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Simpson M, Narwal A, West E, Martin J, Bagot CN, Page AR, Watson HG, Whyte CS, Mutch NJ. Fibrinogenolysis and fibrinolysis in vaccine-induced immune thrombocytopenia and thrombosis. J Thromb Haemost 2023; 21:3589-3596. [PMID: 37734715 DOI: 10.1016/j.jtha.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare syndrome associated with adenoviral vector vaccines for COVID-19. The syndrome is characterized by thrombosis, anti-platelet factor 4 (PF4) antibodies, thrombocytopenia, high D-dimer, and hypofibrinogenemia. OBJECTIVES To investigate abnormalities in fibrinolysis that contribute to the clinical features of VITT. METHODS Plasma samples from 18 suspected VITT cases were tested for anti-PF4 by ELISA and characterized as meeting criteria for VITT (11/18) or deemed unlikely (7/18; non-VITT). Antigen levels of PAI-1, factor XIII (FXIII), plasmin-α2antiplasmin (PAP), and inflammatory markers were quantified. Plasmin generation was quantified by chromogenic substrate. Western blotting was performed with antibodies to fibrinogen, FXIII-A, and plasminogen. RESULTS VITT patients 10/11 had scores indicative of overt disseminated intravascular coagulation, while 0/7 non-VITT patients met the criteria. VITT patients had significantly higher levels of inflammatory markers, IL-1β, IL-6, IL-8, TNFα, and C-reactive protein. In VITT patients, both fibrinogen and FXIII levels were significantly lower, while PAP and tPA-mediated plasmin generation were higher compared to non-VITT patients. Evidence of fibrinogenolysis was observed in 9/11 VITT patients but not in non-VITT patients or healthy controls. Fibrinogen degradation products were apparent, with obvious cleavage of the fibrinogen α-chain. PAP complex was evident in those VITT patients with fibrinogenolysis, but not in non-VITT patients or healthy donors. CONCLUSION VITT patients show evidence of overt disseminated intravascular coagulation and fibrinogenolysis, mediated by dysregulated plasmin generation, as evidenced by increased PAP and plasmin generation. These observations are consistent with the clinical presentation of both thrombosis and bleeding in VITT.
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Affiliation(s)
- Megan Simpson
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. https://twitter.com/SimpsonMegan8
| | - Anuj Narwal
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Eric West
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jill Martin
- Department of Haematology Laboratory, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Andrew R Page
- Department of Haematology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Henry G Watson
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Claire S Whyte
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. https://twitter.com/ClaireW63108369
| | - Nicola J Mutch
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
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Atkinson S, McKeown A, Caveney D, West E, Kennedy PJ, Macinnes S. The SECURE STAIRS Framework: Preliminary Evaluation of Trauma Informed Training Developments Within the Children and Young People's Secure Estate. Community Ment Health J 2023; 59:1129-1135. [PMID: 36749491 PMCID: PMC9903271 DOI: 10.1007/s10597-023-01092-3] [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: 10/17/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
The SECURE STAIRS framework promotes trauma informed understanding and training across the workforce to inform work with children and young people. A component of the framework is the 'Trauma Informed Practice with Children and Young People in Secure Settings' (TIPSS) training programme for multidisciplinary staff. Between November 2020 and May 2021, a total of 123 members of multidisciplinary staff from a Secure Children's Home (SCH) in the North East of England attended five-day TIPSS training. A pre-post repeated measures design was adopted. Paired samples t-tests were used to analyse pre- and post- questionnaires regarding self-reported levels of (i) knowledge, (ii) understanding and (iii) confidence across Attachment and Developmental Trauma, Understanding Complex Behaviour and Trauma Informed Care training modules. Staff reported significant (p ≤ .001) post-training improvements in knowledge, understanding, and confidence across all three training modules. Implications of findings are discussed, and further developments outlined.
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Affiliation(s)
- S. Atkinson
- The Kolvin Service, Specialist Children & Young People’s Services CBU, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas House, St Nicholas Hospital, Newcastle upon Tyne, NE33XT UK
| | - A. McKeown
- The Kolvin Service, Specialist Children & Young People’s Services CBU, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas House, St Nicholas Hospital, Newcastle upon Tyne, NE33XT UK
| | - D. Caveney
- The Kolvin Service, Specialist Children & Young People’s Services CBU, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas House, St Nicholas Hospital, Newcastle upon Tyne, NE33XT UK
| | - E. West
- The Kolvin Service, Specialist Children & Young People’s Services CBU, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas House, St Nicholas Hospital, Newcastle upon Tyne, NE33XT UK
| | - P. J. Kennedy
- The Kolvin Service, Specialist Children & Young People’s Services CBU, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas House, St Nicholas Hospital, Newcastle upon Tyne, NE33XT UK
| | - S. Macinnes
- Aycliffe Secure Centre, Newton Aycliffe, DL56JB UK
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West E, Morley PJ, Jump AS, Donoghue DNM. Satellite data track spatial and temporal declines in European beech forest canopy characteristics associated with intense drought events in the Rhön Biosphere Reserve, central Germany. Plant Biol (Stuttg) 2022; 24:1120-1131. [PMID: 35088506 PMCID: PMC10078791 DOI: 10.1111/plb.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
The increasing intensity and frequency of droughts under climate change demands effective ways to monitor drought impacts. We sought to determine how different satellite remote sensing sources influence our ability to identify temporal and spatial impacts on European beech forest canopy health during intense drought events. Imagery from three satellite series (MODIS, Landsat and Sentinel-2) was used to observe changes in canopy health during the intense droughts of 2003 and 2018 in the Rhön Biosphere Reserve, central Germany. Monthly normalized difference vegetation index (NDVI) anomalies were calculated for each satellite between 2000-2020 and compared against temperature, precipitation and the standardized precipitation evapotranspiration index (SPEI). Severe canopy impacts in 2003 and 2018 were associated with low NDVI in August and September. At the stand-scale, Sentinel-2 data allowed a spatially detailed understanding of canopy-level impacts, while MODIS provided the clearest temporal progression of the drought's impacts on the forest canopy. Low NDVI values were not exclusively associated with extremes of either temperature and precipitation individually; however, low canopy NDVI in August was associated with SPEI values below -1.5. Although the intense drought of 2018, as defined by meteorological parameters, peaked in July, canopy NDVI did not decline until August, highlighting that our ability to detect canopy impact during drought events is sensitive to the timing of image acquisition. No single satellite sensor affords a full picture of the temporal or spatial progression of drought impacts. Consequently, using sensors in tandem provides the best possible representation of canopy health during intense drought events.
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Affiliation(s)
- E. West
- Department of GeographyDurham UniversityDurhamUK
| | - P. J. Morley
- Department of GeographyDurham UniversityDurhamUK
- Faculty of Natural SciencesBiological and Environmental SciencesStirling UniversityStirlingUK
| | - A. S. Jump
- Faculty of Natural SciencesBiological and Environmental SciencesStirling UniversityStirlingUK
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Short S, Kendall J, West E, Chalmers A, McBain C, Melcher A, Collinson F, Phillip R, Brown S, Samson A. P11.64.A Long-term follow up and translational data from the ReoGlio phase Ib trial of GM-CSF and intravenous pelareorep (Reovirus) alongside standard of care in GBM. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
We previously reported safety data from a phase Ib, open-label study of intravenous oncolytic virus pelareorep with GM-CSF alongside standard chemoradiotherapy in newly diagnosed glioblastoma confirming that the combination is well tolerated. We now report on long-term follow up and analysis of translational samples from tumour and blood in a subset of patients.
