referral to sleep surgery. The interviews were audio-recorded, transcribed, and analyzed using content analysis to identify themes.
Results
Ten adult patients with OSA who were evaluated in sleep surgery clinic were approached and enrolled from March through April 2021. Barriers to sleep surgery clinic included delays in OSA diagnosis due to limited OSA awareness and perceived inconvenience of sleep study, providers faulting patient for persistent sleep symptoms, patient-reported lack of urgency by providers in troubleshooting noninvasive management options, scheduling delays and waitlists, and cost. Patients were open to trialing noninvasive treatment options, though opportunities for reevaluation and shared decision-making may address unmet needs, as inadequate improvements led to frustration after multiple encounters. Patients appreciated providers who were empathetic and provided information sharing, in terms of transparent and understandable explanations.
Conclusion
This study focused on experiences of patients with OSA and barriers faced to reach sleep surgery consultation. Improved communication structure to discuss unresolved concerns and remaining management options, as well as vetted resources, would set the foundation for effective shared decision-making and timely referral for sleep surgery consultation.
Support (If Any)
Academy of Otolaryngology Head and Neck Surgery Resident Research Centralized Otolaryngology Research Efforts (CORE). NIH T32 DC000018.
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19
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Jasper B, Stillerova T, Anstey C, Weaver E. Reduction in preterm birth rates during and after the COVID-19 lockdown in Queensland Australia. Aust N Z J Obstet Gynaecol 2022; 62:851-858. [PMID: 35581948 PMCID: PMC9348165 DOI: 10.1111/ajo.13538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/08/2022] [Accepted: 03/18/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preventative strategies for preterm birth are lacking. Recent evidence proposed COVID-19 lockdowns may have contributed to changes in preterm birth. AIMS To determine the prevalence of preterm birth and birth outcomes during and after the COVID-19 lockdown at the Sunshine Coast University Hospital and the overall state of Queensland, Australia. METHODS Retrospective cohort analysis of all births in Queensland including the Sunshine Coast University Hospital, during two epochs, April 1-May 31, 2020 (lockdown) and June 1-July 31, 2020 (post-lockdown), compared to antecedent calendar-matched periods in 2018-2019. Prevalence of preterm birth, stillbirth, and late terminations were examined. RESULTS There were 64 989 births in Queensland from April to July 2018-2020. At the Sunshine Coast University Hospital, there was a significantly higher chance of birth at term during both lockdown (odds ratio (OR) 1.81, 95% CI 1.17, 2.79; P = 0.007) and post-lockdown (OR 2.01, 95% CI 1.27, 3.18; P = 0.003). At the same centre, prevalence of preterm birth was 5.5% (30/547) during lockdown, compared to 9.1% (100/1095) in previous years, a 40.0% relative reduction (P = 0.016). At this centre during lockdown, emergency caesareans concurrently decreased (P < 0.01) and instrumental vaginal births increased (P < 0.01). In Queensland overall, there was a nonsignificant decrease in the prevalence of preterm birth during lockdown. CONCLUSIONS There is a link between lockdown and a reduction in the prevalence of preterm birth on the Sunshine Coast. The cause is speculative at present, although increased influenza vaccination rates, decreased transmission of infections, and improved air quality may have been favourable in reducing preterm birth. Further research is needed to determine a causal link.
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Affiliation(s)
- Brittany Jasper
- Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,School of Medicine, Griffith University, Brisbane, Queensland, Australia.,North West Anglia Healthcare NHS Trust, Cambridgeshire, UK
| | - Tereza Stillerova
- Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,School of Medicine, Griffith University, Brisbane, Queensland, Australia.,Department of Obstetrics and Gynaecology, Cairns Hospital, Cairns, Queensland, Australia
| | - Christopher Anstey
- School of Medicine, Griffith University, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,School of Medicine, Griffith University, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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20
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Dhoble S, Patravale V, Weaver E, Lamprou DA, Patravale T. Comprehensive Review on Novel Targets and Emerging Therapeutic Modalities for Pulmonary Arterial Hypertension. Int J Pharm 2022; 621:121792. [PMID: 35513217 DOI: 10.1016/j.ijpharm.2022.121792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/17/2022] [Accepted: 04/28/2022] [Indexed: 01/17/2023]
Abstract
Pulmonary Arterial Hypertension (PAH) is the progressive increase in mean pulmonary arterial pressure (mPAP) (≥ 20 mmHg at rest). Current treatment strategies include the drugs targeting at nitric oxide pathway, endothelin receptors, prostaglandin receptors, thromboxane receptors and phosphodiesterase inhibitors, which provides the symptomatic relief. Despite of these treatments, the mortality amongst the PAH patients remains high due to non-reversal of the condition. This review primarily covers the introduction of PAH and the current treatments of the disease. This is followed by the newer disease targets expressed in the pathobiology of the disease like Rho Kinase Pathway, Vasoactive Intestinal Peptide Pathway, Receptor Tyrosine Kinases, Serotonin signalling pathway, Voltage-gated potassium (Kv) channel pathway. Newer formulation strategies for targeting at these specific receptors were covered and includes nano formulations like liposomes, Micelles, Polymeric Nanoparticles, Solid Lipid Nanoparticles (SLN), Bioresorbable stents, NONOates, Cell-Based Therapies, miRNA therapy for PAH. Novel targets were identified for their role in the pathogenesis of the PAH and needs to be targeted with new molecules or existing molecules effectively. Nanosystems have shown their potential as alternative carriers on the virtue of their better performance than traditional drug delivery systems.
