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Schauwecker N, Patro A, Holder JT, Bennett ML, Perkins E, Moberly AC. Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits? Otolaryngol Head Neck Surg 2024; 170:1411-1420. [PMID: 38353294 DOI: 10.1002/ohn.677] [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: 10/01/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 04/30/2024]
Abstract
OBJECTIVE To assess patient factors, audiometric performance, and patient-reported outcomes in cochlear implant (CI) patients who would not have qualified with in-quiet testing alone. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. METHODS Adult CI recipients implanted between 2012 and 2022 were identified. Patients with preoperative AzBio Quiet > 60% in the implanted ear, requiring multitalker babble to qualify, comprised the in-noise qualifying (NQ) group. NQ postoperative performance was compared with the in-quiet qualifying (QQ) group using CNC, AzBio Quiet, and AzBio +5 dB signal-to-noise ratio. Speech, Spatial and Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL-10), and daily device usage were also compared between the groups. RESULTS The QQ group (n = 771) and NQ group (n = 67) were similar in age and hearing loss duration. NQ had higher average preoperative and postoperative speech recognition scores. A larger proportion of QQ saw significant improvement in CNC and AzBio Quiet scores in the CI-only listening condition (eg, CI-only AzBio Quiet: 88% QQ vs 51% NQ, P < .001). Improvement in CI-only AzBio +5 dB and in all open set testing in the best-aided binaural listening condition was similar between groups (eg, Binaural AzBio Quiet 73% QQ vs 59% NQ, P = .345). Postoperative SSQ ratings, CIQOL scores, and device usage were also equivalent between both groups. CONCLUSION Patients who require in-noise testing to meet CI candidacy demonstrate similar improvements in best-aided speech perception and patient-reported outcomes as in-QQ, supporting the use of in-noise testing to determine CI qualification for borderline CI candidates.
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Affiliation(s)
- Natalie Schauwecker
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Wall A, Burton L, Perkins E. Organizational response to the COVID-19 pandemic and its association with moral distress in community mental health teams in the UK: A qualitative study. Int J Ment Health Nurs 2024; 33:378-387. [PMID: 37828702 DOI: 10.1111/inm.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
In March 2020, Coronavirus-19 (COVID-19) rapidly spread across the globe impacting the mental health of the population and putting an overwhelming pressure on health services. Much has been written about the impact of the pandemic on health-care workers working in hospital settings but less attention has been paid to its effect on community mental health teams (CMHTs). This study is based on 21 remote interviews with community mental health professionals during the first wave of the COVID-19 pandemic. Interviews were transcribed and analysed using a thematic analysis whereby codes of similar meaning were grouped into main themes. Analysis identified three major contributors to moral distress; changes in the nature of contact with service users, changes to the place of work, and difficulties of balancing risks to the families of CMHT staff and service users. This study demonstrates that necessary organizational changes instituted to minimize the spread of COVID-19, required different ways of working which were not perceived to be in the best interests of service users or the families of CMHT staff. In order to comply with Government directives, CMHT staff were forced to behave in a way which did not match their moral values causing them to experience moral distress.
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Hepworth LR, Kirkham JJ, Perkins E, Helliwell B, Howard C, Liptrot M, Tawana S, Wilson E, Rowe FJ. Validation of the brain injury associated visual impairment - impact questionnaire (BIVI-IQ). Qual Life Res 2024; 33:777-791. [PMID: 38112864 PMCID: PMC10894123 DOI: 10.1007/s11136-023-03565-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The Brain Injury associated Visual Impairment - Impact Questionnaire (BIVI-IQ) was developed to assess the impact of post-stroke visual impairment. The development of the questionnaire used robust methods involving stroke survivors and clinicians. The aim of this study was to assess the validity of the BIVI-IQ in a stroke population. METHODS Stroke survivors with visual impairment were recruited from stroke units, outpatient clinics and non-healthcare settings. Participants were asked to complete questionnaire sets on three separate occasions; the BIVI-IQ at each visit with additional questionnaires at baseline and visit 2. Vision assessment and anchor questions from participants and clinicians were collected. The analysis included assessment of missing data, acceptability, Rasch model analysis, test-retest reliability, construct validity (NEI VFQ-25, EQ-5D-5L) and responsiveness to change. RESULTS 316 stroke survivors completed at least one questionnaire of the 326 recruited. Mean age was 67 years and 64% were male. Adequate fit statistics to the Rasch model were reached (χ2 = 73.12, p = 0.02) with two items removed and thresholds of two adjusted, indicating validity and unidimensionality. Excellent test-retest reliability was demonstrated (ICC = 0.905) with a 3-month interval. Construct validity was demonstrated with a strong significant correlation to the NEI VFQ-25 (r = 0.837, p < 0.01). The BIVI-IQ also demonstrated responsiveness to change with significant differences identified between groups based on participant and clinician anchor questions (X2 = 23.29, p < 0.001; X2 = 24.56, p < 0.001). CONCLUSION The BIVI-IQ has been shown to be valid and practical for 'everyday' use by clinicians and researchers to monitor vision-related quality of life in stroke survivors with visual impairment.
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Affiliation(s)
- L R Hepworth
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
- Northern Care Alliance NHS Foundation Trust, Salford, UK.
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK.
| | - J J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - E Perkins
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - B Helliwell
- VISable, Patient and Public Representative, Liverpool, UK
| | - C Howard
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - M Liptrot
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - S Tawana
- Buckinghamshire Healthcare NHS Trust, High Wycombe, UK
| | - E Wilson
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - F J Rowe
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
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Fortune A, Perkins E, Paize F, Palanisami B, Gladstone M. Managing mothers' and fathers' uncertainty during their journey through early neurodevelopmental follow-up for their high-risk infants-A qualitative account. Child Care Health Dev 2024; 50:e13168. [PMID: 37737651 DOI: 10.1111/cch.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early diagnosis of cerebral palsy is possible by 5 months corrected age for 'at-risk' infants, using diagnostic tools such as the Hammersmith Infant Neurological Examination (HINE), Prechtl's General Movements Assessment (GMA) and magnetic resonance imaging (MRI). This is an uncertain and stressful time for parents where provision of appropriate information and support is essential. AIM To explore parents' views and experiences in relation to the new early neurodevelopmental follow-up of 'at-risk' infants. METHODS Thirteen in-depth one-to-one qualitative interviews were conducted by the primary researcher, with eight parents (six mothers and two fathers) of 'at-risk' infants eligible for a follow-up clinic where the GMA and HINE were performed at 12-week corrected age. Interviews used a pre-piloted topic guide and took place before and after the clinic. Interviews were audio-recorded, transcribed verbatim and analysed using inductive coding and thematic analysis using the framework approach. FINDINGS Seven themes were identified: (1) attempting to manage uncertainty, (2) taking priority, (3) trusting professionals, (4) independence in the parent role, (5) feeling understood, (6) patterns of care and (7) individuality. Parents reported experiencing uncertainty about their current situation and future. Adequate preparation for and timing of information are vital. When uncertainty is poorly managed, parents' wellbeing suffers. Individual parents' perspectives and infants' developmental trajectories differ, and information should be tailored specifically for this. CONCLUSION A parent's understanding of the journey through neurodevelopmental care for their high risk infants is initially very limited. Implementing a counselling service for parents to access psychological support and digital reminder system for clinic appointments, as well as providing more tailored information through trusted professionals, could all improve future parents' experiences.
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Affiliation(s)
- Alice Fortune
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, Institute of Population Health, Liverpool, UK
| | - Fauzia Paize
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - Melissa Gladstone
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Kilada S, French N, Perkins E, Hungerford D. Pregnant women's attitudes and behaviours towards antenatal vaccination against Influenza and COVID-19 in the Liverpool City Region, United Kingdom: Cross-sectional survey. Vaccine X 2023; 15:100387. [PMID: 37753114 PMCID: PMC10518603 DOI: 10.1016/j.jvacx.2023.100387] [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: 06/30/2022] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Objectives Influenza poses a serious health risk to pregnant women and their babies. Despite this risk, influenza vaccine uptake in pregnant women in the UK is less than 50%. Little is known about how COVID-19 affects pregnant women, but its management may affect attitudes and behaviours towards vaccination in pregnancy. The study objectives were to establish attitudes and knowledge of pregnant women towards influenza disease and influenza vaccination and to compare these to attitudes and knowledge about COVID-19 and COVID-19 vaccination. Design A cross-sectional survey was conducted using an online questionnaire distributed through local advertisement and social media outlets. Information was sought on attitudes and knowledge of influenza and COVID-19 and their respective vaccines. Participants and setting Pregnant women residing in Liverpool City Region, UK. Results Of the 237 respondents, 73.8% reported receiving an influenza vaccine. Over half (56.5%) perceived themselves to be at risk from influenza, 70.5% believed that if they got influenza, their baby would get ill, and 64.6% believed getting influenza could hurt their baby, 60.3% believed that the influenza vaccine would prevent their baby from getting ill, and 70.8% believed it would protect their baby. Only 32.9% of respondents stated they would receive the COVID-19 vaccine if it were available to them. However, 80.2% stated they would receive a COVID-19 vaccine if they were not pregnant. Most of the women stated that they would accept a vaccine if recommended to them by healthcare professionals. Conclusions Acceptance of the influenza and COVID-19 vaccines during pregnancy seems to be more related to the safety of the baby rather than the mother. Women perceived their child to be more at risk than themselves. Information about influenza and COVID-19 vaccine safety as well as healthcare provider recommendations play an important role in vaccine uptake in pregnant women.