METHODS
15 patients with newly diagnosed GBM were treated with GM-CSF 50μg subcutaneously on days 1-3 and intravenous pelareorep on days 4-5 in weeks 1 and 4 of chemoradiotherapy, and subsequently in week 1 of each adjuvant temozolomide course: 7 patients received 1x1010TCID50 (dose level 1); 8 received 3x1010TCID50 (dose level 2). The primary objective was to determine the maximum tolerated dose of pelareorep and GM-CSF with standard chemoradiotherapy. Following a protocol amendment we also collected survival data in all patients up to August 2021. Serial blood samples were taken from three patients, at baseline, during chemoradiotherapy and in the first adjuvant cycle. Peripheral blood mononuclear cells were analysed for immune checkpoint expression by flow cytometry, RNAseq gene expression and T-cell receptor clonality, whilst plasma cytokines were quantified by Luminex.
RESULTS
This combination was well tolerated with 87% of patients completing treatment as planned. Survival data analysis showed that median OS was 12.6 months in dose level 1 and 16.1 months in dose level 2, median OS for all patients was 13.1 months. The 24-month survival estimate for all patients was 25.0%, 16.7% for dose level 1 and 33.3% for dose level 2. One patient in dose level 1 remains alive at 43 months post registration without further treatment. Laboratory data showed that pelareorep infusion resulted in inflammatory cytokine and chemokine secretion, immune checkpoint modulation, and upregulation of inflammatory pathways. There was also increased peripheral clonal tumour-specific T-cell proliferation following pelareorep infusion.
CONCLUSION
Although based on small numbers, these long-term follow up data suggest this may be an active combination in a subset of GBM patients. Translational data confirm that pelareorep potentially activates tumour-targeting immune pathways in GBM, with consequential immune checkpoint modulation. These data support a combination clinical trial of pelareorep, radiotherapy and immune checkpoint blockade in GBM.
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Affiliation(s)
- S Short
- University of Leeds , Leeds , United Kingdom
| | - J Kendall
- University of Leeds , Leeds , United Kingdom
| | - E West
- University of Leeds , Leeds , United Kingdom
| | - A Chalmers
- University of Glasgow , Glasgow , United Kingdom
| | - C McBain
- The Christie Hospital, Manchester , Manchester , United Kingdom
| | - A Melcher
- Institute of Cancer Research , London , United Kingdom
| | - F Collinson
- University of Leeds , Leeds , United Kingdom
| | - R Phillip
- University of Leeds , Leeds , United Kingdom
| | - S Brown
- University of Leeds , Leeds , United Kingdom
| | - A Samson
- University of Leeds , Leeds , United Kingdom
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5
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Paul O, Tao JQ, West E, Litzky L, Feldman M, Montone K, Rajapakse C, Bermudez C, Chatterjee S. Pulmonary vascular inflammation with fatal coronavirus disease 2019 (COVID-19): possible role for the NLRP3 inflammasome. Respir Res 2022; 23:25. [PMID: 35144622 PMCID: PMC8830114 DOI: 10.1186/s12931-022-01944-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023] Open
Abstract
Background Pulmonary hyperinflammation is a key event with SARS-CoV-2 infection. Acute respiratory distress syndrome (ARDS) that often accompanies COVID-19 appears to have worse outcomes than ARDS from other causes. To date, numerous lung histological studies in cases of COVID-19 have shown extensive inflammation and injury, but the extent to which these are a COVID-19 specific, or are an ARDS and/or mechanical ventilation (MV) related phenomenon is not clear. Furthermore, while lung hyperinflammation with ARDS (COVID-19 or from other causes) has been well studied, there is scarce documentation of vascular inflammation in COVID-19 lungs. Methods Lung sections from 8 COVID-19 affected and 11 non-COVID-19 subjects, of which 8 were acute respiratory disease syndrome (ARDS) affected (non-COVID-19 ARDS) and 3 were from subjects with non-respiratory diseases (non-COVID-19 non-ARDS) were H&E stained to ascertain histopathological features. Inflammation along the vessel wall was also monitored by expression of NLRP3 and caspase 1. Results In lungs from COVID-19 affected subjects, vascular changes in the form of microthrombi in small vessels, arterial thrombosis, and organization were extensive as compared to lungs from non-COVID-19 (i.e., non-COVID-19 ARDS and non-COVID-19 non-ARDS) affected subjects. The expression of NLRP3 pathway components was higher in lungs from COVID-19 ARDS subjects as compared to non-COVID-19 non-ARDS cases. No differences were observed between COVID-19 ARDS and non-COVID-19 ARDS lungs. Conclusion Vascular changes as well as NLRP3 inflammasome pathway activation were not different between COVID-19 and non-COVID-19 ARDS suggesting that these responses are not a COVID-19 specific phenomenon and are possibly more related to respiratory distress and associated strategies (such as MV) for treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-01944-8.
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Affiliation(s)
- Oindrila Paul
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Jian Qin Tao
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Eric West
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Leslie Litzky
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA
| | - Michael Feldman
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA
| | - Kathleen Montone
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA
| | - Chamith Rajapakse
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA
| | - Christian Bermudez
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA
| | - Shampa Chatterjee
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.
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6
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Paul O, Tao JQ, West E, Litzky L, Feldman M, Montone K, Rajapakse C, Bermudez C, Chatterjee S. Vascular Inflammation in Lungs of Patients with Fatal Coronavirus Disease 2019 (COVID-19): Possible Role for the NLRP3 Inflammasome.. [PMID: 34494018 PMCID: PMC8423225 DOI: 10.21203/rs.3.rs-842167/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Hyperinflammation is a key event that occurs with SARS-CoV-2 infection. In the lung, hyperinflammation leads to structural damage to tissue. To date, numerous lung histological studies have shown extensive alveolar damage, but there is scarce documentation of vascular inflammation in postmortem lung tissue. Methods: Lung sections from 8 COVID-19 affected and 11 non-COVID-19 subjects [of which 8 were acute respiratory disease syndrome (ARDS) affected and 3 were from subjects with non-respiratory diseases] were stained for H & E to ascertain histopathological features including presence of thrombi/microthrombi. Inflammation along the vessel wall was also monitored by quantification of the expression of moieties of the NLRP3 inflammasome pathway (NLRP3 and caspase-1). Results: In lungs from “fatal COVID-19”, vascular changes in the form of microthrombi in small vessels, arterial thrombosis, and organization were extensive as compared to lungs from “non-COVID-19 non respiratory disease” affected subjects. The NLRP3 pathway components were significantly higher in lungs from COVID-19 subjects as compared to non-COVID-19 fatal cases without respiratory disease. No significant differences were observed between COVID-19 lungs and non-COVID-19 ARDS lungs. Conclusion: We posit that inflammasome formation along the vessel wall is a characteristic of lung inflammation that accompanies COVID-19. Thus, the NLRP3 inflammasome pathway seems to be probable candidate that drives amplification of inflammation post SARS-CoV-2 infection.
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Affiliation(s)
- Oindrila Paul
- University of Pennsylvania Perelman School of Medicine
| | - Jian Qin Tao
- University of Pennsylvania Perelman School of Medicine
| | - Eric West
- University of Pennsylvania Perelman School of Medicine
| | - Leslie Litzky
- University of Pennsylvania Perelman School of Medicine
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7
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West E, Moore K, Kupeli N, Sampson E, Nair P, Aker N, Davies N. Rapid review of decision-making for place of care and death in older people: Lessons for COVID-19. Eur Psychiatry 2021. [PMCID: PMC9471237 DOI: 10.1192/j.eurpsy.2021.732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults, including those living with dementia. In the context of COVID-19, decision-making surrounding place of care and place of death in this population involves significant new challenges. Objectives To explore key factors that influence place of care and place of death decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19. Methods Rapid review of reviews, undertaken using WHO guidance for rapid reviews. Ten papers were included for full data extraction. These papers were published between 2005-2020. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation. Results Papers included discussed actual place of death, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. Factors such as caregiver capacity, the availability of multidisciplinary teams, cultural appropriateness of care packages and advanced care planning were found to be key. Conclusions The process and outcomes of decision-making for older people are affected by many factors – all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.