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Affiliation(s)
- Sagar Dhoble
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga (East), Mumbai 400 019, India
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga (East), Mumbai 400 019, India.
| | - Edward Weaver
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom.
| | - Tanmay Patravale
- Department of General Surgery, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590 010, India
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21
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Weaver E, O'Connor E, Cole DK, Hooker A, Uddin S, Lamprou DA. Microfluidic-mediated self-assembly of phospholipids for the delivery of biologic molecules. Int J Pharm 2022; 611:121347. [PMID: 34890709 DOI: 10.1016/j.ijpharm.2021.121347] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022]
Abstract
The encapsulation of biologic molecules using a microfluidic platform is a procedure that has been understudied but shows great promise from initial reported studies. The study focusses upon the encapsulation of bovine serum albumin (BSA) under various parameters and using multiple phospholipids to identify optimal conditions for the manufacturing of protein loaded lipid nanoparticles. Additionally, encapsulation of the enzyme trypsin (TRP) has been investigated to show the eligibility of the system to other biological medications. All liposomes were subject to rigorous physicochemical characterisation, including differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FTIR), to document the successful synthesis of the liposomes. Drug-loaded liposome stability was investigated over a 28-day period at 5 °C and 37 °C, which showed encouraging results for 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) at all concentrations of BSA used. The sample containing 1 mg/ml BSA grew by only 10% over the study, which considering liposomes should be affected highly by biologic adsorption, shows great promise for the formulations. Encapsulation and in vitro release studies showed improved loading capacity for BSA compared to conventional methods, whilst maintaining a concise controlled release of the active pharmaceutical ingredient (API).
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Affiliation(s)
- Edward Weaver
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Edward O'Connor
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - David K Cole
- Immunocore, 92 Park Dr, Milton, Abingdon OX14 4RY, UK
| | - Andrew Hooker
- Immunocore, 92 Park Dr, Milton, Abingdon OX14 4RY, UK
| | - Shahid Uddin
- Immunocore, 92 Park Dr, Milton, Abingdon OX14 4RY, UK
| | - Dimitrios A Lamprou
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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22
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Ballacchino G, Weaver E, Mathew E, Dorati R, Genta I, Conti B, Lamprou DA. Manufacturing of 3D-Printed Microfluidic Devices for the Synthesis of Drug-Loaded Liposomal Formulations. Int J Mol Sci 2021; 22:ijms22158064. [PMID: 34360832 PMCID: PMC8348465 DOI: 10.3390/ijms22158064] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Microfluidic technique has emerged as a promising tool for the production of stable and monodispersed nanoparticles (NPs). In particular, this work focuses on liposome production by microfluidics and on factors involved in determining liposome characteristics. Traditional fabrication techniques for microfluidic devices suffer from several disadvantages, such as multistep processing and expensive facilities. Three-dimensional printing (3DP) has been revolutionary for microfluidic device production, boasting facile and low-cost fabrication. In this study, microfluidic devices with innovative micromixing patterns were developed using fused deposition modelling (FDM) and liquid crystal display (LCD) printers. To date, this work is the first to study liposome production using LCD-printed microfluidic devices. The current study deals with 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) liposomes with cholesterol (2:1) prepared using commercial and 3D-printed microfluidic devices. We evaluated the effect of microfluidic parameters, chip manufacturing, material, and channel design on liposomal formulation by analysing the size, PDI, and ζ-potential. Curcumin exhibits potent anticancer activity and it has been reported that curcumin-loaded liposomes formulated by microfluidics show enhanced encapsulation efficiency when compared with other reported systems. In this work, curcumal liposomes were produced using the developed microfluidic devices and particle sizing, ζ-potential, encapsulation efficiency, and in vitro release studies were performed at 37 °C.
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Affiliation(s)
- Giulia Ballacchino
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK; (G.B.); (E.W.); (E.M.)
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (R.D.); (I.G.)
| | - Edward Weaver
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK; (G.B.); (E.W.); (E.M.)
| | - Essyrose Mathew
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK; (G.B.); (E.W.); (E.M.)
| | - Rossella Dorati
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (R.D.); (I.G.)
| | - Ida Genta
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (R.D.); (I.G.)
| | - Bice Conti
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (R.D.); (I.G.)
- Correspondence: (B.C.); (D.A.L.); Tel.: +39-0382-987378 (B.C.); +44-(0)28-9097-2617 (D.A.L.)
| | - Dimitrios A. Lamprou
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK; (G.B.); (E.W.); (E.M.)
- Correspondence: (B.C.); (D.A.L.); Tel.: +39-0382-987378 (B.C.); +44-(0)28-9097-2617 (D.A.L.)