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Affiliation(s)
- Samantha Kilada
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Neil French
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- Centre for Global Vaccine Research, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Dan Hungerford
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- Centre for Global Vaccine Research, University of Liverpool, Liverpool, UK
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Brennan JR, Sharma R, Lindquist NR, Cass ND, Krishnapura SG, Kloosterman N, Perkins E, Bennett ML, O'Malley MR, Haynes DS, Tawfik KO. Presbycusis and Hearing Preservation in Observed Vestibular Schwannomas. Otol Neurotol 2023; 44:817-821. [PMID: 37442597 DOI: 10.1097/mao.0000000000003947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE We reviewed a cohort of patients with untreated sporadic vestibular schwannoma (VS) and examined the relationship between high-frequency hearing loss (HFHL) in the non-VS ear and long-term hearing outcomes in the VS-affected ear. We hypothesized that the progression of HFHL is associated with accelerated hearing decline in sporadic VS. STUDY DESIGN Retrospective cohort study. SETTING Tertiary center. PATIENTS We studied 102 patients with sporadic VS diagnosed from 1999 to 2015 with ≥5 years of observation (median, 6.92; interquartile range, 5.85-9.29). Sixty-six patients had AAO-HNS class A/B hearing at presentation and were included in analysis. INTERVENTIONS Audiometry, serial magnetic resonance imaging for observation of VS. MAIN OUTCOME MEASURES Four-frequency pure tone average (PTA) and word recognition scores (WRS) in the VS-affected ear. Decline in high-frequency PTA (average of thresholds at 4000, 6000, and 8,000 Hz) was defined as ≥10 dB during the study period. Decline in WRS was defined as ≥10%. RESULTS Compared with those without, patients with progressive HFHL in the non-VS ear were more likely to experience a decline in WRS in the VS ear (80% vs. 54%, p = 0.031). However, the same group showed no difference (52% vs. 41%, p = 0.40) in decline in PTA of the VS ear. CONCLUSIONS Patients with observed VS who experience progressive HFHL in the non-VS ear are more likely to experience significant declines in speech understanding in the VS-affected ear over time. Patients with a history of presbycusis may have an increased risk of losing serviceable hearing because of sporadic VS.
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Affiliation(s)
- Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
Neonatal Severe Acute Respiratory Syndrome-CoronaVirus-2 infections can be community-acquired or vertically-acquired. The analysis of neonatal patients requiring hospitalization reported in the EPICENTRE worldwide registry shows that community-acquired cases have clinical features (fever, respiratory signs, feeding difficulties, P < 0.0001) and received antibiotics (P = 0.014) more frequently than vertically-acquired patients. Severe Acute Respiratory Syndrome-CoronaVirus-2 infections should be considered in the clinical workout of neonatal infections.
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Affiliation(s)
- Daniele De Luca
- From the Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
- Physiopathology and therapeutic innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Elizabeth Perkins
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Jones K, Rivera C, Bindas B, Woodard L, Perkins E. Sports: An underutilized tool for patients with disabilities. J Fam Pract 2023; 72:102-106. [PMID: 37075210 DOI: 10.12788/jfp.0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sport activities promote health and well-being in this population, which is disproportionately affected by obesity, sedentary lifestyle, and social isolation.
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Affiliation(s)
- Kristina Jones
- Morsani College of Medicine (Ms. Jones, Ms. Rivera, and Drs. Bindas and Woodward) and College of Behavioral and Community Sciences (Dr. Perkins), University of South Florida, Tampa
| | - Cianna Rivera
- Morsani College of Medicine (Ms. Jones, Ms. Rivera, and Drs. Bindas and Woodward) and College of Behavioral and Community Sciences (Dr. Perkins), University of South Florida, Tampa
| | - Bradford Bindas
- Morsani College of Medicine (Ms. Jones, Ms. Rivera, and Drs. Bindas and Woodward) and College of Behavioral and Community Sciences (Dr. Perkins), University of South Florida, Tampa
| | - Laurie Woodard
- Morsani College of Medicine (Ms. Jones, Ms. Rivera, and Drs. Bindas and Woodward) and College of Behavioral and Community Sciences (Dr. Perkins), University of South Florida, Tampa
| | - Elizabeth Perkins
- Morsani College of Medicine (Ms. Jones, Ms. Rivera, and Drs. Bindas and Woodward) and College of Behavioral and Community Sciences (Dr. Perkins), University of South Florida, Tampa
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Pereira-Fantini PM, Ferguson K, McCall K, Oakley R, Perkins E, Byars S, Williamson N, Nie S, Tingay DG. Respiratory strategy at birth initiates distinct lung injury phenotypes in the preterm lamb lung. Respir Res 2022; 23:346. [DOI: 10.1186/s12931-022-02244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
A lack of clear trial evidence often hampers clinical decision-making during support of the preterm lung at birth. Protein biomarkers have been used to define acute lung injury phenotypes and improve patient selection for specific interventions in adult respiratory distress syndrome. The objective of the study was to use proteomics to provide a deeper biological understanding of acute lung injury phenotypes resulting from different aeration strategies at birth in the preterm lung.
Methods
Changes in protein abundance against an unventilated group (n = 7) were identified via mass spectrometry in a biobank of gravity dependent and non-dependent lung tissue from preterm lambs managed with either a Sustained Inflation (SI, n = 20), Dynamic PEEP (DynPEEP, n = 19) or static PEEP (StatPEEP, n = 11). Ventilation strategy-specific pathways and functions were identified (PANTHER and WebGestalt Tool) and phenotypes defined using integrated analysis of proteome, physiological and clinical datasets (MixOmics package).
Results
2372 proteins were identified. More altered proteins were identified in the non-dependent lung, and in SI group than StatPEEP and DynPEEP. Different inflammation, immune system, apoptosis and cytokine pathway enrichment were identified for each strategy and lung region. Specific integration maps of clinical and physiological outcomes to specific proteins could be generated for each strategy.
Conclusions
Proteomics mapped the molecular events initiating acute lung injury and identified detailed strategy-specific phenotypes. This study demonstrates the potential to characterise preterm lung injury by the direct aetiology and response to lung injury; the first step towards true precision medicine in neonatology.
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Furtado T, Perkins E, Pinchbeck G, McGowan C, Watkins F, Christley R. Exploring human behavior change in equine welfare: Insights from a COM-B analysis of the UK's equine obesity epidemic. Front Vet Sci 2022; 9:961537. [DOI: 10.3389/fvets.2022.961537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
While equine obesity is understood by equine professionals to be a serious and widespread welfare problem, thus far approaches to reducing the prevalence of obesity in the UK's leisure horses have mainly been limited to educating owners about the dangers of obesity in their horses. In human health, approaches to behavior change encourage holistic thinking around human behavior, recognizing the importance of the connection between the individuals' knowledge, attitudes, habits, and the social and physical environments. This study used qualitative data from interviews with horse owners and professionals, open-access discussion fora and focus groups in order to collate extensive information about the factors shaping the UK's equine obesity crisis. The data were initially analyzed using a grounded theory method to determine the common themes, and were then analyzed using the COM-B model of behavior change, in order to identify areas where human behavior change might be better supported. The analysis highlighted the importance of a holistic approach to behavior change, since all areas of the COM-B were important in limiting owners' recognition of, and response to, equine obesity. For example, environments and social norms limited the likelihood of owners proactively managing horse weight, and owners also found it difficult to identify overweight horses, and evaluate the risks of long-term health issues as a result of weight, with short-term negative impacts of weight management. While interventions often aim to educate owners into changing their behavior, this analysis highlights the importance of creative and holistic approaches which work alongside the owners' motivations, while shaping the social and physical environments.
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Smith R, Furtado T, Brigden C, Pinchbeck G, Perkins E. A Qualitative Exploration of UK Leisure Horse Owners' Perceptions of Equine Wellbeing. Animals (Basel) 2022; 12:2937. [PMID: 36359063 PMCID: PMC9654126 DOI: 10.3390/ani12212937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 02/10/2024] Open
Abstract
Human assessment of equine wellbeing is fundamental to ensuring the optimal care of domestic horses. However, terminology associated with wellbeing is still not fully defined and there are currently no validated quality of life (QoL) assessment tools. Furthermore, little is known about what equine wellbeing or QoL means to horse owners, or how their beliefs impact on the management decisions they make for their horse. This study sought to establish how UK leisure horse owners use wellbeing-related terminology by exploring their accounts within a focus group setting. Four online focus group discussions (FGD) were held and qualitative data were collected. FGDs involved a semi-structured discussion, followed by a group activity to compare seven equine wellbeing-related terms of interest introduced by the facilitator. The collected data were analysed using a constructivist grounded theory approach, and also by content analysis, to examine the frequency and subjective meaning of the terms of interest. The results showed that horse owners did not clearly delineate between different terms, rather, they used the terms in the context of their own assessments of their horse. The meanings assigned to what owners experienced with their horse were individual and subjective, shaped by past experiences, relationships with their animal, and peers or social groups. This individualised construction of equine wellbeing impacted on the meaning conveyed when using wellbeing-related terminology. In this study, we extend the literature on equine wellbeing terminology usage, and highlight differences between the academic literature and the real-world experiences of horse owners.
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Affiliation(s)
- Rebecca Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK
| | - Tamzin Furtado
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK
| | - Charlotte Brigden
- Equine Department, University Centre Myerscough, St Michael’s Road, Bilsborrow, Preston PR3 0RY, UK
| | - Gina Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK
| | - Elizabeth Perkins
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block H, Pembroke Place, Liverpool L69 3GF, UK
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Burton L, Wall A, Perkins E. Making It Work: The Experiences of Delivering a Community Mental Health Service during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:12056. [PMID: 36231359 PMCID: PMC9564938 DOI: 10.3390/ijerph191912056] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic forced rapid innovative change to healthcare delivery. Understanding the unique challenges faced by staff may contribute to different approaches when managing future pandemics. Qualitative interviews were conducted with 21 staff from a Community Mental Health Team in the North West of England, UK, three months after the first wave of the pandemic. Thematic analysis was used to examine data reporting the challenges arising when working to deliver a service during the pandemic. Data is discussed under four headings; "senior trust managers trying to make it work", "individuals making it work", "making it work as a team", and "making it work through working at home". Clear communication was essential to ensure adherence to guidelines while providing safe care delivery. The initial response to the pandemic involved the imposition of boundaries on staff by senior leadership to ensure that vulnerable service users received a service while maintaining staff safety. The data raises questions about how boundaries were determined, the communication methods employed, and whether the same outcome could have been achieved through involving staff more in decision-making processes. Findings could be used to design interventions to support mental health staff working to deliver community services during future crises.
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Gifford RH, Sunderhaus LW, Holder JT, Berg KA, Dawant BM, Noble JH, Perkins E, Camarata S. Speech recognition as a function of the number of channels for pediatric cochlear implant recipients. JASA Express Lett 2022; 2:094403. [PMID: 36182337 PMCID: PMC9488908 DOI: 10.1121/10.0013428] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/26/2022] [Indexed: 06/16/2023]
Abstract
This study investigated the number of channels required for asymptotic speech recognition for ten pediatric cochlear implant (CI) recipients with precurved electrode arrays. Programs with 4-22 active electrodes were used to assess word and sentence recognition in noise. Children demonstrated significant performance gains up to 12 electrodes for continuous interleaved sampling (CIS) and up to 22 channels with 16 maxima. These data are consistent with the latest adult CI studies demonstrating that modern CI recipients have access to more than 8 independent channels and that both adults and children exhibit performance gains up to 22 channels.