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8
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West E, Sampson EL, Davies N. 529 ASSESSING DISCOMFORT AND DISTRESS IN OLDER INPATIENTS WITH DEMENTIA. Age Ageing 2021. [DOI: 10.1093/ageing/afab119.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Up to 42% of acute hospital inpatients have dementia. This can make it more difficult for patients to communicate their needs, this in turn may lead to distress and agitation. The aim of this study is to explore the prevalence of distress and discomfort in inpatients with dementia in acute hospitals who may not be able to communicate their needs.
Methods
A series of existing clinical and observational methods were used to measure various aspects of the experience of hospitalised in patients with dementia, and staff working with these patients on wards. These measures looked to identify sources of discomfort, observe the effect of the environment, understand how staff currently identify discomfort and explore associations with behaviours that challenge.
Results
94 patients and their next of kin have been approached; 79 consented to being included in the study, and 67 have been fully assessed. Almost 20% of patients assessed have severe psychiatric problems. ~70% of patients were severely disoriented at assessment. Patients assessed were often sleepy (62%), hadn’t moved for a long period of time (48%) and reported agitation (60%), anxiety (60%) and depression (70%). Staff reported agitation and aggression in 56% of patients, with high frequencies of incidents per patient.
Conclusions
Signs of distress and agitation are common in hospitalised persons with dementia. Patients are often disoriented, which impedes communication of needs. This also has a high burden on staff, as many behavioural and psychiatric symptoms of dementia are experienced daily on wards.
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Affiliation(s)
- E West
- Marie Curie Palliative Care Research Department, University College London, UK
| | - E L Sampson
- Barnet Enfield, Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - N Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London and UK Centre for ageing population Studies, Research Department of Primary Care and Population Health, University College London, UK
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Low R, West E, Sampson PL. 494 DISCOMFORT IN PEOPLE WITH DEMENTIA ADMITTED TO AN ACUTE GENERAL MEDICAL HOSPITAL: A HOSPITAL CROSS SECTIONAL STUDY OF PREVALENCE. Age Ageing 2021. [DOI: 10.1093/ageing/afab117.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The acute hospital is a challenging place for a person with dementia whose ability to communicate discomfort and need is impaired. Their discomfort may go unnoticed due to insufficient staffing and time resources in this acute environment. Concerns have been raised about the consequences of these overlooked discomfort (e.g. distress and agitation), and hence how we can correctly identify their sources and severity. This study aimed to describe the source of discomfort and challenging behaviours in people with dementia (PwD) in UK acute hospital.
Method
A cross-sectional observational study of 49 patients with dementia admitted to a NHS acute hospital. Their discomfort was detected and its sources were identified (Sources of Discomfort Scale) during an hour observation when they were at rest and moved by staff. Their challenging behaviours were also recorded (Neuropsychiatric Inventory) through interviewing with the ward staff, as well as documentation of severity of dementia and presence of delirium.
Results
The overall prevalence of discomfort was 98%, with excessively sleepy or tired being the commonest; 39 (80%) participants experienced three or more type of discomfort. The commonest sources of discomfort were physical (e.g. constipation) and environmental (e.g. physically restrained), affecting up to 43 (88%) and 42 (83%) participants respectively. There was also evidence of an association between delirium and sleepiness or tiredness’s discomfort, meaning that PwD with delirium were nearly triply as likely to feel uncomfortable because of sleepiness or tiredness. Challenging behaviours affected over 80% of our participants, with agitation or aggression being the commonest. On average, these behaviours were moderately severe.
Conclusion
Discomfort and challenging behaviours were very common in PwD admitted to acute hospitals. Patients and staff would benefit from more accurate and frequent detection of discomfort by focusing on non-pain-related discomfort and using observational scales.
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Affiliation(s)
- R Low
- University College of London, London, United Kingdom
| | - E West
- University College of London, London, United Kingdom
| | - P L Sampson
- University College of London, London, United Kingdom
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Capaccione KM, Yang H, West E, Patel H, Ma H, Patel S, Fruauff A, Loeb G, Maddocks A, Borowski A, Lala S, Nguyen P, Lignelli A, D'souza B, Desperito E, Ruzal-Shapiro C, Salvatore MM. Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review. Acad Radiol 2021; 28:595-607. [PMID: 33583712 PMCID: PMC7859715 DOI: 10.1016/j.acra.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 commonly presents with upper respiratory symptoms; however, studies have shown that SARS-CoV-2 infection affects multiple organ systems. Here, we review the pathophysiology and imaging characteristics of SARS-CoV-2 infection in organ systems throughout the body and explore commonalities. OBJECTIVE Familiarity with the underlying pathophysiology and imaging characteristics is essential for the radiologist to recognize these findings in patients with COVID-19 infection. Though pulmonary findings are the most prevalent presentation, COVID-19 may have multiple manifestations and recognition of the extrapulmonary manifestations is especially important because of the potential serious and long-term effects of COVID-19 on multiple organ systems.
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Affiliation(s)
- K M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032.
| | - H Yang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E West
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Fruauff
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - G Loeb
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Maddocks
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Borowski
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Lala
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - P Nguyen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Lignelli
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - B D'souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E Desperito
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - C Ruzal-Shapiro
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - M M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
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11
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West E, Kupeli N, Moore K, Sampson E, Aker N, Nair P, Davies N. Rapid development of a decision-aid for people with dementia and their families during COVID-19. Eur Psychiatry 2021. [PMCID: PMC9471073 DOI: 10.1192/j.eurpsy.2021.277] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionCOVID-19 as a pandemic has disproportionately affected older adults, including those with dementia. The effects on health and social care systems has necessitated a rapid-response approach to care planning and decision-making in this population, with reflexivity and responsiveness to changing individual and system needs at its core. In light of this, a decision-making tool to help families of persons with dementia was developed using a combination of qualitative data and evidence synthesis.ObjectivesTo develop a decision-aid using a combination of assessment and evidence-gathering methods for families of persons with dementia.MethodsSemi-structured interviews with helpline staff from national end-of-life and supportive care organisations formed the basis of the tool design. Co-design with people living with dementia, current and former carers and experts in general practice and social care shaped the next stage. Simultaneously, a rapid review of current evidence on making decisions with older people at the end of life was undertaken.ResultsOutput from interviews covered many topics, including trust, agency and confusion in making decisions in the context of COVID-19. The rapid review of existing evidence highlighted the need to consider both process and outcome elements of decision-making.ConclusionsCombining different sources and forms of evidence was efficient and valuable in creating a novel decision-making tool for persons with dementia and their families within the context of COVID-19. The decision-aid covered care planning, caregiver support systems, access to information and contingency considerations. Upon publication, the tool was adopted by NHS England and other leading healthcare organisations.DisclosureNo significant relationships.
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Lavery MJ, Vasile C, Cathcart C, Bell H, Khirwadkar N, West E, Mullen L. An umbilical lesion. Clin Exp Dermatol 2021; 46:971-973. [PMID: 33619749 DOI: 10.1111/ced.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- M J Lavery
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C Vasile
- Department of Histopathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C Cathcart
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - H Bell
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N Khirwadkar
- Department of Histopathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - E West
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - L Mullen
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Affiliation(s)
- E. West
- Davies Veterinary Specialists Higham Gobion Hertfordshire UK
| | - F. Malalana
- School of Veterinary Science Philip Leverhulme Equine Hospital University of Liverpool Neston UK
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Samson A, West E, Turnbull S, Scott K, Tidswell E, Kingston J, Johnpulle M, Bendjama K, Stojkowitz N, Lusky M, Toogood G, Twelves C, Ralph C, Anthoney A, Melcher A, Collinson F. Single intravenous preoperative administration of the oncolytic virus Pexa-Vec to prime anti-tumour immunity. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Thakkar M, West E. Double-ended K-wires: watch out for the sting in the tail. Ann R Coll Surg Engl 2019; 101:618-619. [PMID: 31532232 DOI: 10.1308/rcsann.2019.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Thakkar
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Bristol, UK
| | - E West
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Bristol, UK
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Griffin R, Psarelli EE, Cox TF, Khedr M, Milan AM, Davison AS, Hughes AT, Usher JL, Taylor S, Loftus N, Daroszewska A, West E, Jones A, Briggs M, Fisher M, McCormick M, Judd S, Vinjamuri S, Sireau N, Dillon JP, Devine JM, Hughes G, Harrold J, Barton GJ, Jarvis JC, Gallagher JA, Ranganath LR. Data on items of AKUSSI in Alkaptonuria collected over three years from the United Kingdom National Alkaptonuria Centre and the impact of nitisinone. Data Brief 2018; 20:1620-1628. [PMID: 30263914 PMCID: PMC6157456 DOI: 10.1016/j.dib.2018.09.021] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/02/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Abstract
Alkaptonuria is a rare genetic disorder characterized by a high level of circulating (and urine) homogentisic acid (HGA), which contributes to ochronosis when it is deposited in connective tissue as a pigmented polymer. In an observational study carried out by National AKU Centre (NAC) in Liverpool, a total of thirty-nine AKU patients attended yearly visits in varying numbers. At each visit a mixture of clinical, joint and spinal assessments were carried out and the results calculated to yield an AKUSSI (Alkaptonuria Severity Score Index), see "Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre" (Ranganath at el., 2018). The aim of this data article is to produce visual representation of the change in the components of AKUSSI over 3 years, through radar charts. The metabolic effect of nitisinone is shown through box plots.