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Suurna MV, Jacobowitz O, Chang J, Koutsourelakis I, Smith D, Alkan U, D'Agostino M, Boon M, Heiser C, Hoff P, Huntley C, Kent D, Kominsky A, Lewis R, Maurer JT, Ravesloot M, Soose R, Steffen A, Weaver E, Williams AM, Woodson T, Yaremchuk K, Ishman SL. Improving outcomes of hypoglossal nerve stimulation therapy: current practice, future directions and research gaps. Proceedings of the 2019 International Sleep Surgery Society Research Forum. J Clin Sleep Med 2021; 17:2477-2487. [PMID: 34279214 DOI: 10.5664/jcsm.9542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypoglossal nerve stimulation (HGNS) has evolved as a novel and effective therapy for patients with moderate-to-severe obstructive sleep apnea (OSA). Despite positive published outcomes of HGNS, there exist uncertainties regarding proper patient selection, surgical technique, and the reporting of outcomes and individual factors that impact therapy effectiveness. According to current guidelines, this therapy is indicated for select patients, and recommendations are based on the Stimulation Therapy for Apnea Reduction (STAR) trial. Ongoing research and physician experiences continuously improve methods to optimize the therapy. An understanding of the way in which airway anatomy, OSA phenotypes, individual health status, psychological conditions and comorbid sleep disorders influence the effectiveness of HGNS is essential to improve outcomes and expand therapy indications. This manuscript presents discussions on current evidence, future directions, and research gaps for HGNS therapy from the 10th International Surgical Sleep Society expert research panel.
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Affiliation(s)
- Maria V Suurna
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | | | - Jolie Chang
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA
| | | | - David Smith
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology - Head and Neck Surgery of University of Cincinnati College of Medicine, Cincinnati, OH
| | - Uri Alkan
- Department of Otorhinolaryngology, Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark D'Agostino
- Southern New England Ear, Nose, Throat and Facial Plastic Surgery Group and Middlesex Hospital, Middletown, CT
| | - Maurits Boon
- Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany
| | - Paul Hoff
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Colin Huntley
- Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - David Kent
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Kominsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Lewis
- Perth Head & Neck Surgery, Hollywood Medical Centre, Nedlands, Australia
| | - Joachim T Maurer
- Division of Sleep Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Ryan Soose
- Division of Sleep Surgery, Department of Otolaryngology, Pittsburgh School of Medicine, UPMC Mercy, University of Pittsburgh, Pittsburgh, PA
| | - Armin Steffen
- Department of otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Edward Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington; Surgery Service, Seattle Veterans Affairs Medical Center; Harborview Medical Center, Seattle, WA
| | - Amy M Williams
- Department of Otolaryngology - Head & Neck Surgery of Henry Ford Health System, Detroit, MI
| | - Tucker Woodson
- Division of Sleep Medicine and Sleep Surgery, Department of Otolaryngology and Human Communication of Medical College of Wisconsin, Milwaukee, WI
| | - Kathleen Yaremchuk
- Department of Otolaryngology - Head & Neck Surgery of Henry Ford Health System, Detroit, MI
| | - Stacey L Ishman
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology - Head and Neck Surgery of University of Cincinnati College of Medicine, Cincinnati, OH
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24
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Ikeda A, Marsh R, McShay C, Saini S, Sardesai M, Weaver E, Boss E. 452 Patient Factors and Preferences in Decision for Sleep Surgery: A Qualitative Analysis. Sleep 2021. [DOI: 10.1093/sleep/zsab072.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Patients with obstructive sleep apnea (OSA) are offered many treatment options spanning the spectrum of lifestyle modification, device therapy, and surgery. Sleep surgery, while often effective, results in moderate morbidity and has variable effectiveness on OSA improvement. Little is known about what patients consider when choosing treatment. We aim to identify factors that influenced the decision for sleep surgery among adults with OSA.
Methods
We conducted semi-structured virtual interviews with patients (≥18 years) with OSA (apnea-hypopnea index ≥5 events per hour of sleep) who underwent sleep surgery at a tertiary academic center, querying patients about factors in their decision for OSA treatment. Interviews were audio-recorded, transcribed, and analyzed for thematic content. We anticipate enrolling 10–18 total participants based on previously reported sample size in specialty groups for thematic saturation in specialty groups (ie, when no new concepts or factors emerge from interviews). Here we report pilot qualitative analysis results.
Results
Of nine eligible patients, eight enrolled (mean +/- standard deviation age 45.8 +/- 13.4 years, 2 female/6 males). Four patients underwent nasal surgery only, two patients underwent staged procedures, one underwent pharyngeal surgery only, and the last underwent nasal surgery with tori removal. Patients reported decision making duration of days to years for scheduling surgery. Reasons for pursuing sleep surgery included fatigue, quality of life, work performance, and safety. Overarching thematic domains related to decision for surgery were (1) major concerns, (2) external factors influencing decision, and (3) retrospective satisfaction/regret with decision. Major concerns involved factors beyond surgeon’s control, such as anesthesia and postoperative pain management, not surgery itself. Family and friends were reported to be highly influential in the process, both in favor and against surgery. Social media features and celebrity patients with OSA heightened awareness of sleep surgery and set preconceived expectations. Patients were mostly satisfied with outcomes, despite unanticipated acute recovery challenges.
Conclusion
This pilot qualitative analysis identifies factors influencing patients’ OSA treatment decisions. Understanding patients’ major concerns and sources of information may help to guide physician counseling, set realistic expectations, offer peri-operative support, and better engage parents in shared decision-making for sleep surgery.
Support (if any)
None.