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Affiliation(s)
- René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Linsey W Sunderhaus
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Jourdan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Katelyn A Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Benoit M Dawant
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Jack H Noble
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Elizabeth Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA , , , , , , ,
| | - Stephen Camarata
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Trip H, Northway R, Perkins E, Mirfin‐Veitch B, Adams R. COVID
‐19: Evolving challenges and opportunities for residential and vocational intellectual disability service providers. Policy Practice Intel Disabi 2022; 19:102-115. [PMID: 35601012 PMCID: PMC9115148 DOI: 10.1111/jppi.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 12/23/2022]
Abstract
The sustainability of service provision continues to be a challenge in the field of intellectual disability due to changes in delivery as part of intermittent or ongoing lockdown requirements during the COVID‐19 global pandemic. There are many facets to this that may have temporary or permanent impacts not only on the sector, but ultimately for service access and outcomes for people with intellectual disability themselves. This narrative literature review identifies both opportunities for, and impacts on, service providers across jurisdictions. These are explored in terms of the effects that suspension, adaptation, continuity or the cessation of service delivery have had, and those that are projected. Such impacts include, but are not limited to, changes in service access and delivery, employment roles and responsibilities, financial sustainability and the need to diversify the services and supports provided and how they are delivered. The relevance of these impacts for family carers and people with intellectual disability is also discussed. Nonetheless, there have also been opportunities which inform the shape of service delivery and pandemic planning into the future.
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Affiliation(s)
- Henrietta Trip
- Centre for Postgraduate Nursing Studies University of Otago Christchurch New Zealand
| | - Ruth Northway
- Faculty of Life Sciences and Education University of South Wales Pontypridd UK
| | - Elizabeth Perkins
- Department of Child and Family Studies University of South Florida Tampa Florida USA
| | - Brigit Mirfin‐Veitch
- Centre for Postgraduate Nursing Studies University of Otago Christchurch New Zealand
- Donald Beasley Institute Dunedin New Zealand
| | - Reece Adams
- Centre for Developmental Disability Health Monash Health Melbourne Victoria Australia
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Furtado T, King M, Perkins E, McGowan C, Chubbock S, Hannelly E, Rogers J, Pinchbeck G. An Exploration of Environmentally Sustainable Practices Associated with Alternative Grazing Management System Use for Horses, Ponies, Donkeys and Mules in the UK. Animals (Basel) 2022; 12:ani12020151. [PMID: 35049774 PMCID: PMC8772570 DOI: 10.3390/ani12020151] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Equestrian land could be a potentially important environmental resource, given that pastureland can help to sequester carbon from the atmosphere, prevent soil erosion and provide diverse ecosystems for native plant and wildlife species. However, equestrian land has been overlooked in environmental research and policy. This study reports on the ways which horse, pony, donkey and mule keepers in the UK described environmental practices as part of their equid care. Through an analysis of survey responses (N = 758) from equid keepers using alternative grazing systems, we report on three very different management approaches which resulted in keepers aiming to promote healthy pastures and healthy animals. This study provides the basis for future research exploring attitudes to sustainability in equid keepers, as well as evaluating the impact of their efforts. Abstract Equestrian grazing management is a poorly researched area, despite potentially significant environmental impacts. This study explored keepers’ use of alternative grazing systems in the care of UK horses, donkeys and mules through an internet survey. The survey was available during the summer of 2020 and comprised closed and open questions, which were analysed with descriptive statistics and iterative thematic analysis, respectively. A total of 758 responses was incorporated into the analysis; the most popular system used were tracks (56.5%), Equicentral (19%), “other” (e.g., non-grass turnout) (12.5%), rewilding (7.5%) and turnout on either moorland (0.7%) or woodland (2.5%). The thematic analysis highlighted that equid keepers across the systems were highly engaged in exploring sustainable practices. Their approaches varied according to each system, yet all aimed to fulfil practices in three major categories, i.e., supporting diverse plant life (usually through restricting equid access to certain areas), supporting wildlife (through the creation of biodiverse environments) and sustainably managing droppings and helminths. Additionally, proponents of the Equicentral systems declared to be aiming to support soil health. These data provide a promising insight into equid keepers’ behaviour and attitudes to sustainability.
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Affiliation(s)
- Tamzin Furtado
- Department of Livestock and One Health, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK;
- Correspondence:
| | - Mollie King
- School of Veterinary Science, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK; (M.K.); (C.M.)
| | - Elizabeth Perkins
- Institute of Population Health, University of Liverpool, Liverpool L69 3GL, UK;
| | - Catherine McGowan
- School of Veterinary Science, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK; (M.K.); (C.M.)
| | - Samantha Chubbock
- World Horse Welfare, Anne Colvin House, Snetterton, Norwich NR16 2LR, UK;
| | - Emmeline Hannelly
- The British Horse Society (Welfare Dept) Abbey Park, Stareton, Warwickshire CV8 2XZ, UK;
| | - Jan Rogers
- The Horse Trust, Slad Ln, Princes Risborough HP27 0PP, UK;
| | - Gina Pinchbeck
- Department of Livestock and One Health, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK;
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Bedford R, Perkins E, Clements J, Hollings M. Recent advancements and application of in vitro models for predicting inhalation toxicity in humans. Toxicol In Vitro 2021; 79:105299. [PMID: 34920082 DOI: 10.1016/j.tiv.2021.105299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/20/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
Animals have been indispensable in testing chemicals that can pose a risk to human health, including those delivered by inhalation. In recent years, the combination of societal debate on the use of animals in research and testing, the drive to continually enhance testing methodologies, and technology advancements have prompted a range of initiatives to develop non-animal alternative approaches for toxicity testing. In this review, we discuss emerging in vitro techniques being developed for the testing of inhaled compounds. Advanced tissue models that are able to recreate the human response to toxic exposures alongside examples of their ability to complement in vivo techniques are described. Furthermore, technology being developed that can provide multi-organ toxicity assessments are discussed.
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Affiliation(s)
- R Bedford
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
| | - E Perkins
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
| | - J Clements
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
| | - M Hollings
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
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Abstract
OBJECTIVE Characterize the speech recognition and sound source localization of patients with unilateral Menière's disease who undergo labyrinthectomy for vertigo control with simultaneous or sequential cochlear implantation. DATABASES REVIEWED PubMed, Embase, and Cochrane databases. METHODS The search was performed on May 6, 2020. The keywords utilized included: "Menière's disease AND cochlear implant;" "cochlear implant AND single sided deafness;" "cochlear implant AND vestibular;" and "labyrinthectomy AND cochlear implant." Manuscripts published in English with a publication date after 1995 that assessed adult subjects (≥18 years of age) were included for review. Subjects must have been diagnosed with Menière's disease unilaterally and underwent labyrinthectomy with simultaneous or sequential cochlear implantation. Reported outcomes with cochlear implant (CI) use included speech recognition as measured with the consonant-nucleus-consonant (CNC) word test and/or sound source localization reported in root-mean squared (RMS) error. The method of data collection and study type were recorded to assess level of evidence. Statistical analysis was performed with Wilcoxon signed ranks test. RESULTS Data from 14 CI recipients met the criteria for inclusion. Word recognition comparisons between the preoperative interval and a postactivation interval demonstrated a significant improvement with the CI (p = 0.014), with an average improvement of 23% (range -16 to 50%). Sound source localization postoperatively with the CI demonstrated an average RMS error of 26° (SD 6.8, range 18.7-43.1°) compared to the 42° (SD 19.1, range 18-85°) in the preoperative or CI off condition, these two conditions were not statistically different (p = 0.148). CONCLUSION Cochlear implantation and labyrinthectomy in adult patients with Menière's disease can support improvements in speech recognition and sound source localization for some CI users, though observed performance may be poorer than traditional CI candidates.
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Affiliation(s)
- Anne Morgan Selleck
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina
| | - Margaret Dillon
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina
| | - Elizabeth Perkins
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin D Brown
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina
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Abstract
Dog walking is a popular everyday activity known to contribute considerably to human health through motivating substantial additional physical activity. However, despite recognition that walking with a dog is substantially different from walking without a dog, little is known sociologically about the practices of dog walking. This study used in-depth interviews with 38 dog owners, combined with autoethnographical observation of dog walking. The aim was to investigate the types of dog walks that occur and the implications of this for the promotion of dog walking to increase human and animal wellbeing. Two distinct types of dog walking were found that had differing influencers and resulting experiences. Functional walks were purposed through feelings of guilt to provide the dog with a convenient form of exercise but were less pleasurable for the owner. In contrast, recreational walks provided significant owner stress-relief and were longer, typically during pleasant weather and at weekends, in less urban environments, and involved more members of the household. Limitations on time availability, conducive weather or accessibility of desirable physical environments for dog walking, generated functional rather than recreational dog walks. These findings have implications for interventions aiming to promote dog walking and for policy relating to the availability of safe and suitable green spaces for encouraging dog walking.