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Affiliation(s)
- R Griffin
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - E E Psarelli
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - T F Cox
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - M Khedr
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A M Milan
- AKU Society, 66 Devonshire Road, Cambridge, UK
| | - A S Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A T Hughes
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - J L Usher
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Taylor
- Department of Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N Loftus
- Department of Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Daroszewska
- Department of Rheumatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.,Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - E West
- Department of Dermatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Jones
- Department of Anaesthesia, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Briggs
- Department of Ophthalmology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Fisher
- Department of Cardiology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M McCormick
- Department of ENT, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Judd
- Department of Dietetics, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Vinjamuri
- Department of Nuclear Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N Sireau
- AKU Society, 66 Devonshire Road, Cambridge, UK
| | - J P Dillon
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - J M Devine
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - G Hughes
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - J Harrold
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - G J Barton
- School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - J C Jarvis
- School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - J A Gallagher
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - L R Ranganath
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
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Ranganath LR, Khedr M, Milan AM, Davison AS, Hughes AT, Usher JL, Taylor S, Loftus N, Daroszewska A, West E, Jones A, Briggs M, Fisher M, McCormick M, Judd S, Vinjamuri S, Griffin R, Psarelli EE, Cox TF, Sireau N, Dillon JP, Devine JM, Hughes G, Harrold J, Barton GJ, Jarvis JC, Gallagher JA. Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: Evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre. Mol Genet Metab 2018; 125:127-134. [PMID: 30055994 DOI: 10.1016/j.ymgme.2018.07.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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: 03/28/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
QUESTION Does Nitisinone prevent the clinical progression of the Alkaptonuria? FINDINGS In this observational study on 39 patients, 2 mg of daily nitisinone inhibited ochronosis and significantly slowed the progression of AKU over a three-year period. MEANING Nitisinone is a beneficial therapy in Alkaptonuria. BACKGROUND Nitisinone decreases homogentisic acid (HGA), but has not been shown to modify progression of Alkaptonuria (AKU). METHODS Thirty-nine AKU patients attended the National AKU Centre (NAC) in Liverpool for assessments and treatment. Nitisinone was commenced at V1 or baseline. Thirty nine, 34 and 22 AKU patients completed 1, 2 and 3 years of monitoring respectively (V2, V3 and V4) in the VAR group. Seventeen patients also attended a pre-baseline visit (V0) in the VAR group. Within the 39 patients, a subgroup of the same ten patients attended V0, V1, V2, V3 and V4 visits constituting the SAME Group. Severity of AKU was assessed by calculation of the AKU Severity Score Index (AKUSSI) allowing comparison between the pre-nitisinone and the nitisinone treatment phases. RESULTS The ALL (sum of clinical, joint and spine AKUSSI features) AKUSSI rate of change of scores/patient/month, in the SAME group, was significantly lower at two (0.32 ± 0.19) and three (0.15 ± 0.13) years post-nitisinone when compared to pre-nitisinone (0.65 ± 0.15) (p < .01 for both comparisons). Similarly, the ALL AKUSSI rate of change of scores/patient/month, in the VAR group, was significantly lower at one (0.16 ± 0.08) and three (0.19 ± 0.06) years post-nitisinone when compared to pre-nitisinone (0.59 ± 0.13) (p < .01 for both comparisons). Combined ear and ocular ochronosis rate of change of scores/patient/month was significantly lower at one, two and three year's post-nitisinone in both VAR and SAME groups compared with pre-nitisinone (p < .05). CONCLUSION This is the first indication that a 2 mg dose of nitisinone slows down the clinical progression of AKU. Combined ocular and ear ochronosis progression was arrested by nitisinone.
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Affiliation(s)
- L R Ranganath
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - M Khedr
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - A M Milan
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - A S Davison
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - A T Hughes
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - J L Usher
- Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - S Taylor
- Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N Loftus
- Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Daroszewska
- Rheumatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK; Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - E West
- Dermatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - A Jones
- Anaesthesia, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Briggs
- Ophthalmology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M Fisher
- Cardiology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - M McCormick
- ENT, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Judd
- Dietetics, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - S Vinjamuri
- Nuclear Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - R Griffin
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - E E Psarelli
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - T F Cox
- Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK
| | - N Sireau
- AKU Society, 66 Devonshire Road, Cambridge, UK
| | - J P Dillon
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - J M Devine
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
| | - G Hughes
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - J Harrold
- Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK
| | - G J Barton
- Liverpool John Moores University, Liverpool, UK
| | - J C Jarvis
- Liverpool John Moores University, Liverpool, UK
| | - J A Gallagher
- Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK
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Morales-Raveendran E, Goodman E, West E, Cone JE, Katz C, Weiss J, Feldman JM, Harrison D, Markowitz S, Federman A, Wisnivesky JP. Associations between asthma trigger reports, mental health conditions, and asthma morbidity among world trade center rescue and recovery workers. J Asthma 2018; 56:833-840. [PMID: 30073876 DOI: 10.1080/02770903.2018.1502300] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: There is limited information regarding asthma triggers in World Trade Center (WTC) rescue and recovery workers (RRW) or how mental health conditions affect the perception of triggers. Methods: We included 372 WTC workers with asthma. The Asthma Trigger Inventory (ATI) assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder (PD). The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Linear regression models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. Results: The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers (partial r2=0.05, p < 0.01), physical activity (partial r2=0.03, p < 0.01) and air pollution (partial r2=0.02, p = 0.04) subscales while PD was significantly associated with air pollution (partial r2=0.03, p = 0.03) and general allergens (partial r2=0.02, p = 0.03). ATI subscales explained a large percentage of variance in asthma control (r2=0.37, p < 0.01) and quality of life scores (r2=0.40, p < 0.01). Psychological subscale scores explained the largest portion of the total variability in ACQ (partial r2= 0.11, p = 0.72) and AQLQ (partial r2=0.14, p = 0.64) scores. Conclusion: RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.