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Affiliation(s)
- Allison Ikeda
- Department of Otolaryngology-Head and Neck Surgery, University of Washington
| | - Robin Marsh
- Human Centered Design and Engineering, University of Washington
| | - Crystina McShay
- Human Centered Design and Engineering, University of Washington
| | - Shireen Saini
- Human Centered Design and Engineering, University of Washington
| | - Maya Sardesai
- Department of Otolaryngology-Head and Neck Surgery, University of Washington
| | - Edward Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington
| | - Emily Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
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Baxter H, Carter E, Marris K, Nugent R, Weaver E. Effect of surgeon volume on long-term quality of life outcomes following tension-free vaginal tape surgery. Int Urogynecol J 2021; 33:2099-2106. [PMID: 33760990 DOI: 10.1007/s00192-021-04714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/31/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The role of the general obstetrician/gynaecologist completing routine urogynaecology procedures is controversial, and some research has suggested that these patients should be referred to high-volume subspecialists. In response to recent public and regulatory scrutiny of vaginal mesh procedures, credentialling guidelines have been released in Australia requiring surgeons to demonstrate a minimum caseload prior to performing tension-free vaginal tape (TVT) surgery for incontinence. Hence, a retrospective cohort study was conducted to evaluate the long-term quality of life outcomes of TVT procedures for high- and low-volume surgeons. METHODS One hundred seventy patients who had undergone TVT surgery between 1 May 2011 and 1 May 2016 in the Sunshine Coast health district were invited to complete the UDI-6 (Urinary Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) surveys. Perioperative information was accessed from available health records. Mean UDI-6 and IIQ-7 scores were compared for high- and low-volume groups, and the groups were assessed for confounding factors. RESULTS Of the 170 patients eligible, 83 completed the surveys (47.2%). No differences in UDI-6 or IIQ-7 scores were found between high- and low-volume surgeons (p > 0.05). High-volume surgeons completed more concomitant procedures amongst survey respondents (p < 0.05), though this was not reproduced when considering all 170 patients eligible for the study. There were no significant differences in age, ASA (American Society of Anaesthesiologists) score or complication rate amongst survey respondents. CONCLUSIONS Amongst the patients surveyed, high- and low-volume surgeons had similar long-term quality of life outcomes for TVT surgery, without any significant difference in complication rate.
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Affiliation(s)
- Harold Baxter
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
| | - Edward Carter
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Kelsi Marris
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
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Janda M, Armfield NR, Kerr G, Kurz S, Jackson G, Currie J, Page K, Weaver E, Yazdani A, Obermair A. Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women. J Patient Exp 2020; 7:372-379. [PMID: 32821797 PMCID: PMC7410135 DOI: 10.1177/2374373519840076] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To evaluate women’s experiences after hysterectomy and predictors of their contentment and regret with the surgical approaches. Methods: Cross-sectional, Patient-Reported Experience Measures survey in 2319 Australian women aged 21 to 90 years (median age of 52 years) who had received hysterectomy in the preceding 2 years. Results: Overall, the vast majority of women (>96%) did not regret having had the hysterectomy. Women who received an open abdominal hysterectomy reported slower recovery with about 7% of women still not fully recovered after 12 months compared to those whose surgery was through a less invasive approach. Women who reported no adverse events, having been given a choice of type of hysterectomy, women who received an alternative to open abdominal hysterectomy, and women who felt prepared for discharge from hospital were significantly more likely to be content with their hysterectomy and report positive patient experiences. Conclusions: Compared with those who received a less invasive approach to hysterectomy, women who received open surgery were more likely to express negative experiences relating to their hospital stay and recovery from surgery. The results inform future improvements of care for women planning a hysterectomy.
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Affiliation(s)
- Monika Janda
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,School of Public Health, Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia
| | - Nigel R Armfield
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Gayle Kerr
- School of Advertising, Marketing and Public Relations, Queensland University of Technology Business School, Brisbane, Australia
| | - Suzanne Kurz
- Royal Brisbane and Women's Hospital, Queensland Centre for Gynaecological Cancer, Brisbane, Australia
| | | | | | - Katie Page
- School of Public Health, Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia
| | - Edward Weaver
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Department of Obstetrics and Gynaecology, Nambour Hospital, Nambour, Australia
| | - Anusch Yazdani
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Andreas Obermair
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Queensland Centre for Gynaecological Cancer, Brisbane, Australia
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27
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Ryder R, Kearney L, Kynn M, Weaver E. Resilience and workplace stress in Australian and New Zealand obstetrics and gynaecology trainees: A cross-sectional survey. Aust N Z J Obstet Gynaecol 2019; 60:225-230. [PMID: 31820440 DOI: 10.1111/ajo.13098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obstetrics and gynaecology training is a demanding vocation; there is a paucity of data on trainee resilience and well-being in this field. AIM To investigate resilience, support and perceived levels of stress and burnout in Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees. MATERIALS AND METHODS A cross-sectional survey of RANZCOG trainees in Australia and New Zealand (n = 638) was distributed electronically in May 2018. RESULTS Two-hundred and thirty-one (36%) valid responses were received. The mean resilience score was moderate (mean = 77; SD = 11). Resilience was significantly associated with general health (F = 7.5, P = 0.007), depression in the last two weeks (F = 4.4, P = 0.013) and seriously considering leaving the program at some point (F = 15.4, P < 0.001). Most participants (204; 88%) stated improvements could be made to the level of trainee support; with over half identifying the support they received from RANZCOG to be low or very low (132; 57%). One-third of participants (76; 33%) rated the support from their direct supervisor as low to very low. Over half of all participants identified high to very high responses to: burnout (127; 55%); personal stress (134; 58%); workplace stress (143; 62%) and depression (103; 45%). CONCLUSION RANZCOG trainees exhibit moderate resilience levels, yet they report high levels of perceived stress, depression and burnout and low-level support from direct supervisors. This may highlight the need for enhanced support and working conditions to allow trainees to remain resilient and thrive in their careers.