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Affiliation(s)
- Carri Westgarth
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Liverpool CH64 7TE, UK.,Institute of Veterinary Science, University of Liverpool, Liverpool CH64 7TE, UK
| | - Robert M Christley
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Liverpool CH64 7TE, UK.,Institute of Veterinary Science, University of Liverpool, Liverpool CH64 7TE, UK
| | - Garry Marvin
- Department of Life Sciences, University of Roehampton, London SW15 4JD, UK
| | - Elizabeth Perkins
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 7ZX, UK
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Perkins E, Lee J, Manzoor N, O’Malley M, Bennett M, Labadie R, Rivas A, Haynes D, Gifford R. The Reality of Hearing Preservation in Cochlear Implantation: Who Is Utilizing EAS? Otol Neurotol 2021; 42:832-837. [PMID: 34111047 PMCID: PMC8627182 DOI: 10.1097/mao.0000000000003074] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the proportion of subjects successfully fit with combined electroacoustic stimulation (EAS) compared with those with preserved hearing (HP) after cochlear implantation (CI). In addition, to 1) report the trends in HP and EAS fit rates over time and 2) identify and characterize those patients who preferred the electric only condition. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Two hundred five postlingually deafened adults with bilateral SNHL and a preoperative low-frequency pure-tone average 80 dB HL or better in the ear to be implanted. INTERVENTIONS Subjects underwent CI from 2013 to 2018 with routine pre- and postoperative audiometric testing performed at 6- and 12-months. MAIN OUTCOME MEASURES Percentage of patients fit with EAS, low-frequency pure-tone average, and threshold shift. RESULTS Overall, 141 patients (78.6%) had HP at activation and 42.6% were fit with EAS. Rates of EAS fitting improved from 36.4% in 2013 to 69.0% in 2018. 93.5% of patients had hearing preserved in 2018 compared with 57.9% in 2013. Six patients rejected EAS after a trial period either because of discomfort or poor sound quality. Eight patients had EAS removed because of loss of aidable hearing over time (between activation to 12 mo). CONCLUSIONS Despite the high percentages of HP in the literature, EAS may be under-utilized in the adult CI population. Moving toward a universal definition of HP across institutions may better represent the potential for EAS fitting and a clinical measure capable of identifying patients best suited to benefit from EAS.
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Affiliation(s)
| | - Jaclyn Lee
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nauman Manzoor
- Otolaryngology/Head & Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals ENT Institute, Cleveland, Ohio
| | | | | | | | - Alejandro Rivas
- Otolaryngology/Head & Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals ENT Institute, Cleveland, Ohio
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Perkins E, Dietrich MS, Manzoor N, O'Malley M, Bennett M, Rivas A, Haynes D, Labadie R, Gifford R. Further Evidence for the Expansion of Adult Cochlear Implant Candidacy Criteria. Otol Neurotol 2021; 42:815-823. [PMID: 33606469 PMCID: PMC8627184 DOI: 10.1097/mao.0000000000003068] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE 1) To complete a follow-up investigation of postoperative outcomes for adult cochlear implant (CI) recipients scoring ≥30% Consonant-Nucleus-Consonant (CNC) preoperatively, and 2) to describe the postoperative performance trajectory for this group of higher performing patients. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS One hundred four (105 ears) postlingually deafened adults who scored ≥30% CNC word recognition in the ear to be implanted preoperatively. INTERVENTIONS One hundred four subjects underwent cochlear implantation. MAIN OUTCOME MEASURES Pre- and postoperative CNC word scores and AzBio sentences in quiet and noise in the ear to be implanted as well as the bilateral-aided condition pre-CI and at 1, 3, 6, and 12 months post-CI. RESULTS Statistically significant improvement was demonstrated for CNC and AzBio sentences in quiet and noise for the CI alone and bilateral listening conditions. Most improvement was demonstrated by 6-months postoperatively (p < 0.001) with the exception of AzBio sentences in noise demonstrating improvement within 3 months (p < 0.001). For patients with preop CNC scores up to 40% (n = 57), all recipients demonstrated either equivocal (n = 17) or statistically significant improvement (n = 40) for CNC word recognition in the CI-alone condition and none demonstrated a significant decrement in the bilateral condition. For patients with preop CNC scores >40% (n = 47, 48 ears), 89.3% (42 patients) demonstrated either equivocal (n = 24, 50%) or statistically significant improvement (n = 19, 39.6%) for CNC word recognition in the CI-only condition and none demonstrated a significant decrement in the bilateral condition. CONCLUSIONS CI candidates with preoperative CNC word scores higher than conventional CI recipients derive statistically significant benefit from cochlear implantation for both the CI ear and best-aided condition. These data provide further support for the expansion of adult CI candidacy up to at least 40% CNC word recognition preoperatively with consideration given to further expansion possibly up to 60%.
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Affiliation(s)
- Elizabeth Perkins
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Furtado T, Perkins E, Pinchbeck G, McGowan C, Watkins F, Christley R. Exploring horse owners' understanding of obese body condition and weight management in UK leisure horses. Equine Vet J 2020; 53:752-762. [PMID: 33002214 DOI: 10.1111/evj.13360] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/26/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Equine obesity is considered one of the most serious welfare concerns in UK leisure horses, yet little is known about how horse owners conceptualise their horse's weight as part of its health, or how they plan and carry out weight management. OBJECTIVES This study aimed to further our understanding of leisure horse owners' perceptions of equine health and awareness of excess fat in order to clarify our understanding of successful strategies for managing equine weight. STUDY DESIGN This study used a qualitative research methodology. METHODS Data comprised 16 threads from online UK equine discussion fora, 28 individual interviews with leisure horse owners, 19 interviews with equine professionals such as vets and nutritionists, and two focus groups with a further 21 horse owners. Data were anonymised and analysed using a grounded theory approach. RESULTS Awareness of excess fat was a complex issue, with owners finding it difficult to differentiate equine obesity from the shape they thought the horse was "meant to be", particularly if the horse was a heavier breed such as a native pony or cob. Owners were not necessarily "aware" or "unaware" of fat, but instead equine body fat was constructed as an integral part of the equine body. For example, owners might say that they thought their horse was an ideal weight yet describe their horse's overall body shape as "like a Thelwell". When owners became aware of fat as a changeable part of the horse's body, and/or a threat to health, the presence of fat was articulated as a strong-willed adversary, and weight management was considered a "battle" or "war". Owners found weight management difficult because they perceived that it had immediate negative welfare implications for the horse, and this therefore interfered with their preferred ownership practices and the horse-human relationship. MAIN LIMITATIONS Interview data are self-reported, and people may not always do what they say they do. CONCLUSIONS This study has provided valuable insight into how owners conceptualise weight and weight management, yielding important information about communicating with owners about weight, tailoring weight management strategies, and promoting positive welfare.
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Affiliation(s)
- Tamzin Furtado
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Elizabeth Perkins
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Gina Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Catherine McGowan
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
| | - Francine Watkins
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Robert Christley
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK
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Bruen AJ, Wall A, Haines-Delmont A, Perkins E. Exploring Suicidal Ideation Using an Innovative Mobile App-Strength Within Me: The Usability and Acceptability of Setting up a Trial Involving Mobile Technology and Mental Health Service Users. JMIR Ment Health 2020; 7:e18407. [PMID: 32985995 PMCID: PMC7551108 DOI: 10.2196/18407] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Suicide is a growing global public health problem that has resulted in an increase in the demand for psychological services to address mental health issues. It is expected that 1 in 6 people on a waiting list for mental health services will attempt suicide. Although suicidal ideation has been shown to be linked to a higher risk of death by suicide, not everybody openly discloses their suicidal thoughts or plans to friends and family or seeks professional help before suicide. Therefore, new methods are needed to track suicide risk in real time together with a better understanding of the ways in which people communicate or express their suicidality. Considering the dynamic nature and challenges in understanding suicide ideation and suicide risk, mobile apps could be better suited to prevent suicide as they have the ability to collect real-time data. OBJECTIVE This study aims to report the practicalities and acceptability of setting up and trialing digital technologies within an inpatient mental health setting in the United Kingdom and highlight their implications for future studies. METHODS Service users were recruited from 6 inpatient wards in the north west of England. Service users who were eligible to participate and provided consent were given an iPhone and Fitbit for 7 days and were asked to interact with a novel phone app, Strength Within Me (SWiM). Interaction with the app involved journaling (recording daily activities, how this made them feel, and rating their mood) and the option to create safety plans for emotions causing difficulties (identifying strategies that helped with these emotions). Participants also had the option to allow the study to access their personal Facebook account to monitor their social media use and activity. In addition, clinical data (ie, assessments conducted by trained researchers targeting suicidality, depression, and sleep) were also collected. RESULTS Overall, 43.0% (80/186 response rate) of eligible participants were recruited for the study. Of the total sample, 67 participants engaged in journaling, with the average number of entries per user being 8.2 (SD 8.7). Overall, only 24 participants created safety plans and the most common difficult emotion to be selected was feeling sad (n=21). This study reports on the engagement with the SWiM app, the technical difficulties the research team faced, the importance of building key relationships, and the implications of using Facebook as a source to detect suicidality. CONCLUSIONS To develop interventions that can be delivered in a timely manner, prediction of suicidality must be given priority. This paper has raised important issues and highlighted lessons learned from implementing a novel mobile app to detect the risk of suicidality for service users in an inpatient setting.
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Affiliation(s)
- Ashley Jane Bruen
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Abbie Wall
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Alina Haines-Delmont
- Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
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Begemann S, Watkins F, Van Hoyweghen I, Vivancos R, Christley R, Perkins E. The Governance of UK Dairy Antibiotic Use: Industry-Led Policy in Action. Front Vet Sci 2020; 7:557. [PMID: 33088824 PMCID: PMC7500462 DOI: 10.3389/fvets.2020.00557] [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] [Received: 05/02/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
This article analyses the progress made in the UK with regard to tackling antibiotic "misuse and overuse" in food-producing animals. Moving beyond statistical realities, the paper examines how the UK's industry-led policy approach is shaping practice. Using a multi-sited ethnography situated in Actor Network Theory and Callon's sociology of markets, the UK dairy supply chain policies and practices were studied. Findings reveal that dairy industry policies only partially address the complex network of people, animals, and the environment in which dairy antibiotics circulate. Antibiotic "misuse and overuse" in agriculture is far from a behavioural matter, with solely farmers and veterinarians to blame. Instead, antibiotic use in food animals is embedded in complex economic networks that constrain radical changes in dairy husbandry management and antibiotic use on farms. More attention toward the needs of the dairy supply chain actors and wider environmental considerations is essential to reduce the dairy sector's dependency on antibiotics and support transition toward responsible farming in the UK.