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Affiliation(s)
- E Morales-Raveendran
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,c Ferkauf Graduate School of Psychology, Yeshiva University , Bronx , NY , USA
| | - E Goodman
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E West
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J E Cone
- b New York City Department of Health and Mental Hygiene, World Trade Center Health Registry , New York , NY , USA
| | - C Katz
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J Weiss
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J M Feldman
- c Ferkauf Graduate School of Psychology, Yeshiva University , Bronx , NY , USA.,d Department of Pediatrics (Academic General Pediatrics), Albert Einstein College of Medicine/Children's Hospital at Montefiore , Bronx , NY , USA
| | - D Harrison
- e Department of Medicine, New York University , New York , NY , USA
| | - S Markowitz
- f Queens College, City University of New York , Flushing , NY , USA
| | - Alex Federman
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J P Wisnivesky
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,g Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Turnbull S, West E, Scott K, Tidswell E, Melcher A, Seymour M, Ralph C, Seligmann J. Revealing potential immune responses (IRs) in patients with advanced colorectal cancer (aCRC) on first line chemotherapy: A prospective study of neutrophil to lymphocyte ratio, immune function and outcome. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Samson A, Scott K, Taggart D, West E, Wilson E, Nuovo G, Thomson S, Stead L, Short S, Melcher A. P07.05 Intravenous delivery of oncolytic reovirus to brain tumours in patients to immunologically prime for sequential checkpoint blockade. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gosling RJ, Breslin M, Fenner J, Vaughan K, West E, Mawhinney I, Birch C, Davies RH. Anin-vitroinvestigation into the efficacy of disinfectants used in the duck industry againstSalmonella. Avian Pathol 2016; 45:576-81. [DOI: 10.1080/03079457.2016.1188369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jebar A, West E, Scott K, Nuovo G, Fuller M, Thomson S, Corns R, Mathew R, SivaKumar G, Cockle J, Van Hille P, Errington F, Appleton E, Migneco G, Taggart D, Coffey M, Rose A, Griffin S, Anth RC. OP25INTRAVENOUS DELIVERY OF ONCOLYTIC REOLYSIN ®TO PRIMARY AND SECONDARY BRAIN TUMOURS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov283.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVES A prospective study to evaluate agreement and precision of a new point-of-care portable analyser, the EPOC analyser, compared with the i-STAT analyser in canine blood. METHODS Blood samples (68 venous and 32 arterial) were obtained from 63 client-owned dogs for clinical reasons and surplus blood was used to analyse agreement between the EPOC and i-STAT analysers. Precision of the EPOC analyser was also assessed by repeat analysis of 20 samples. Measured analytes included pH, partial pressures of carbon dioxide and oxygen and concentrations of sodium, potassium, ionised calcium, glucose and haematocrit. Haemoglobin, base excess, bicarbonate and saturation of haemoglobin with oxygen were calculated. RESULTS EPOC precision was acceptable, but agreement was poor for sodium, haematocrit, haemoglobin and base excess. Overall, method comparison was poor for pH, partial pressure of oxygen, sodium, haematocrit, haemoglobin and base excess. CLINICAL SIGNIFICANCE The EPOC analyser is useful for dogs, although clinically significant differences between the EPOC and i-STAT analysers exist for some analytes, and as such these analysers should not be used interchangeably.
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Affiliation(s)
- E West
- School of Veterinary Science, Leahurst Campus, University of Liverpool, Neston, CH64 7TE
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Duric N, Littrup P, Schmidt S, Li C, Roy O, Bey-Knight L, Janer R, Kunz D, Chen X, Goll J, Wallen A, Zafar F, Allada V, West E, Jovanovic I, Li K, Greenway W. Breast imaging with the SoftVue imaging system: first results. MEDICAL IMAGING 2013: ULTRASONIC IMAGING, TOMOGRAPHY, AND THERAPY 2013; 8675. [PMID: 37033290 PMCID: PMC10079278 DOI: 10.1117/12.2002513] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
For women with dense breast tissue, who are at much higher risk for developing breast cancer, the performance of mammography is at its worst. Consequently, many early cancers go undetected when they are the most treatable. Improved cancer detection for women with dense breasts would decrease the proportion of breast cancers diagnosed at later stages, which would significantly lower the mortality rate. The emergence of whole breast ultrasound provides good performance for women with dense breast tissue, and may eliminate the current trade-off between the cost effectiveness of mammography and the imaging performance of more expensive systems such as magnetic resonance imaging. We report on the performance of SoftVue, a whole breast ultrasound imaging system, based on the principles of ultrasound tomography. SoftVue was developed by Delphinus Medical Technologies and builds on an early prototype developed at the Karmanos Cancer Institute. We present results from preliminary testing of the SoftVue system, performed both in the lab and in the clinic. These tests aimed to validate the expected improvements in image performance. Initial qualitative analyses showed major improvements in image quality, thereby validating the new imaging system design. Specifically, SoftVue's imaging performance was consistent across all breast density categories and had much better resolution and contrast. The implications of these results for clinical breast imaging are discussed and future work is described.
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Affiliation(s)
- Neb Duric
- Karmanos Cancer Institute, Wayne State University, 4100 John R. Street, 5 HWCRC, Detroit, MI 48201
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Peter Littrup
- Karmanos Cancer Institute, Wayne State University, 4100 John R. Street, 5 HWCRC, Detroit, MI 48201
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Steven Schmidt
- Karmanos Cancer Institute, Wayne State University, 4100 John R. Street, 5 HWCRC, Detroit, MI 48201
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Cuiping Li
- Karmanos Cancer Institute, Wayne State University, 4100 John R. Street, 5 HWCRC, Detroit, MI 48201
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Olivier Roy
- Karmanos Cancer Institute, Wayne State University, 4100 John R. Street, 5 HWCRC, Detroit, MI 48201
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Lisa Bey-Knight
- Karmanos Cancer Institute, Wayne State University, 4100 John R. Street, 5 HWCRC, Detroit, MI 48201
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Roman Janer
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Dave Kunz
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Xiaoyang Chen
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Jeffrey Goll
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Andrea Wallen
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Fouzaan Zafar
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Veerendra Allada
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Eric West
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Ivana Jovanovic
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - Kuo Li
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
| | - William Greenway
- Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, MI 48170
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Gianani R, Campbell-Thompson M, Sarkar SA, Wasserfall C, Pugliese A, Solis JM, Kent SC, Hering BJ, West E, Steck A, Bonner-Weir S, Atkinson MA, Coppieters K, von Herrath M, Eisenbarth GS. Dimorphic histopathology of long-standing childhood-onset diabetes. Diabetologia 2010; 53:690-8. [PMID: 20062967 DOI: 10.1007/s00125-009-1642-y] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 11/27/2009] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS Childhood diabetes is thought to usually result from autoimmune beta cell destruction (type 1A) with eventual total loss of beta cells. Analysis of C-peptide in children characterised at diabetes onset for autoantibodies shows heterogeneous preservation of insulin secretion in long-standing diabetes. The aim of this study was to characterise the pancreases of childhood-onset diabetes in order to define the pathological basis of this heterogeneity. METHODS We evaluated 20 cadaveric organ donor pancreases of childhood-onset long-term patients for disease heterogeneity and obtained corresponding C-peptide measurements. RESULTS Pancreases from the majority of cadaveric donors contained only insulin-deficient islets (14 of 20). The remaining six patients (30%) had numerous insulin-positive cells within at least some islets, with two different histological patterns. Pattern A (which we would associate with type 1A diabetes) had lobular retention of areas with 'abnormal' beta cells producing the apoptosis inhibitor survivin and HLA class I. In pattern B, 100% of all islets contained normal-appearing but quantitatively reduced beta cells without survivin or HLA class I. CONCLUSIONS/INTERPRETATION Our data demonstrate that C-peptide secretion in long-standing diabetic patients can be explained by two different patterns of beta cell survival,possibly reflecting different subsets of type 1 diabetes.
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Affiliation(s)
- R Gianani
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Court, Aurora, CO 80055, USA.
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Luhach A, West E, Amos D, Arnold R. Management of ACS in a Rural NSW Setting. Cost Effectiveness of Rural Cardiac Catheterisation Laboratories. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Analgesic agents were administered perioperatively to an eight-year-old Springer Spaniel undergoing amputation of its right thoracic limb. The amputation was carried out due to a painful, infiltrative and poorly differentiated sarcoma involving the nerves of the brachial plexus. A combination of pre-emptive and multimodal perioperative analgesic strategies was used; including intravenous (IV) infusions of fentanyl, morphine, lidocaine and ketamine.
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Affiliation(s)
- E West
- Small Animal Teaching Hospital, Leahurst, University of Liverpool, Neston CH64 7TE.