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Affiliation(s)
- Rebecca Ryder
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,Discipline of Obstetrics and Gynaecology, University of Queensland, Brisbane, Queensland, Australia
| | - Lauren Kearney
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Mary Kynn
- School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,Discipline of Obstetrics and Gynaecology, University of Queensland, Brisbane, Queensland, Australia
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28
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Janda M, Armfield NR, Kerr G, Kurz S, Jackson G, Currie J, Page K, Weaver E, Yazdani A, Obermair A. Surgical approach to hysterectomy and barriers to using minimally invasive methods. Aust N Z J Obstet Gynaecol 2018; 58:690-695. [PMID: 29763509 DOI: 10.1111/ajo.12824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/08/2018] [Indexed: 11/28/2022]
Abstract
Minimally invasive approaches to hysterectomy have been shown to be safe, effective and have recovery advantages over open hysterectomy, yet in Australia 36% of hysterectomies are still conducted by open surgery. In 2006, a survey of Australian gynaecological specialists found the main impediment to increasing laparoscopic hysterectomy to be a lack of surgical skills training opportunities. We resurveyed specialists to explore contemporary factors influencing surgeons' approaches to hysterectomy; 258 (estimated ~19%) provided analysable responses. Despite >50% of surveyed specialists wishing to practise laparoscopic hysterectomy in the future, lack of surgical skills, arising from the lack of training opportunities, remains the main impediment.
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Nigel R Armfield
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gayle Kerr
- QUT Business School, School of Advertising, Marketing and Public Relations, Queensland University of Technology, Brisbane, Australia
| | - Suzanne Kurz
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Graeme Jackson
- Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Australia
| | | | - Katie Page
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Edward Weaver
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Obstetrics and Gynaecology, Nambour Hospital, Nambour, Australia
| | - Anusch Yazdani
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andreas Obermair
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Queensland Centre for Gynaecological Cancer, Brisbane, Australia
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29
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Janda M, Armfield NR, Page K, Kerr G, Kurz S, Jackson G, Currie J, Weaver E, Yazdani A, Obermair A. Factors influencing women's decision making in hysterectomy. Patient Educ Couns 2018; 101:504-510. [PMID: 28918105 DOI: 10.1016/j.pec.2017.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/31/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore factors influencing how well-informed women felt about hysterectomy, influences on their decision making, and on them receiving a less-invasive alternative to open surgery. METHODS Online questionnaire, conducted in 2015-2016, of women who had received a hysterectomy in Australia, in the preceding two years. RESULTS Questionnaires were completed by 2319/6000 women (39% response). Most women (n=2225; 96%) felt well-informed about hysterectomy. Women were more aware of the open abdominal approach (n=1798; 77%), than of less-invasive vaginal (n=1552; 67%), laparoscopic (n=1540; 66%), laparoscopic-assisted (n=1303; 56%), and robotic approaches (n=289; 12%). Most women (n=1435; 62%) reported their gynaecologist was the most influential information source. Women who received information about hysterectomy from a GP (OR=1.47; 95% CI 1.15-1.90), or from a gynaecologist (OR=1.3; 95% CI 1.06-1.58), were more likely to feel better informed (p<0.01). CONCLUSION This study is important because it helps clinicians, researchers and health policy makers to understand why many women still receive an open abdominal approach despite many learned societies recommending to avoid it if possible. PRACTICE IMPLICATIONS Additional information, or education about avoiding open abdominal approach where possible may lead to a greater number of women receiving less-invasive types of hysterectomy in the future.
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Affiliation(s)
- Monika Janda
- Queensland University of Technology, School of Public Health, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| | - Nigel R Armfield
- The University of Queensland, Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia
| | - Katie Page
- Queensland University of Technology, School of Public Health, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| | - Gayle Kerr
- Queensland University of Technology, QUT Business School, School of Advertising, Marketing and Public Relations, Brisbane, Queensland, Australia
| | - Suzanne Kurz
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Jason Currie
- Vanguard Health, Brisbane, Queensland, Australia
| | - Edward Weaver
- The University of Queensland, Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia; Nambour Hospital, Nambour, Queensland, Australia
| | - Anusch Yazdani
- The University of Queensland, Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia
| | - Andreas Obermair
- The University of Queensland, Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia; Queensland Centre for Gynaecological Cancer, Brisbane, Queensland, Australia.