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Affiliation(s)
- Stephanie Begemann
- Knowledge, Technology and Innovation Group, University of Wageningen, Wageningen, Netherlands.,NIHR HPRU in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Francine Watkins
- Department of Public Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Ine Van Hoyweghen
- Life Sciences & Society Lab, Centre of Sociological Research, KU Leuven, Leuven, Belgium
| | - Roberto Vivancos
- Field Service, Public Health England, Liverpool, United Kingdom.,NIHR HPRU in Gastrointestinal Infections, Liverpool, United Kingdom
| | - Robert Christley
- NIHR HPRU in Emerging and Zoonotic Infections, Liverpool, United Kingdom.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Elizabeth Perkins
- Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Liverpool, United Kingdom
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Gwee A, Cranswick N, McMullan B, Perkins E, Bolisetty S, Gardiner K, Daley A, Ward M, Chiletti R, Donath S, Hunt R, Curtis N. Continuous Versus Intermittent Vancomycin Infusions in Infants: A Randomized Controlled Trial. Pediatrics 2019; 143:peds.2018-2179. [PMID: 30700564 DOI: 10.1542/peds.2018-2179] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In adults, continuous infusions of vancomycin (CIV) are associated with earlier attainment of target drug concentrations, require fewer blood samples for monitoring, and may reduce drug toxicity. We aimed to determine, in young infants, if CIV or intermittent infusions of vancomycin (IIV) better achieves target vancomycin concentrations at the first steady-state level and to compare the frequency of drug-related adverse effects. METHODS In a multicenter randomized controlled trial in 2 tertiary neonatal units over a 40-month period, young infants aged 0 to 90 days requiring vancomycin therapy for at least 48 hours were randomly assigned to CIV and IIV. RESULTS Of 111 infants randomized, 104 were included in the intention-to-treat analysis. Baseline characteristics were similar for both groups. The proportion of infants achieving target concentrations at the first steady-state level was higher for CIV compared with IIV (45 in 53 [85%] vs 21 in 51 [41%]; P < .001). Fewer dose adjustments were required in the CIV group (median 0; range 0-1) compared with the IIV group (median 1; range 0-3; P < .001). The mean daily dose required to achieve target concentrations was lower with CIV compared with IIV (40.6 [SD 10.7] vs 60.6 [SD 53.0] mg/kg per day, respectively; P = .01). No drug-related adverse effects occurred in either group. CONCLUSIONS In young infants, CIV is associated with earlier and improved attainment of target concentrations compared with IIV. Lower total daily doses are required to achieve target levels with CIV. There is no difference in the rate of drug-related adverse effects.
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Affiliation(s)
- Amanda Gwee
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; .,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Noel Cranswick
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, Australia.,Department of Paediatrics, University of New South Wales, Sydney, Australia; and
| | | | - Srinivas Bolisetty
- Department of Paediatrics, University of New South Wales, Sydney, Australia; and.,Royal Hospital for Women, Randwick, Australia
| | - Kaya Gardiner
- Murdoch Children's Research Institute, Parkville, Australia
| | - Andrew Daley
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Meredith Ward
- Department of Paediatrics, University of New South Wales, Sydney, Australia; and.,Royal Hospital for Women, Randwick, Australia
| | - Roberto Chiletti
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Susan Donath
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Rodney Hunt
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
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Begemann S, Perkins E, Van Hoyweghen I, Christley R, Watkins F. How Political Cultures Produce Different Antibiotic Policies in Agriculture: A Historical Comparative Case Study between the United Kingdom and Sweden. Sociol Ruralis 2018; 58:765-785. [PMID: 30449903 PMCID: PMC6220949 DOI: 10.1111/soru.12206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 06/09/2023]
Abstract
The purpose of this article is to provide an understanding of how different countries formulate and regulate antibiotic use in animals raised for human consumption. A comparative case study was undertaken, analysing historical documents from the 1950s to the 1990s from the UK, the first country to produce a scientific report on the public health risks of agricultural antibiotic use; and Sweden, the first country to produce legislation on the growth promotor use of antibiotics in food animals. Sheila Jasanoff's concepts of 'co-production' and 'political cultures' have been used to explore how both countries used different styles of scientific reasoning and justification of the risks of agricultural antibiotic use. It will be argued that national dynamics between policy, science and public knowledges co-produced different risk classifications and patterns of agricultural antibiotic use between both countries. UK's political culture used 'expert committees' to remove the issue from public debate and to inform agricultural antibiotic policies. In contrast, the Swedish 'consensus-oriented' political culture made concerns related to agricultural antibiotic use into a cooperative debate that included multiple discourses. Understanding how national policies, science and public knowledges interact with the risks related to agricultural antibiotic use can provide valuable insights in understanding and addressing countries agricultural use of antibiotics.
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Affiliation(s)
- Stephanie Begemann
- NIHR Health Protection Research Unit in Emerging and Zoonotic InfectionsInstitute of Infection and Global HealthUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Elizabeth Perkins
- Health Services ResearchInstitute of Psychology Health and Society, University of LiverpoolLiverpoolUnited Kingdom
| | - Ine Van Hoyweghen
- Life Sciences & Society LabCentre of Sociological Research (CeSO), KU LeuvenLeuvenBelgium
| | - Robert Christley
- Epidemiology and Population HealthNIHR Health Protection Research Unit in Emerging and Zoonotic InfectionsInstitute of Infection and Global HealthUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Francine Watkins
- School of MedicineInstitute of Psychology Health and Society, University of LiverpoolLiverpoolUnited Kingdom
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Haines A, Perkins E, Evans EA, McCabe R. Multidisciplinary team functioning and decision making within forensic mental health. Ment Health Rev (Brighton) 2018; 23:185-196. [PMID: 30464703 PMCID: PMC6201820 DOI: 10.1108/mhrj-01-2018-0001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the operation of multidisciplinary team (MDT) meetings within a forensic hospital in England, UK. DESIGN/METHODOLOGY/APPROACH Mixed methods, including qualitative face to face interviews with professionals and service users, video observations of MDT meetings and documentary analysis. Data were collected from 142 staff and 30 service users who consented to take part in the research and analysed using the constant comparison technique of grounded theory and ethnography. FINDINGS Decisions taken within MDT meetings are unequally shaped by the professional and personal values and assumptions of those involved, as well as by the power dynamics linked to the knowledge and responsibility of each member of the team. Service users' involvement is marginalised. This is linked to a longstanding tradition of psychiatric paternalism in mental health care. RESEARCH LIMITATIONS/IMPLICATIONS Future research should explore the nuances of interactions between MDT professionals and service users during the meetings, the language used and the approach taken by professionals to enable/empower service user to be actively involved. PRACTICAL IMPLICATIONS Clear aims, responsibilities and implementation actions are a pre-requisite to effective MDT working. There is a need to give service users greater responsibility and power regarding their care. ORIGINALITY/VALUE While direct (video) observations were very difficult to achieve in secure settings, they enabled unmediated access to how people conducted themselves rather than having to rely only on their subjective accounts (from the interviews).
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Affiliation(s)
- Alina Haines
- Health Services Research, University of Liverpool, Liverpool, UK
| | | | - Elizabeth A Evans
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rhiannah McCabe
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Mercer D, Perkins E. Sex, gender and the carceral: Female staff experiences of working in forensic care with sexual offenders. Int J Law Psychiatry 2018; 59:38-43. [PMID: 29996986 DOI: 10.1016/j.ijlp.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/18/2017] [Revised: 04/12/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
English high-secure hospitals have contained individuals deemed mentally disordered, and dangerous, since the mid-nineteenth century. With the development of gender sensitive services female patients have been moved out of these institutions into smaller secure settings. Female staff continue to work in high secure hospitals, but are often in a minority in these services. Little is known about how female staff experience the everyday world of work. This paper is based on in-depth interviews with female nurses employed in a unit caring for detained male sexual offenders with a diagnosis of personality disorder. It forms part of a much larger discourse-analytic study of nine patients, with a history of sexual offending, and eighteen mental health nurses, which focused on talk about pornography and criminality. The findings from this project have been previously reported in Mercer and Perkins (2014). This paper demonstrates how patriarchy remains an enduring cultural characteristic of caring for men detained under the Mental Health Act (1983, 2007) because of sexually violent crimes against women and children. It textures the ward environment and the relationships between people who work within it, constructing women as 'outsiders' and producing a masculine culture which leaves female staff feeling vulnerable and at risk. The analytic focus of the paper is concerned with exploring how women experience working in the male-dominated environment of a high-security Personality Disorder Unit (PDU). Three discursive repertoires are identified: the institutional space as male, the impact of working with men detained as a result of sexual offending, and the construction of therapeutic work as a 'job for the boys'. In this world, female staff, as a product of their gender, constructed themselves both as at risk and inviting risk.
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Affiliation(s)
- Dave Mercer
- Department of Nursing, University of Liverpool, United Kingdom
| | - Elizabeth Perkins
- William Rathbone VI Chair of Community Nursing Research, Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
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Abstract
BACKGROUND The concept of recovery is contested throughout the existing literature and in mental health services. Little research exists that gives voice to service user perspectives of recovery. AIM This paper explores how service users in two recovery oriented services run by the National Health Service in North West England talked about recovery and what it meant to them. METHOD 14 service users accessing these services took part in semi-structured qualitative interviews focusing on the concept of recovery. Data were analysed using an interpretive phenomenological analysis approach. RESULTS Service users talked about recovery as a dynamic, day to day process as well as an outcome; specifically related to being discharged from inpatient settings. A number of factors including relationships and medication were cited to have the potential to make or break recovery. CONCLUSIONS The study highlights the continued dominance of the biomedical model in mental health services. Service users appear to have internalised staff and services' understanding of recovery perhaps unsurprisingly given the power differential in these relationships. Implications for clinical practice are explored.
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Affiliation(s)
- Rhiannah McCabe
- a Northumberland, Tyne and Wear NHS Foundation Trust , Newcastle Upon Tyne , UK.,b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and
| | - Richard Whittington
- b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and
| | - Laura Cramond
- b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and.,c Pennine Care NHS Foundation Trust , Ashton-Under-Lyne , UK
| | - Elizabeth Perkins
- b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and
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Perkins E, Rooth M, Dillon M, Brown K. Simultaneous labyrinthectomy and cochlear implantation in unilateral meniere's disease. Laryngoscope Investig Otolaryngol 2018; 3:225-230. [PMID: 30062139 PMCID: PMC6057226 DOI: 10.1002/lio2.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/20/2018] [Accepted: 03/30/2018] [Indexed: 11/10/2022] Open
Abstract
Objective In a single‐institution, FDA‐approved IDE study, subjects with unilateral Meniere's disease and intractable vertigo underwent concurrent labyrinthectomy and cochlear implantation to determine speech perception, localization, and quality of life outcomes. Methods Three subjects with unilateral Meniere's disease with normal or near‐normal hearing in the contralateral ear underwent simultaneous labyrinthectomy and cochlear implantation. Sound localization, speech perception in noise and quiet, tinnitus handicap index, and quality of life measures were evaluated at 1, 3, and 6 months after implant activation. Results Sound localization testing demonstrated immediate benefit postimplantation with the cochlear implant (CI). RMS error with CI on was 22 degrees (±2) and with CI off was 63 (±15) at 6 months. Mean CI alone scores were 22% (±20) at 1 month and improved to 43% (±20) and 49% (±11) at the 3‐ and 6‐month intervals, respectively. AzBio sentences in babble (0 dB SNR) scores presented in the most challenging listening condition (S0NContra) were 28% (±20) at 1 month, 38% (±18) at 3 months, and 45% (±24) at 6 months. Tinnitus Handicap Inventory (THI) significantly improved from an average preoperative score of 42 (±26) to 0 at 6 months. Quality of life measures improved overall over the postimplantation follow‐up intervals. Conclusions Subjects with unilateral Meniere's Disease who underwent simultaneous labyrinthectomy and cochlear implantation experienced improvements in sound localization, speech understanding, tinnitus severity, and quality of life with device use. There was a trend for better performance over the postoperative intervals. Level of Evidence 2b.