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Berhane Y, Worku A, Bejiga A, Adamu L, Alemayehu W, Bedri A, Haile Z, Ayalew A, Adamu W, Gebre T, Kebede TD, West E, West S. National Survey on Blindness, Low Vision and Trachoma in Ethiopia: Methods and Study Clusters Profile. ETHIOP J HEALTH DEV 2008. [DOI: 10.4314/ejhd.v21i3.10049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Berhane Y, Worku A, Bejiga A, Adamu L, Alemayehu W, Bedri A, Haile Z, Ayalew A, Adamu Y, Gebre T, Kebede TD, West E, West S. Prevalence of Trachoma in Ethiopia. ETHIOP J HEALTH DEV 2008. [DOI: 10.4314/ejhd.v21i3.10051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Berhane Y, Worku A, Bejiga A, Adamu L, Alemayehu W, Bedri A, Haile Z, Ayalew A, Adamu Y, Gebre T, Kebede TD, West E, West S. Prevalence and causes of blindness and Low Vision in Ethiopia. ETHIOP J HEALTH DEV 2008. [DOI: 10.4314/ejhd.v21i3.10050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Larson G, Cucchi T, Fujita M, Matisoo-Smith E, Robins J, Anderson A, Rolett B, Spriggs M, Dolman G, Kim TH, Thuy NTD, Randi E, Doherty M, Due RA, Bollt R, Djubiantono T, Griffin B, Intoh M, Keane E, Kirch P, Li KT, Morwood M, Pedriña LM, Piper PJ, Rabett RJ, Shooter P, Van den Bergh G, West E, Wickler S, Yuan J, Cooper A, Dobney K. Phylogeny and ancient DNA of Sus provides insights into neolithic expansion in Island Southeast Asia and Oceania. Proc Natl Acad Sci U S A 2007; 104:4834-9. [PMID: 17360400 PMCID: PMC1829225 DOI: 10.1073/pnas.0607753104] [Citation(s) in RCA: 234] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Human settlement of Oceania marked the culmination of a global colonization process that began when humans first left Africa at least 90,000 years ago. The precise origins and dispersal routes of the Austronesian peoples and the associated Lapita culture remain contentious, and numerous disparate models of dispersal (based primarily on linguistic, genetic, and archeological data) have been proposed. Here, through the use of mtDNA from 781 modern and ancient Sus specimens, we provide evidence for an early human-mediated translocation of the Sulawesi warty pig (Sus celebensis) to Flores and Timor and two later separate human-mediated dispersals of domestic pig (Sus scrofa) through Island Southeast Asia into Oceania. Of the later dispersal routes, one is unequivocally associated with the Neolithic (Lapita) and later Polynesian migrations and links modern and archeological Javan, Sumatran, Wallacean, and Oceanic pigs with mainland Southeast Asian S. scrofa. Archeological and genetic evidence shows these pigs were certainly introduced to islands east of the Wallace Line, including New Guinea, and that so-called "wild" pigs within this region are most likely feral descendants of domestic pigs introduced by early agriculturalists. The other later pig dispersal links mainland East Asian pigs to western Micronesia, Taiwan, and the Philippines. These results provide important data with which to test current models for human dispersal in the region.
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Affiliation(s)
- Greger Larson
- Department of Medical Biochemistry and Microbiology, Uppsala University Biomedical Center, Box 597, 751 24 Uppsala, Sweden
- Henry Wellcome Ancient Biomolecules Centre, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, United Kingdom
- To whom correspondence may be addressed. E-mail: or
| | - Thomas Cucchi
- Department of Archaeology, University of Durham, South Road, Durham DH1 3L, United Kingdom
- Département Ecologie et Gestion de la Biodiversité, Unité Mixte de Recherche 5197, Muséum National d'Histoire Naturelle, 55 Rue Buffon, 75231 Paris Cedex 5, France; and
| | - Masakatsu Fujita
- Department of Archaeology, University of Durham, South Road, Durham DH1 3L, United Kingdom
| | - Elizabeth Matisoo-Smith
- Department of Anthropology and Allan Wilson Centre for Molecular Ecology and Evolution, University of Auckland, P.O. Box 92019, Auckland, New Zealand
| | - Judith Robins
- Department of Anthropology and Allan Wilson Centre for Molecular Ecology and Evolution, University of Auckland, P.O. Box 92019, Auckland, New Zealand
| | - Atholl Anderson
- Department of Archaeology and Natural History, Research School of Pacific and Asian Studies, and
| | - Barry Rolett
- Department of Anthropology, University of Hawaii, 2424 Maile Way, Honolulu, HI 96822
| | - Matthew Spriggs
- School of Archaeology and Anthropology, Faculty of Arts, The Australian National University, Canberra ACT 0200, Australia
| | - Gaynor Dolman
- Australian Centre for Ancient DNA, Earth, and Environmental Sciences, University of Adelaide, South Australia 5005, Australia
| | - Tae-Hun Kim
- Animal Genomics Laboratory, Animal Genomics and Bioinformatics Division, National Livestock Research Institute Rural Development Administration, 564 Omockchun-Dong, Gwonseon-Gu, Suwon 441-706, Korea
| | - Nguyen Thi Dieu Thuy
- Institute of Biotechnology Vietnamese Academy of Science and Technology, 18 Hoang Quoc Viet Road, Cau Giay, Ha Noi, Vietnam
| | - Ettore Randi
- Laboratorio di Genetica, Istituto Nazionale per la Fauna Selvatica, Via Cà Fornacetta, 9, 40064 Ozzano Emilia Bologna, Italy
| | - Moira Doherty
- Department of Anthropology and Allan Wilson Centre for Molecular Ecology and Evolution, University of Auckland, P.O. Box 92019, Auckland, New Zealand
| | - Rokus Awe Due
- Indonesian Centre for Archaeology, Jl. Raya Condet Pejaten 4, Jakarta 12001, Indonesia
| | - Robert Bollt
- Department of Anthropology, University of Hawaii, 2424 Maile Way, Honolulu, HI 96822
| | - Tony Djubiantono
- Indonesian Centre for Archaeology, Jl. Raya Condet Pejaten 4, Jakarta 12001, Indonesia
| | - Bion Griffin
- Department of Anthropology, University of Hawaii, 2424 Maile Way, Honolulu, HI 96822
| | - Michiko Intoh
- Department of Social Research, National Museum of Ethnology, Osaka 565-8511, Japan
| | - Emile Keane
- Department of Archaeology, University of Durham, South Road, Durham DH1 3L, United Kingdom
| | - Patrick Kirch
- Department of Anthropology, University of California, 232 Kroeber Hall, Berkeley, CA 94720
| | - Kuang-Ti Li
- Institute of History and Philology, Academia Sinica, Nankang, Taipei 11529, Taiwan
| | - Michael Morwood
- Department of Archaeology and Palaeoanthropology, School of Human and Environmental Studies, University of New England, Armidale, New South Wales 2351, Australia
| | | | - Philip J. Piper
- Centre for Palaeoecology and Evolution, Department of Archaeology, University of York, The King's Manor, York YO1 7EP, United Kingdom
| | - Ryan J. Rabett
- The McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge CB2 3ER, United Kingdom
| | - Peter Shooter
- 107 Dunbar Street, Mount Gravatt East, Brisbane Q4122, Australia
| | - Gert Van den Bergh
- Royal Netherlands Institute for Sea Research, NL-1790 AB Den Burg, Texel, The Netherlands
| | - Eric West
- Naval Facilities Engineering Command Pacific, 258 Makalapa Drive, Pearl Harbor, HI 96860
| | - Stephen Wickler
- Department of Archaeology, Tromsø University Museum, N-9037 Tromsø, Norway
| | - Jing Yuan
- Research Centre for Archaeological Science, Institute of Archaeology, Chinese Academy of Social Sciences, Beijing 100710, China
| | - Alan Cooper
- Australian Centre for Ancient DNA, Earth, and Environmental Sciences, University of Adelaide, South Australia 5005, Australia
| | - Keith Dobney
- Department of Archaeology, University of Durham, South Road, Durham DH1 3L, United Kingdom
- To whom correspondence may be addressed. E-mail: or
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West E, Lautenslager T, Smolka J, Hudzik T, Maciag C. GABA‐A Selective Positive Modulators: Anxiolytic Efficacy versus Side Effects. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a235-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E. West
- NeuroscienceAstraZeneca Pharmaceuticals1800 Concord PikeWilmingtonDE19850
| | - T. Lautenslager
- NeuroscienceAstraZeneca Pharmaceuticals1800 Concord PikeWilmingtonDE19850
| | - J. Smolka
- NeuroscienceAstraZeneca Pharmaceuticals1800 Concord PikeWilmingtonDE19850
| | - T. Hudzik
- NeuroscienceAstraZeneca Pharmaceuticals1800 Concord PikeWilmingtonDE19850
| | - C. Maciag
- NeuroscienceAstraZeneca Pharmaceuticals1800 Concord PikeWilmingtonDE19850
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McOrist J, Sharma MD, Sheppard CJR, West E, Matsuda K. Hyperresolving phase-only filters with an optically addressable liquid crystal spatial light modulator. Micron 2003; 34:327-32. [PMID: 12932777 DOI: 10.1016/s0968-4328(03)00059-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hyperresolving (sometimes called 'superresolving' or 'ultraresolving') phase-only filters can be generated using an optically addressable liquid crystal spatial light modulator. This approach avoids the problems of low efficiency, and coupling between amplitude and phase modulation, that arise when using conventional liquid crystal modulators. When addressed by a programmed light intensity distribution, it allows filters to be changed rapidly to modify the response of a system or permit the investigation of different filter designs. In this paper we present experimental hyperresolved images obtained using an optically addressable parallel-aligned nematic LCD with two zone Toraldo type phase-only filters. The images are compared with theoretical predictions.