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30
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Piccirillo JF, Yueh B, Davies L, Weaver E. Addressing the Challenges for Otolaryngology Research to Inform Patient Care and Outcomes. JAMA Otolaryngol Head Neck Surg 2017; 143:865-868. [PMID: 28687818 DOI: 10.1001/jamaoto.2017.0967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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]
Affiliation(s)
- Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, Missouri.,Editor
| | - Bevan Yueh
- Department of Otolaryngology/Head & Neck Surgery, University of Minnesota, Minneapolis
| | - Louise Davies
- Veterans Affairs Outcomes Group, Geisel School of Medicine at Dartmouth, White River Junction, Vermont
| | - Edward Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle
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31
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Michaud C, Weaver E, Frith J, Peppers B, Hostoffer R. P051 Influence of winter weather on the pollen season in northeast Ohio. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.060] [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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32
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Aston B, Weaver E. Risks and benefits of hysteroscopy and endometrial sampling as a standard procedure for assessing serendipitous findings of endometrial thickening in postmenopausal women. Aust N Z J Obstet Gynaecol 2014; 54:597-9. [PMID: 25308710 DOI: 10.1111/ajo.12259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/05/2014] [Indexed: 12/18/2022]
Abstract
A retrospective study was undertaken of 35 asymptomatic postmenopausal women undergoing hysteroscopy, dilatation and curettage (H D&C) for an incidental finding of thickened endometrium to assess the rate of significant pathological findings, cost per finding and complication rate of any procedures performed. This study found one case of endometrial adenocarcinoma (1/35; 3%) at an estimated cost per significant finding of $507,116 with an estimated 11.6 complication events per finding.
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Affiliation(s)
- Benjamin Aston
- Princess Alexandra Hospital, Wooloongabba, Queensland, Australia
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33
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Byford S, Weaver E, Anstey C. Has the incidence of hypoxic ischaemic encephalopathy in Queensland been reduced with improved education in fetal surveillance monitoring? Aust N Z J Obstet Gynaecol 2014; 54:348-53. [PMID: 24597944 DOI: 10.1111/ajo.12200] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 02/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypoxic ischaemic encephalopathy (HIE) is secondary to intrapartum asphyxia and the fifth largest cause of death of children under five. Incorrect use and interpretation of intrapartum cardiotocographs has been identified as a contributing factor to the development of HIE. Therefore, RANZCOG introduced the Fetal Surveillance Education Program (FSEP) to improve education and practice of intrapartum care. AIM To investigate the incidence of HIE throughout Queensland between 2003 and 2011 during the introduction and implementation of RANZCOG FSEP. METHODS The incidence of HIE admissions at each hospital in Queensland (2003-2011) was collated from Queensland Health Statistics Centre. RANZCOG FSEP provided data regarding course attendees throughout Queensland (2006-2011). Hospitals were grouped into four regions. Statistical analysis was conducted using Stata(TM) (version 12.0) - data appeared to follow a damped harmonic model. RESULTS The posteducation (2006-2011) HIE rate was significantly lower (P = 0.02) than the pre-education (2003-2005) rate. The final model predicted a stabilisation of HIE occurrence rate at approximately 160 events/100,000 live births by 2012. This rate was stable if the level of education was maintained but rose back to the initial rate of 250 events/100,000 live births if the education participation was discontinued. CONCLUSIONS This study identified a significant reduction in the incidence of HIE--a potentially life-threatening newborn condition--between 2003 and 2011, during and following FSEP implementation. Notwithstanding the inevitable limitations of state-based data collection, these results are encouraging. For such improvements to be sustained, education must reach all staff engaged in intrapartum care and be regularly repeated.
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Affiliation(s)
- Sally Byford
- Department of Obstetrics & Gynaecology, Nambour General Hospital, Nambour, Queensland, Australia
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34
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Lim M, Dimech W, Gemert CV, Boyle D, McCarthy D, Weaver E, Donovan B, Hellard M. P3.017 Chlamydia Trachomatis Repeat Testing in Australia. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0477] [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: 11/03/2022]
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35
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Weaver E, Vaughan T. SUCCESSFUL INTERVENTION: RAISING AWARENESS OF ADVANCED CARE PLANNING (ACP) IN THE RURAL COMMUNITY SETTING:. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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36
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Gradisar M, Dohnt H, Gardner G, Paine S, Starkey K, Menne A, Slater A, Wright H, Hudson JL, Weaver E, Trenowden S. A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. Sleep 2011; 34:1671-80. [PMID: 22131604 DOI: 10.5665/sleep.1432] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD). DESIGN Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only. SETTING Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia. PATIENTS 49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17). INTERVENTIONS CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene. MEASUREMENTS AND RESULTS DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up. CONCLUSIONS CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed. CLINICAL TRIAL INFORMATION Australia-New Zealand Trials Registry Number: ACTRN12610001041044.
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Affiliation(s)
- Michael Gradisar
- Child & Adolescent Sleep Clinic, School of Psychology, Flinders University, Adelaide, SA, Australia.
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Abstract
Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antibiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature.