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Affiliation(s)
- Elizabeth Perkins
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Meredith Rooth
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Margaret Dillon
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Kevin Brown
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
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Matos MJ, Oliveira BL, Martínez-Sáez N, Guerreiro A, Cal PMSD, Bertoldo J, Maneiro M, Perkins E, Howard J, Deery MJ, Chalker JM, Corzana F, Jiménez-Osés G, Bernardes GJL. Chemo- and Regioselective Lysine Modification on Native Proteins. J Am Chem Soc 2018; 140:4004-4017. [PMID: 29473744 PMCID: PMC5880509 DOI: 10.1021/jacs.7b12874] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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Site-selective chemical
conjugation of synthetic molecules to proteins
expands their functional and therapeutic capacity. Current protein
modification methods, based on synthetic and biochemical technologies,
can achieve site selectivity, but these techniques often require extensive
sequence engineering or are restricted to the N-
or C-terminus. Here we show the computer-assisted
design of sulfonyl acrylate reagents for the modification of a single lysine residue on native protein sequences. This
feature of the designed sulfonyl acrylates, together with the innate
and subtle reactivity differences conferred by the unique local microenvironment
surrounding each lysine, contribute to the observed regioselectivity
of the reaction. Moreover, this site selectivity was predicted computationally,
where the lysine with the lowest pKa was
the kinetically favored residue at slightly basic pH. Chemoselectivity
was also observed as the reagent reacted preferentially at lysine,
even in those cases when other nucleophilic residues such as cysteine
were present. The reaction is fast and proceeds using a single molar
equivalent of the sulfonyl acrylate reagent under biocompatible conditions
(37 °C, pH 8.0). This technology was demonstrated by the quantitative
and irreversible modification of five different proteins including
the clinically used therapeutic antibody Trastuzumab without prior
sequence engineering. Importantly, their native secondary structure
and functionality is retained after the modification. This regioselective
lysine modification method allows for further bioconjugation through
aza-Michael addition to the acrylate electrophile that is generated
by spontaneous elimination of methanesulfinic acid upon lysine labeling.
We showed that a protein–antibody conjugate bearing a site-specifically
installed fluorophore at lysine could be used for selective imaging
of apoptotic cells and detection of Her2+ cells, respectively. This
simple, robust method does not require genetic engineering and may
be generally used for accessing diverse, well-defined protein conjugates
for basic biology and therapeutic studies.
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Affiliation(s)
- Maria J Matos
- Department of Chemistry , University of Cambridge , Lensfield Road , Cambridge , U.K
| | - Bruno L Oliveira
- Department of Chemistry , University of Cambridge , Lensfield Road , Cambridge , U.K
| | - Nuria Martínez-Sáez
- Department of Chemistry , University of Cambridge , Lensfield Road , Cambridge , U.K
| | - Ana Guerreiro
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa , Avenida Professor Egas Moniz , Lisboa , Portugal
| | - Pedro M S D Cal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa , Avenida Professor Egas Moniz , Lisboa , Portugal
| | - Jean Bertoldo
- Department of Chemistry , University of Cambridge , Lensfield Road , Cambridge , U.K
| | - María Maneiro
- Centro Singular de Investigación en Química Biolóxica e Materiais Moleculares (CIQUS) and Departamento de Química Orgánica , Universidade de Santiago de Compostela , calle Jenaro de la Fuente s/n , Santiago de Compostela , Spain
| | - Elizabeth Perkins
- Albumedix Ltd, Castle Court, 59 Castle Boulevard , Nottingham , United Kingdom
| | - Julie Howard
- Cambridge Centre for Proteomics, Cambridge Systems Biology Centre, Department of Biochemistry , University of Cambridge , Tennis Court Road , Cambridge , U.K
| | - Michael J Deery
- Cambridge Centre for Proteomics, Cambridge Systems Biology Centre, Department of Biochemistry , University of Cambridge , Tennis Court Road , Cambridge , U.K
| | - Justin M Chalker
- Centre for NanoScale Science and Technology, College of Science and Engineering , Flinders University Bedford Park , South Australia , Australia
| | - Francisco Corzana
- Departamento de Química , Universidad de La Rioja , Centro de Investigación en Síntesis Química , Logroño , Spain
| | - Gonzalo Jiménez-Osés
- Departamento de Química , Universidad de La Rioja , Centro de Investigación en Síntesis Química , Logroño , Spain
| | - Gonçalo J L Bernardes
- Department of Chemistry , University of Cambridge , Lensfield Road , Cambridge , U.K.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa , Avenida Professor Egas Moniz , Lisboa , Portugal
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Appleton L, Perkins E. Bridging the impact of cancer on relationships: the role of help in the long-term support of the patient. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
OBJECTIVE To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies. METHOD Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach. RESULTS There were three areas in which care home staff reported balancing safety and risk against the individual needs of residents. First, the physical environment created a tension between safety and accessibility to the outside world, which meant that care homes provided highly structured or limited access to outdoor space. Second, care home managers reflected a balancing act between an individual's autonomy and the need to protect their residents' dignity. Finally, care home managers highlighted the ways in which an individual's needs were framed by the needs of other residents to the extent that on some occasions an individual's needs were subjugated to the needs of the general population of a home. CONCLUSION There was a strong, even dominant, ethos of risk management and keeping people safe. Managing individual needs while maintaining a safe care home environment clearly is a constant dynamic interpersonal process of negotiating and balancing competing interests for care home managers.
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Affiliation(s)
- Elizabeth A Evans
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Elizabeth Perkins
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Pam Clarke
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Alina Haines
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | | | - Richard Whittington
- a Department of Health Services Research, Health & Community Care Research Unit (HaCCRU), Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK.,c Broset Centre for Research & Education in Forensic Psychiatry, St. Olav's Hospital , Trondheim , Norway
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Robin C, Perkins E, Watkins F, Christley R. Pets, Purity and Pollution: Why Conventional Models of Disease Transmission Do Not Work for Pet Rat Owners. Int J Environ Res Public Health 2017; 14:ijerph14121526. [PMID: 29215554 PMCID: PMC5750944 DOI: 10.3390/ijerph14121526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/02/2017] [Accepted: 12/02/2017] [Indexed: 11/16/2022]
Abstract
In the United Kingdom, following the emergence of Seoul hantavirus in pet rat owners in 2012, public health authorities tried to communicate the risk of this zoonotic disease, but had limited success. To explore this lack of engagement with health advice, we conducted in-depth, semi-structured interviews with pet rat owners and analysed them using a grounded theory approach. The findings from these interviews suggest that rat owners construct their pets as different from wild rats, and by elevating the rat to the status of a pet, the powerful associations that rats have with dirt and disease are removed. Removing the rat from the contaminated outside world moves their pet rat from being 'out of place' to 'in place'. A concept of 'bounded purity' keeps the rat protected within the home, allowing owners to interact with their pet, safe in the knowledge that it is clean and disease-free. Additionally, owners constructed a 'hierarchy of purity' for their pets, and it is on this structure of disease and risk that owners base their behaviour, not conventional biomedical models of disease.
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Affiliation(s)
- Charlotte Robin
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK.
- NIHR Health Protection Research Unit, University of Liverpool, Ronald Ross Building, Liverpool L69 7BE, UK.
| | - Elizabeth Perkins
- NIHR Health Protection Research Unit, University of Liverpool, Ronald Ross Building, Liverpool L69 7BE, UK.
- Health Services Research Department, Institute of Psychology Health and Society, University of Liverpool, Liverpool L69 3GL, UK.
| | - Francine Watkins
- NIHR Health Protection Research Unit, University of Liverpool, Ronald Ross Building, Liverpool L69 7BE, UK.
- Department of Public Health & Policy, Institute of Psychology Health and Society, University of Liverpool, Liverpool L69 3GL, UK.
| | - Robert Christley
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK.
- NIHR Health Protection Research Unit, University of Liverpool, Ronald Ross Building, Liverpool L69 7BE, UK.
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Appleton L, Perkins E. Bridging the impact of cancer on relationships: The role of help in the long-term support of the patient. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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36
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Westgarth C, Christley RM, Marvin G, Perkins E. I Walk My Dog Because It Makes Me Happy: A Qualitative Study to Understand Why Dogs Motivate Walking and Improved Health. Int J Environ Res Public Health 2017; 14:ijerph14080936. [PMID: 28825614 PMCID: PMC5580638 DOI: 10.3390/ijerph14080936] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Abstract
Dog walking is a popular everyday physical activity. Dog owners are generally more active than non-owners, but some rarely walk with their dog. The strength of the dog–owner relationship is known to be correlated with dog walking, and this qualitative study investigates why. Twenty-six interviews were combined with autoethnography of dog walking experiences. Dog walking was constructed as “for the dog”, however, owners represented their dog’s needs in a way which aligned with their own. Central to the construction of need was perceptions of dog personality and behaviour. Owners reported deriving positive outcomes from dog walking, most notably, feelings of “happiness”, but these were “contingent” on the perception that their dogs were enjoying the experience. Owner physical activity and social interaction were secondary bonuses but rarely motivating. Perceptions and beliefs of owners about dog walking were continually negotiated, depending on how the needs of the owner and dog were constructed at that time. Complex social interactions with the “significant other” of a pet can strongly motivate human health behaviour. Potential interventions to promote dog walking need to account for this complexity and the effect of the dog-owner relationship on owner mental wellbeing.