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Affiliation(s)
- J McOrist
- Physical Optics Laboratory, School of Physics, University of Sydney, Sydney, NSW 2006, Australia
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Bruhn C, Bruhn J, Cotter A, Garrett C, Klenk M, Powell C, Stanford G, Steinbring Y, West E. Consumer Attitudes Toward Use of Probiotic Cultures. J Food Sci 2002. [DOI: 10.1111/j.1365-2621.2002.tb08754.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ströher U, West E, Bugany H, Klenk HD, Schnittler HJ, Feldmann H. Infection and activation of monocytes by Marburg and Ebola viruses. J Virol 2001; 75:11025-33. [PMID: 11602743 PMCID: PMC114683 DOI: 10.1128/jvi.75.22.11025-11033.2001] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2001] [Accepted: 07/26/2001] [Indexed: 11/20/2022] Open
Abstract
In this study we investigated the effects of Marburg virus and Ebola virus (species Zaire and Reston) infections on freshly isolated suspended monocytes in comparison to adherent macrophages under culture conditions. Our data showed that monocytes are permissive for both filoviruses. As is the case in macrophages, infection resulted in the activation of monocytes which was largely independent of virus replication. The activation was triggered similarly by Marburg and Ebola viruses, species Zaire and Reston, as indicated by the release of the proinflammatory cytokines interleukin-1beta (IL-1beta), tumor necrosis factor alpha, and IL-6 as well as the chemokines IL-8 and gro-alpha. Our data suggest that infected monocytes may play an important role in the spread of filoviruses and in the pathogenesis of filoviral hemorrhagic disease.
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Affiliation(s)
- U Ströher
- Institut für Virologie, Philipps-Universität, D-35037 Marburg, Germany
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36
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West E. A hospital nurse: 1935-1940. Hist Nurs Bull 2001; 2:36-46. [PMID: 11613858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Abstract
Some hospital trusts and health authorities consistently outperform others on different dimensions of performance. Why? There is some evidence that "management matters", as well as the combined efforts of individual clinicians and teams. However, studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically. A larger, and arguably more rigorous, body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Studies in these traditions have focused on the effects of decentralisation, participation, innovative work practices, and "complementarities" on outcome variables such as job satisfaction and performance. The aim of this paper is to identify a number of reviews and research traditions that might bring new ideas into future work on the determinants of hospital performance. Ideally, future research should be more theoretically informed and should use longitudinal rather than cross sectional research designs. The use of statistical methods such as multilevel modelling, which allow for the inclusion of variables at different levels of analysis, would enable estimation of the separate contribution that structure and process make to hospital outcomes.
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Affiliation(s)
- E West
- Royal College of Nursing, Radcliffe Infirmary, Woodstock Road, Oxford OX1 6HE, UK.
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Abstract
AIMS OF THE PAPER To identify recent trends in the academic field of health policy, setting them in the context of wider changes in the socio-political and research environments and considering their implications for nursing research. BACKGROUND Health policy is a well-established field of academic study and research in the United Kingdom (UK). The 1990s have seen some important intellectual developments in this field, as well as some major changes in the context of health-related research. DESIGN A selective review of the relevant literature. CONCLUSIONS The Department of Health's new Research & Development strategy can be understood as part of a wider trend, moving away from the traditional, university-based model of knowledge production towards a new one which involves other groups, such as employers, practitioners and patients. This may increase the opportunities for health care professionals in general - and nurses in particular - to influence the research agenda and to participate as researchers in the critical evaluation of health policy.
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Mercer VS, Abrams S, Connelly C, Trabue L, West E. NO EFFECT OF A DISTRACTING ENVIRONMENT ON CLINICAL MEASURES OF BALANCE AND GAIT IN COMMUNITY DWELLERS OVER 65 YEARS OF AGE. J Geriatr Phys Ther 2001. [DOI: 10.1519/00139143-200124010-00008] [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: 11/08/2022]
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West E, Scott C. Nursing in the public sphere: breaching the boundary between research and policy. J Adv Nurs 2000; 32:817-24. [PMID: 11095219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Nurses and nursing are associated traditionally with activities in a private sphere. This paper argues that, if clinical care is to be improved, nurses need to take a more active public role in making and implementing health policy at both local and national levels. In the current climate, empirical evidence is one of the most important tools for influencing health policy. This paper discusses contemporary models of the policy-making process before outlining a number of strategies that could be used to increase the policy impact of nursing research. Finally, while the current climate in the United Kingdom health-care arena presents opportunities for researchers to have an impact on policy, the growth of health policy research as a distinct field of scholarship also poses a number of challenges and dangers.
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Affiliation(s)
- E West
- Royal College of Nursing Institute, Radcliffe Infirmary, Oxford, England
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Abstract
Organisational sociology has long accepted that mistakes of all kinds are a common, even normal, part of work. Medical work may be particularly prone to error because of its complexity and technological sophistication. The results can be tragic for individuals and families. This paper describes four intrinsic characteristics of organisations that are relevant to the level of risk and danger in healthcare settings--namely, the division of labour and "structural secrecy" in complex organisations; the homophile principle and social structural barriers to communication; diffusion of responsibility and the "problem of many hands"; and environmental or other pressures leading to goal displacement when organisations take their "eyes off the ball". The paper argues that each of these four intrinsic characteristics invokes specific mechanisms that increase danger in healthcare organisations but also offer the possibility of devising strategies and behaviours to increase patient safety. Stated as hypotheses, these ideas could be tested empirically, thus adding to the evidence on which the avoidance of adverse events in healthcare settings is based and contributing to the development of theory in this important area.
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Affiliation(s)
- E West
- Royal College of Nursing, Radcliffe Infirmary, Oxford, UK. elizabeth.