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Affiliation(s)
- E Weaver
- Dept. of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA
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Rhee J, Weaver E. Clinical Consensus Statement. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.615] [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: 10/19/2022]
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Woodson BT, Weaver E, Pang K, Friendman N. Surgery and Clinical Guidelines for Sleep Apnea. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.644] [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: 11/16/2022]
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Huntley T, Jacobowitz O, Weaver E, Kezirian E, Woodson BT. OSA Surgical Options. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.643] [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: 10/19/2022]
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Weaver E, Gradisar M, Dohnt H, Lovato N, Douglas P. The effect of presleep video-game playing on adolescent sleep. J Clin Sleep Med 2010; 6:184-189. [PMID: 20411697 PMCID: PMC2854707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
STUDY OBJECTIVES Video-game use before bedtime has been linked with poor sleep outcomes for adolescents; however, experimental evidence to support this link is sparse. The present study investigated the capacity of presleep video-game playing to extend sleep latency and reduce subjective feelings of sleepiness in adolescents. The arousing psychophysiologic mechanisms involved and the impact of presleep video-game playing on sleep architecture were also explored. METHOD Thirteen male adolescent "evening types" (mean age = 16.6 years, SD = 1.1) participated in a counterbalanced, within-subjects design with experimental (active video gaming) and control (passive DVD watching) conditions. The experiment was conducted in the Flinders University Sleep Research Laboratory. RESULTS Relative to the control condition, presleep video-game playing increased sleep-onset latency (Z= 2.45, p= .01) and reduced subjective sleepiness (Z = 2.36, p = .02)-but only slightly. Video gaming was related to changes in cognitive alertness (as measured by a power: p < 0.01) but not physiologic arousal (as measured by heart rate: p > 0.05). Contrary to previous findings, sleep architecture was unaffected (both rapid eye movement and slow wave sleep: p > 0.05). CONCLUSIONS Results suggest the direct effect of presleep video-game playing on adolescent sleep may be more modest than previously thought, suggesting that surveys linking stimulating presleep activities to poor sleep need substantiating with empirical evidence.
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Affiliation(s)
- Edward Weaver
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Michael Gradisar
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Hayley Dohnt
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Nicole Lovato
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Paul Douglas
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Affiliation(s)
- Edward Weaver
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Michael Gradisar
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Hayley Dohnt
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Nicole Lovato
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Paul Douglas
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Jacobowitz O, Kezirian EJ, Steward DL, Weaver E, Woodson BT, Huntley TC, Mickelson S. What to Do After Unsuccessful Sleep Apnea Surgery? Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.077] [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: 11/28/2022]
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Pujols J, López-Soria S, Segalés J, Fort M, Sibila M, Rosell R, Solanes D, Russell L, Campbell J, Crenshaw J, Weaver E, Polo J. Lack of transmission of porcine circovirus type 2 to weanling pigs by feeding them spray-dried porcine plasma. Vet Rec 2009; 163:536-8. [PMID: 18978366 DOI: 10.1136/vr.163.18.536] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
An experiment was conducted to determine whether spray-dried porcine plasma containing 2.47 x 10(5) dna copies of porcine circovirus type 2 (pcv-2) could infect weanling pigs when fed to them. Five specific pathogen-free (spf) weanling pigs were fed ad libitum for 45 days a control diet and six pigs were fed a test diet containing 8 kg sdpp per 100 kg feed. The two groups were housed in separate biosecurity level-3 rooms. None of the pigs in either group developed any clinical signs or became pcv-2 viraemic or seroconverted.
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Affiliation(s)
- J Pujols
- Centre de Recerca en Sanitat Animal (cresa), Fundación uab-irta, Esfera uab, Universitat Autonoma de Barcelona, Barcelona, Spain
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Riley MA, Baker AA, Schmit JM, Weaver E. Effects of Visual and Auditory Short-Term Memory Tasks on the Spatiotemporal Dynamics and Variability of Postural Sway. J Mot Behav 2005; 37:311-24. [PMID: 15967756 DOI: 10.3200/jmbr.37.4.311-324] [Citation(s) in RCA: 83] [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] [Indexed: 11/23/2022]
Abstract
The authors measured postural sway while participants (N = 20 in each experiment) stood on a rigid or a compliant surface, with their eyes open or closed, and while they did or did not perform a short-term memory (STM) task. In Experiment 1, the STM stimuli were presented visually; in Experiment 2, the stimuli were presented auditorily. In both experiments, fine-scaled, mediolateral postural-sway variability decreased as the cognitive load imposed by the STM task increased. That effect was independent of support surface and vision manipulations. The spatiotemporal profile of postural sway was affected by both visual and auditory STM tasks, but to a greater degree by the auditory task. The authors discuss implications of the results for theories and models of postural control.
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Affiliation(s)
- M A Riley
- Department of Psychology, ML 0376, 429 Dyer Hall, University of Cincinnati, Cincinnati, OH 45221-0376, USA.