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Affiliation(s)
- Carri Westgarth
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7ZX, UK.
- Institute of Veterinary Science, University of Liverpool, Liverpool L69 7ZX, UK.
| | - Robert M Christley
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7ZX, UK.
- Institute of Veterinary Science, University of Liverpool, Liverpool L69 7ZX, UK.
| | - Garry Marvin
- Department of Life Sciences, University of Roehampton, London SW15 5PJ, UK.
| | - Elizabeth Perkins
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 7ZX, UK.
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Williamson H, Perkins E, Lulinski A, Armstrong M, Baldwin J, Levin B, Massey O. Medicaid Managed Care and Adults With Intellectual or Developmental Disabilities and Their Family Caregivers. Am J Occup Ther 2017. [DOI: 10.5014/ajot.2017.71s1-rp401a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/1/2017
States are reforming their Medicaid programs to a managed care approach. Opportunities exist for the field of occupational therapy to help inform current and future managed care reform efforts. Occupational therapists can contribute to encouraging stakeholder engagement and informing family caregiver support efforts.
Primary Author and Speaker: Heather Williamson
Contributing Authors: Elizabeth Perkins, Amie Lulinski, Mary Armstrong, Julie Baldwin, Bruce Levin, Oliver Massey
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Appleton L, Perkins E. The construction of help during radiotherapy: Redefining informal care. Psychooncology 2017; 26:2057-2062. [PMID: 28294461 DOI: 10.1002/pon.4420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study will explore how help is constructed during and following radiotherapy for patients with cancer. METHODS Grounded theory methods were used in the study to explore the way in which family members and friends constructed a role for themselves in relation to patients receiving radiotherapy. A total of 22 helpers were interviewed. Patients were being treated for a range of cancers including breast, prostate, colorectal, and head and neck. RESULTS Respondents in this study consistently defined themselves as "helpers" rather than "carers." While radiotherapy as a treatment modality was mostly seen as noninvasive, the cancer diagnosis cast a long shadow over the lives of helpers and patients creating a separation in longstanding relationships. Helpers experienced this separation as "otherness." Help became an important vehicle for bridging this separation. Individuals developed different ways of knowing about the patient as the basis for providing help. Two different types of help were identified in this study: the behind the scenes, largely invisible work that helpers undertook to help the patient without their knowledge and the explicit visible help that was much more commonly negotiated and discussed between helpers and patients. CONCLUSIONS The study provides the basis for a greater understanding on the part of professionals into the impact of diagnosis and radiotherapy treatment on family and friends. In doing so, the study identifies opportunities for the experience of helpers to be recognised and supported by professionals.
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Affiliation(s)
- Lynda Appleton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | - Elizabeth Perkins
- Institute of Psychology, Health and Society, William Rathbone VI Chair of Community Nursing Research, University of Liverpool, Liverpool, UK
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39
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Perkins E, Gambles M, Houten R, Harper S, Haycox A, O’Brien T, Richards S, Chen H, Nolan K, Ellershaw JE. The care of dying people in nursing homes and intensive care units: a qualitative mixed-methods study. Health Serv Deliv Res 2016. [DOI: 10.3310/hsdr04200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn England and Wales the two most likely places of death are hospitals (52%) and nursing homes (22%). The Department of Health published its National End of Life Care Strategy in July 2008 (Department of Health.End of Life Care Strategy: Promoting High Quality Care For All Adults at the End of Life. London: Department of Health; 2008) to improve the provision of care, recommending the use of the Liverpool Care Pathway for the Dying Patient (LCP).AimThe original aim was to assess the impact of the LCP on care in two settings: nursing homes and intensive care units (ICUs).DesignQualitative, matched case study.MethodsData were collected from 12 ICUs and 11 nursing homes in England: (1) documentary analysis of provider end-of-life care policy documents; (2) retrospective analysis of 10 deaths in each location using written case notes; (3) interviews with staff about end-of-life care; (4) observation of the care of dying patients; (5) analysis of the case notes pertaining to the observed patient’s death; (6) interview with a member of staff providing care during the observed period; (7) interview with a bereaved relative present during the observation; (8) economic analysis focused on the observed patients; and (9) strict inclusion and selection criteria for nursing homes and ICUs applied to match sites on LCP use/non-LCP use.ResultsIt was not possible to meet the stated aims of the study. Although 23 sites were recruited, observations were conducted in only 12 sites (eight using the LCP). A robust comparison on the basis of LCP use could not, therefore, take place. Although nurses in both settings reported that the LCP supported good care, the LCP was interpreted and used differently across sites, with the greatest variation in ICUs. Although not able to address the original research question, this study provides an unprecedented insight into care at the end of life in two different settings. The majority of nursing homes had implemented some kind of ‘pathway’ for dying patients and most homes participating in the observational stage were using the LCP. However, training in care of the dying was variable and specific issues were identified relating to general practitioner involvement, the use of anticipatory drugs and the assessment of consciousness and the swallowing reflex. In ICUs, end-of-life care was inextricably linked with the withdrawal of active treatment and controlling the pace of death. The data highlight how the decision to withdraw was made and, importantly, how relatives were involved in this process. The fact that most patients died soon after the withdrawal of interventions was reported to limit the appropriateness of the LCP in this setting.LimitationsAlthough the recruitment of matched sites was achieved, variable site participation resulted in a skewed sample. Issues with the sample size and a blurring of LCP use and non-use limit the extent to which the ambitious aims of the study were achieved.ConclusionsThis study makes a unique contribution to understanding the complexity of care at the end of life in two very different settings. More research is needed into the ways in which an organisational culture can be created within which the principles of good end-of-life care become translated into practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Elizabeth Perkins
- Health and Community Care Research Unit, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Maureen Gambles
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rachel Houten
- Management School, University of Liverpool, Liverpool, UK
| | - Sheila Harper
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Alan Haycox
- Management School, University of Liverpool, Liverpool, UK
| | - Terri O’Brien
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sarah Richards
- Management School, University of Liverpool, Liverpool, UK
| | - Hong Chen
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kate Nolan
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John E Ellershaw
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Tingay DG, Rajapaksa A, McCall K, Zonneveld CEE, Black D, Perkins E, Sourial M, Lavizzari A, Davis PG. The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs. Pediatr Res 2016; 79:916-21. [PMID: 26866905 DOI: 10.1038/pr.2016.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/07/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (Cdyn) in preterm lambs. METHODS Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH2O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth. All lambs then received the same management for 60-min with alveolar-arterial oxygen difference (AaDO2) and Cdyn measured at regular time points. RESULTS Overall, the OLV strategy improved Cdyn and AaDO2 (all epochs except Surfactant) compared to SI (all P < 0.05; two-way ANOVA). Irrespective of strategy, Cdyn was better in the Steroid group in the first 10 min (all P < 0.05). Thereafter, Cdyn was similar to Steroid epoch in the OLV + Surfactant, but not SI + Surfactant group. OLV influenced the effect of steroid and surfactant (P = 0.005) on AaDO2 more than SI (P = 0.235). CONCLUSIONS The antenatal state of the lung influences the type and impact of a recruitment maneuver at birth. The effectiveness of surfactant maybe enhanced using PEEP-based time-dependent recruitment strategies rather than approaches solely aimed at initial lung liquid clearance.
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Affiliation(s)
- David G Tingay
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Neonatology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Neonatal Research Group, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Anushi Rajapaksa
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen McCall
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Cornelis E E Zonneveld
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Don Black
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Elizabeth Perkins
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Magdy Sourial
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Neonatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anna Lavizzari
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università degli Studi di Milano, Milano, Italy
| | - Peter G Davis
- Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Neonatal Research Group, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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41
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Agbesi MPK, Naylor S, Perkins E, Borsuk HS, Sykes D, Maclaine JS, Wang Z, Cox JPL. Complex flow in the nasal region of guitarfishes. Comp Biochem Physiol A Mol Integr Physiol 2016; 193:52-63. [PMID: 26780177 DOI: 10.1016/j.cbpa.2015.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/16/2015] [Accepted: 12/30/2015] [Indexed: 11/25/2022]
Abstract
Scent detection in an aquatic environment is dependent on the movement of water. We set out to determine the mechanisms for moving water through the olfactory organ of guitarfishes (Rhinobatidae, Chondrichthyes) with open nasal cavities. We found at least two. In the first mechanism, which we identified by observing dye movement in the nasal region of a life-sized physical model of the head of Rhinobatos lentiginosus mounted in a flume, olfactory flow is generated by the guitarfish's motion relative to water, e.g. when it swims. We suggest that the pressure difference responsible for motion-driven olfactory flow is caused by the guitarfish's nasal flaps, which create a region of high pressure at the incurrent nostril, and a region of low pressure in and behind the nasal cavity. Vortical structures in the nasal region associated with motion-driven flow may encourage passage of water through the nasal cavity and its sensory channels, and may also reduce the cost of swimming. The arrangement of vortical structures is reminiscent of aircraft wing vortices. In the second mechanism, which we identified by observing dye movement in the nasal regions of living specimens of Glaucostegus typus, the guitarfish's respiratory pump draws flow through the olfactory organ in a rhythmic (0.5-2 Hz), but continuous, fashion. Consequently, the respiratory pump will maintain olfactory flow whether the guitarfish is swimming or at rest. Based on our results, we propose a model for olfactory flow in guitarfishes with open nasal cavities, and suggest other neoselachians which this model might apply to.