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West E. Masters and marriages, profits and paternalism: slave owners' perspectives on cross-plantation unions in Antebellum South Carolina. Slavery Abol 2000; 21:56-72. [PMID: 17657917 DOI: 10.1080/01440390008575295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Rogers JH, Ciossek T, Ullrich A, West E, Hoare M, Muir EM. Distribution of the receptor EphA7 and its ligands in development of the mouse nervous system. Brain Res Mol Brain Res 1999; 74:225-30. [PMID: 10640695 DOI: 10.1016/s0169-328x(99)00284-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
EphA7 is a receptor tyrosine kinase of the Eph family. We have mapped EphA7 immunoreactivity and ligand binding in mouse embryo heads and developing brain. Immunoreactivity for the full-length receptor is found in all the cell populations that express EphA7 mRNA. In particular, it is located on growing axons from EphA7-expressing neurons, both in the trigeminal nerve and in developing brain. In many cases it persists in terminal fields in adult brain. Ligand is detected in a largely complementary distribution in embryos, but is surprisingly weak or undetectable in the target regions of many EphA7-positive axons postnatally.
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Affiliation(s)
- J H Rogers
- Department of Physiology, University of Cambridge, Downing St., Cambridge, UK.
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Ciossek T, Ullrich A, West E, Rogers JH. Segregation of the receptor EphA7 from its tyrosine kinase-negative isoform on neurons in adult mouse brain. Brain Res Mol Brain Res 1999; 74:231-6. [PMID: 10640696 DOI: 10.1016/s0169-328x(99)00285-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The EphA7 gene encodes not only a typical receptor tyrosine kinase (TK+) but also an isoform lacking the tyrosine kinase domain (TK-). We have made antibodies to localise EphA7 TK+ and TK- isoforms in mouse brain. The TK- isoform was not detectable prenatally, despite reported expression of the TK- mRNA in the embryo. However, both TK+ and TK- isoforms showed striking distributions in adult brain. TK+ receptor immunoreactivity was strong in neuropil throughout most of the telencephalon, probably on fine arborisations from neurons which expressed EphA7 during development (in cerebral cortex, hippocampus, and striatum). In contrast, TK- receptor immunoreactivity was conspicuous on cell bodies and proximal dendrites of a limited number of neuronal types, some of which carried EphA7 TK+ receptor on their axons. This suggests that the TK- receptor, acting as a dominant negative antagonist, may ensure that the TK+ receptor only responds to signals encountered by the growing extremities of axons or dendrites.
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Affiliation(s)
- T Ciossek
- Max-Planck-Institut for Biochemistry, 82152 Martinsried, Germany.
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West E, Barron DN, Dowsett J, Newton JN. Hierarchies and cliques in the social networks of health care professionals: implications for the design of dissemination strategies. Soc Sci Med 1999; 48:633-46. [PMID: 10080364 DOI: 10.1016/s0277-9536(98)00361-x] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Interest in how best to influence the behaviour of clinicians in the interests of both clinical and cost effectiveness has rekindled concern with the social networks of health care professionals. Ever since the seminal work of Coleman et al. [Coleman, J.S., Katz, E., Menzel, H., 1966. Medical Innovation: A Diffusion Study. Bobbs-Merrill, Indianapolis.], networks have been seen as important in the process by which clinicians adopt (or fail to adopt) new innovations in clinical practice. Yet very little is actually known about the social networks of clinicians in modern health care settings. This paper describes the professional social networks of two groups of health care professionals, clinical directors of medicine and directors of nursing, in hospitals in England. We focus on network density, centrality and centralisation because these characteristics have been linked to access to information, social influence and social control processes. The results show that directors of nursing are more central to their networks than clinical directors of medicine and that their networks are more hierarchical. Clinical directors of medicine tend to be embedded in much more densely connected networks which we describe as cliques. The hypotheses that the networks of directors of nursing are better adapted to gathering and disseminating information than clinical directors of medicine, but that the latter could be more potent instruments for changing, or resisting changes, in clinical behaviour, follow from a number of sociological theories. We conclude that professional socialisation and structural location are important determinants of social networks and that these factors could usefully be considered in the design of strategies to inform and influence clinicians.
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Affiliation(s)
- E West
- Royal College of Nursing Institute, Radcliffe Infirmary, Oxford, UK.
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Simpson T, Wilson D, Mucken N, Martin S, West E, Guinn N. Implementation and evaluation of a liberalized visiting policy. Am J Crit Care 1996; 5:420-6. [PMID: 8922157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Visiting policies have been liberalized in ICUs, but the process and outcome of policy modifications have not been well described. OBJECTIVES To describe the process by which nurses in one critical care unit modified visiting from a restricted to a liberalized (i.e., modified open) policy, and to evaluate the nurses' perceptions about visiting before and after the policy was liberalized. METHODS A group of ICU/coronary care unit nurses met to discuss changes in their unit's visiting policy. Before the change was initiated, nurses (N = 36) in the unit were informally surveyed regarding their perceptions and attitudes about visiting. After a 3-month trial of liberalized visiting, in which visiting hours were increased at the discretion of the nursing staff, nurses (N = 32) were surveyed using a questionnaire about their beliefs, attitudes, level of satisfaction, and perceptions of their actual visiting policy. RESULTS Nurses confirmed that the visiting policy had become liberalized, and they believed that liberalized visiting had positive effects on patients' emotional well-being. Nurses had more positive attitudes about the effects of liberalized visiting on families than on patients and unit function. Most nurses were satisfied with liberalized visiting. However, attitudes differed about how liberalized visiting affected patients' physiological responses or the unit function. CONCLUSIONS Effective implementation of liberalized visiting depends on assessment of the following: nurses' beliefs, attitudes, and satisfaction about a change toward a more open visiting policy; staff involvement in determining the policy; and nurse manager and clinical nurse specialist support.
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Affiliation(s)
- T Simpson
- University of Washington School of Nursing, Seattle, USA
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Abstract
BACKGROUND: Visiting policies have been liberalized in ICUs, but the process and outcome of policy modifications have not been well described. OBJECTIVES: To describe the process by which nurses in one critical care unit modified visiting from a restricted to a liberalized (i.e., modified open) policy, and to evaluate the nurses' perceptions about visiting before and after the policy was liberalized. METHODS: A group of ICU/coronary care unit nurses met to discuss changes in their unit's visiting policy. Before the change was initiated, nurses (N = 36) in the unit were informally surveyed regarding their perceptions and attitudes about visiting. After a 3-month trial of liberalized visiting, in which visiting hours were increased at the discretion of the nursing staff, nurses (N = 32) were surveyed using a questionnaire about their beliefs, attitudes, level of satisfaction, and perceptions of their actual visiting policy. RESULTS: Nurses confirmed that the visiting policy had become liberalized, and they believed that liberalized visiting had positive effects on patients' emotional well-being. Nurses had more positive attitudes about the effects of liberalized visiting on families than on patients and unit function. Most nurses were satisfied with liberalized visiting. However, attitudes differed about how liberalized visiting affected patients' physiological responses or the unit function. CONCLUSIONS: Effective implementation of liberalized visiting depends on assessment of the following: nurses' beliefs, attitudes, and satisfaction about a change toward a more open visiting policy; staff involvement in determining the policy; and nurse manager and clinical nurse specialist support.
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West E, Simon OR, Morrison EY. Streptozotocin alters pancreatic beta-cell responsiveness to glucose within six hours of injection into rats. W INDIAN MED J 1996; 45:60-2. [PMID: 8772396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 24-hour glycaemic profile following streptozotocin (80 mg/kg. i.p.) injection was investigated in fasted rats. The most prominent changes in blood glucose were hyperglycaemia associated with low levels of plasma insulin after two hours followed by hypoglycaemia associated with high levels of plasma insulin after six hours; subsequently hyperglycaemia progressively developed and this was associated with decreasing levels of plasma insulin. Further probing revealed that at two hours after streptozotocin injection, the pancreatic beta-cells could not respond to an oral glucose load while, at six hours after, there was an apparent return of beta-cell responsiveness, but subsequently beta-cell responsiveness was progressively lost and histological examination revealed cellular damage. From these results, it is concluded that within six hours of injection, streptozotocin initiates pancreatic beta-cell damage which leads to the development of diabetes mellitus.
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Affiliation(s)
- E West
- Department of Pharmacology, University of the West Indies, Jamaica
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