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Kerr BJ, Kiddt MT, Cuaron JA, Bryant KL, Parr TM, Maxwell CV, Weaver E. Utilization of spray-dried blood cells and crystalline isoleucine in nursery pig diets1. J Anim Sci 2004; 82:2397-404. [PMID: 15318740 DOI: 10.2527/2004.8282397x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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
Three experiments were conducted to evaluate spray-dried blood cells (SDBC) and crystalline isoleucine in nursery pigs. In Exp. 1, 120 pigs were used to evaluate 0, 2, 4, and 6% SDBC (as-fed basis) in a sorghum-based diet. There were six replicates of each treatment and five pigs per pen, with treatments imposed at an initial BW of 9.3 kg and continued for 16 d. Increasing SDBC from 0 to 4% had no effect on ADG, ADFI, and G:F. Pigs fed the 6% SDBC diet had decreased ADG (P < 0.01) and G:F (P = 0.06) compared with pigs fed diets containing 0, 2, or 4% SDBC. In Exp. 2, 936 pigs were used to test diets containing 2.5 or 5% SDBC (as-fed basis) vs. two control diets. There were six replicates of each treatment at industry (20 pigs per pen) and university (six pigs per pen) locations. Treatments were imposed at an initial BW of 5.9 and 8.1 kg at the industry and the university locations, respectively, and continued for 16 d. Little effect on pig performance was noted by supplementing 2.5% SDBC, with or without crystalline Ile, in nursery diets. Pigs fed the 5% SDBC diet without crystalline Ile had decreased ADG (P < 0.01), ADFI (P < or = 0.10), and G:F (P < 0.05) compared with pigs fed the control diets. Supplementation of Ile restored ADG, ADFI, and G:F to levels that were not different from that of pigs fed the control diets. In Exp. 3, 1,050 pigs were used to test diets containing 5, 7.5, or 9% SDBC (as-fed basis) vs. a control diet. There were six replicates of each treatment at the industry (20 pigs per pen) location and five replicates at the university (six pigs per pen) locations. Treatments were imposed at an initial BW of 6.3 and 7.0 kg at the industry and university locations, respectively, and continued for 16 d. Supplementation of 5% SDBC without crystalline Ile decreased ADG and G:F (P < 0.01) compared with pigs fed the control diet, but addition of Ile increased ADG (P < 0.01) to a level not different from that of pigs fed the control diet. The decreased ADG, ADFI, and G:F noted in pigs fed the 7.5% SDBC diet was improved by addition of Ile (P < 0.01), such that ADG and ADFI did not differ from those of pigs fed the control diet. Pigs fed diets containing 9.5% SDBC exhibited decreased ADG, ADFI, and G:F (P < 0.01), all of which were improved by Ile addition (P < 0.01); however, ADG (P < 0.05) and G:F (P = 0.09) remained lower than for pigs fed the control diet. These data indicate that SDBC can be supplemented at relatively high levels to nursery diets, provided that Ile requirements are met.
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Affiliation(s)
- B J Kerr
- USDA-ARS, Swine Odor and Manure Management Research Unit, Ames, IA 50011-3310, USA.
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Nascimento AB, Mitchell DG, Rubin R, Weaver E. Sinusoidal spread of liver metastases from renal cell carcinoma: simulation of diffuse liver disease on MR imaging. Abdom Imaging 2002; 27:196-8. [PMID: 11847581 DOI: 10.1007/s00261-001-0065-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2001] [Indexed: 10/28/2022]
Abstract
Rarely, hepatic metastases can simulate hepatic infiltrative diseases. We present a case of a patient with advanced metastatic renal cell carcinoma who developed hepatomegaly and clinical signs of hepatocellular injury. On magnetic resonance imaging, the injury simulated a diffuse process, e.g., acute fulminant viral or chemical hepatitis or drug toxicity. Despite its high resolution, magnetic resonance imaging might not depict focal lesions in patients with extensive metastases. In correlation with clinical history, malignant disease should be considered when diffusely abnormal hepatic signal intensity is noted.
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Affiliation(s)
- A B Nascimento
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, 1096 Main Building, Philadelphia, PA 19107, USA
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Nascimento AB, Mitchell DG, Rubin R, Weaver E. Diffuse desmoplastic breast carcinoma metastases to the liver simulating cirrhosis at MR imaging: report of two cases. Radiology 2001; 221:117-21. [PMID: 11568328 DOI: 10.1148/radiol.2211001754] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [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: 12/28/2022]
Abstract
Two patients with breast carcinoma, without a prior diagnosis of liver lesions, had proved desmoplastic hepatic metastases that resembled cirrhosis at magnetic resonance (MR) imaging. The cirrhotic appearance of the livers may have resulted from the hepatotoxic effects of chemotherapy and/or hepatic infiltration by the metastatic tumor itself. Despite its high soft-tissue contrast, MR imaging may fail to depict extensive metastases from breast carcinoma, especially when they simulate other diseases (eg, cirrhosis). Correlation of MR imaging findings with clinical history is mandatory.
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Affiliation(s)
- A B Nascimento
- Departments of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 1096 Main Bldg, Philadelphia, PA 19107, USA
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Feske U, Frank E, Kupfer DJ, Shear MK, Weaver E. Anxiety as a predictor of response to interpersonal psychotherapy for recurrent major depression: an exploratory investigation. Depress Anxiety 2000; 8:135-41. [PMID: 9871814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Major depression and anxiety frequently co-occur, but the implications for psychological treatments have rarely been studied. We examined predictors of acute response to interpersonal psychotherapy in 134 consecutively treated female outpatients with recurrent unipolar depression. Women who failed to remit with interpersonal psychotherapy alone experienced higher levels of somatic anxiety, were more likely to meet criteria for lifetime panic disorder, were more likely to meet criteria for nonendogenous or nonmelancholic depression, and reported greater vocational impairment, higher levels of global severity, a longer duration of the index episode, and, somewhat surprisingly, lower levels of social impairment at pretreatment evaluation. A series of backwards stepping logistic regression analyses showed higher levels of baseline somatic anxiety and social functioning to be the most consistent predictors of nonresponse. Our findings strengthen existing evidence that concomitant anxiety can adversely affect the outcome of interpersonal therapy for depression.
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Affiliation(s)
- U Feske
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pennsylvania, USA.
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