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Affiliation(s)
- Mawuli P K Agbesi
- Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, UK
| | - Sara Naylor
- Heron Island Research Station, The University of Queensland, Queensland 4680, Australia
| | - Elizabeth Perkins
- Heron Island Research Station, The University of Queensland, Queensland 4680, Australia
| | - Heather S Borsuk
- Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, UK
| | - Dan Sykes
- Imaging and Analysis Centre, Natural History Museum, Cromwell Road, London SW7 5BD, UK
| | - James S Maclaine
- Department of Life Sciences, Natural History Museum, Cromwell Road, London SW7 5BD, UK
| | - Zhijin Wang
- Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, UK
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Shannon LM, Jackson A, Newell J, Perkins E, Neal C. Examining factors associated with treatment completion in a community-based program for individuals with criminal justice involvement. Addict Sci Clin Pract 2015. [PMCID: PMC4347576 DOI: 10.1186/1940-0640-10-s1-a60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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43
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Tingay DG, Lavizzari A, Zonneveld CEE, Rajapaksa A, Zannin E, Perkins E, Black D, Sourial M, Dellacà RL, Mosca F, Adler A, Grychtol B, Frerichs I, Davis PG. An individualized approach to sustained inflation duration at birth improves outcomes in newborn preterm lambs. Am J Physiol Lung Cell Mol Physiol 2015; 309:L1138-49. [DOI: 10.1152/ajplung.00277.2015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/17/2015] [Indexed: 01/18/2023] Open
Abstract
A sustained first inflation (SI) at birth may aid lung liquid clearance and aeration, but the impact of SI duration relative to the volume-response of the lung is poorly understood. We compared three SI strategies: 1) variable duration defined by attaining volume equilibrium using real-time electrical impedance tomography (EIT; SIplat); 2) 30 s beyond equilibrium (SIlong); 3) short 30-s SI (SI30); and 4) positive pressure ventilation without SI (no-SI) on spatiotemporal aeration and ventilation (EIT), gas exchange, lung mechanics, and regional early markers of injury in preterm lambs. Fifty-nine fetal-instrumented lambs were ventilated for 60 min after applying the allocated first inflation strategy. At study completion molecular and histological markers of lung injury were analyzed. The time to SI volume equilibrium, and resultant volume, were highly variable; mean (SD) 55 (34) s, coefficient of variability 59%. SIplat and SIlong resulted in better lung mechanics, gas exchange and lower ventilator settings than both no-SI and SI30. At 60 min, alveolar-arterial difference in oxygen was a mean (95% confidence interval) 130 (13, 249) higher in SI30 vs. SIlong group (two-way ANOVA). These differences were due to better spatiotemporal aeration and tidal ventilation, although all groups showed redistribution of aeration towards the nondependent lung by 60 min. Histological lung injury scores mirrored spatiotemporal change in aeration and were greatest in SI30 group ( P < 0.01, Kruskal-Wallis test). An individualized volume-response approach to SI was effective in optimizing aeration, homogeneous tidal ventilation, and respiratory outcomes, while an inadequate SI duration had no benefit over positive pressure ventilation alone.
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Affiliation(s)
- David G. Tingay
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
- Neonatology, The Royal Children's Hospital, Parkville, Australia
- Neonatal Research, The Royal Women's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Anna Lavizzari
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
- Neonatal Intensive Care Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico-Università Degli Studi di Milano, Milano, Italy
| | | | - Anushi Rajapaksa
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
| | - Emanuela Zannin
- Laboratorio di Tecnologie Biomediche, Dipartimento di Elettronica, Informazione e Ingegneria Biomedica-DEIB, Politecnico di Milano University, Milano, Italy
| | - Elizabeth Perkins
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
| | - Don Black
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
| | - Magdy Sourial
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
| | - Raffaele L. Dellacà
- Laboratorio di Tecnologie Biomediche, Dipartimento di Elettronica, Informazione e Ingegneria Biomedica-DEIB, Politecnico di Milano University, Milano, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico-Università Degli Studi di Milano, Milano, Italy
| | - Andy Adler
- Systems and Computer Engineering, Carleton University, Ottawa, Canada
| | - Bartłomiej Grychtol
- Fraunhofer Project Group for Automation in Medicine and Biotechnology, Mannheim, Germany
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany; and
| | - Peter G. Davis
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
- Neonatal Research, The Royal Women's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Harris R, Perkins E, Holt R, Brown S, Garner J, Mosedale S, Moss P, Farrier A. Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice. Health Serv Deliv Res 2015. [DOI: 10.3310/hsdr03280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIndependent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance.AimsTo identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice.MethodsFollowing a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners.ResultsWe found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level).ConclusionsResponses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Rebecca Harris
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Robin Holt
- Department of Organisation and Management, Management School, University of Liverpool, Liverpool, UK
| | - Steve Brown
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jayne Garner
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Sarah Mosedale
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Phil Moss
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Alan Farrier
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Dargaville PA, Lavizzari A, Padoin P, Black D, Zonneveld E, Perkins E, Sourial M, Rajapaksa AE, Davis PG, Hooper SB, Moss TJ, Polglase GR, Tingay DG. An authentic animal model of the very preterm infant on nasal continuous positive airway pressure. Intensive Care Med Exp 2015. [PMID: 26215815 PMCID: PMC4512986 DOI: 10.1186/s40635-015-0051-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The surge in uptake of nasal continuous positive airway pressure (CPAP) for respiratory support in preterm infants has occurred in the absence of an authentic animal model. Such a model would allow investigation of research questions of physiological and therapeutic importance. We therefore aimed to develop a preterm lamb model of the non-intubated very preterm infant on CPAP. METHODS After staged exteriorisation and instrumentation, preterm lambs were delivered from anaesthetised ewes at 131 to 133 days gestation. Via a single nasal prong (4-mm internal diameter, 6- to 7-cm depth), positive pressure was delivered from the outset, with nasal intermittent positive pressure ventilation (NIPPV) used until transition to nasal CPAP was attempted, and periodically thereafter for hypoventilation. Caffeine and doxapram were used as respiratory stimulants. Gastric distension was prevented with an oesophageal balloon. Cardiorespiratory parameters and results of arterial blood gas analyses were monitored throughout the study period, which continued for 150 min after first transition to CPAP. RESULTS Ten preterm lambs were studied, at gestation 132 ± 1 days (mean ± SD) and birth weight 3.6 ± 0.45 kg. After stabilisation on NIPPV, transition to nasal CPAP was first attempted at 28 ± 11 min. There was transient respiratory acidosis, with gradual resolution as spontaneous respiratory activity increased. In the final hour, 79% ± 33% of time was spent on CPAP alone, with typical respiratory rates around 60 breaths per minute. PaCO2 at end-experiment was 58 ± 36 mmHg. CONCLUSIONS Non-intubated preterm lambs can be effectively transitioned to nasal CPAP soon after birth. This animal model will be valuable for further research.
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Affiliation(s)
- Peter A Dargaville
- Department of Paediatrics, Royal Hobart Hospital, 48 Liverpool St, Hobart, Tasmania, 7000, Australia,
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Harris R, Garner J, Perkins E. A discourse of disconnection – challenges to clinical engagement and collaborative dental commissioning. Br Dent J 2015; 218:393-7; discussion 397. [DOI: 10.1038/sj.bdj.2015.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 11/09/2022]
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Haines A, Lane S, McGuire J, Perkins E, Whittington R. Offending outcomes of a mental health youth diversion pilot scheme in England. Crim Behav Ment Health 2015; 25:126-140. [PMID: 24910166 DOI: 10.1002/cbm.1916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 12/06/2013] [Accepted: 04/15/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND A youth justice diversion scheme designed to enhance health provision for young people with mental health and developmental problems as soon as they enter the youth justice system has been piloted in six areas of England. AIM As part of a wider evaluation of the first youth justice diversion scheme outside the USA, our aim here was to examine re-offending. We sought to test the hypothesis that a specialised service for young people with mental health difficulties would be associated with reductions in re-offending. In addition, we examined factors associated with the re-offending that occurred. METHODS Two hundred and eight young offenders with access to the diversion scheme and 200 without were compared in four geographical area pairings to allow for socio-demographic contextual differences. Officially recorded re-offending was ascertained for 15-30 months after study entry. We also tested characteristics associated with re-offending among everyone entering the diversion scheme (n = 870). RESULTS There was no statistically significant difference in re-offending rates between the diversion and comparison samples, but those with access to diversion had significantly longer periods of desistance from offending than those who did not. In multivariate analysis, the only significant characteristic associated with re-offending was history of previous offending. CONCLUSIONS Prevention of re-offending is only one of the potentially beneficial outcomes of diversion of young people who are vulnerable because of mental health problems, but it is an important one. The advantage of longer survival without prevention of re-offending suggests that future research should explore critical timings for these young people. The equivocal nature of the findings suggests that a randomised controlled trial would be justified.
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Affiliation(s)
- Alina Haines
- Health Services Research, Liverpool University, Liverpool, UK
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Porcellato L, Masson G, O'Mahony F, Jenkinson S, Vanner T, Cheshire K, Perkins E. ‘It's something you have to put up with’-service users’ experiences ofin uterotransfer: a qualitative study. BJOG 2015; 122:1825-32. [DOI: 10.1111/1471-0528.13235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- L Porcellato
- Centre for Public Health; Faculty of Education, Health and Community; Liverpool John Moores University; Liverpool UK
| | - G Masson
- Maternity Centre; Royal Stoke University Hospital; Stoke on Trent UK
| | - F O'Mahony
- Maternity Centre; Royal Stoke University Hospital; Stoke on Trent UK
| | - S Jenkinson
- Royal Wolverhampton Hospitals NHS Trust; New Cross Hospital; Wolverhampton UK
| | - T Vanner
- Royal Wolverhampton Hospitals NHS Trust; New Cross Hospital; Wolverhampton UK
| | - K Cheshire
- Royal Wolverhampton Hospitals NHS Trust; New Cross Hospital; Wolverhampton UK
| | - E Perkins
- Maternity Centre; Royal Stoke University Hospital; Stoke on Trent UK
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Appleton L, Wyatt D, Perkins E, Parker C, Crane J, Jones A, Moorhead L, Brown V, Wall C, Pagett M. The impact of prostate cancer on men's everyday life. Eur J Cancer Care (Engl) 2014; 24:71-84. [DOI: 10.1111/ecc.12233] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 01/10/2023]
Affiliation(s)
- L. Appleton
- The Clatterbridge Cancer Centre NHS Foundation Trust; Wirral UK
| | - D. Wyatt
- University of Chester/Clatterbridge Cancer Centre; Faculty of Health and Social Care; University of Chester; Chester UK
| | - E. Perkins
- Health and Community Care Research Unit; Institute of Psychology, Health and Society; University of Liverpool; Liverpool UK
| | - C. Parker
- Urology; Aintree University Hospital; Liverpool UK
| | - J. Crane
- School of Health Sciences; University of Liverpool; Liverpool UK
| | | | | | - V. Brown
- Hospice of the Good Shepherd; Chester UK
| | - C. Wall
- Faculty of Education Health and Community; Liverpool John Moores University; Liverpool UK
| | - M. Pagett
- The Clatterbridge Cancer Centre NHS Foundation Trust; Wirral UK
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