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Reeves BC, Wickens R, O'Connor SR, Gidman EA, Ward E, Treanor C, Peto T, Burton BJL, Knox PC, Lotery A, Sivaprasad S, Donnelly M, Rogers CA, Hogg RE. Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home. BMJ Open 2024; 14:e077196. [PMID: 38453199 PMCID: PMC10921518 DOI: 10.1136/bmjopen-2023-077196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack). DESIGN Diagnostic Test Accuracy study. SETTING Six UK hospitals. METHODS The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges. RESULTS Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers. CONCLUSIONS Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose. TRIAL REGISTRATION NUMBER ISRCTN79058224.
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Affiliation(s)
- Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robin Wickens
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sean R O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eleanor Alma Gidman
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - E Ward
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charlene Treanor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Tunde Peto
- Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
| | - Ben J L Burton
- James Paget University Hospitals NHS Trust, Liverpool, UK
| | | | | | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chris A Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Hanson S, Belderson P, Ward E, Naughton F, Notley C. Lest we forget. Illuminating lived experience of the Covid-19 pandemic and lockdown. Soc Sci Med 2023; 332:116080. [PMID: 37451941 DOI: 10.1016/j.socscimed.2023.116080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
The COVID-19 pandemic and associated 'lockdowns' profoundly impacted people's lives in 2020-2021 and beyond. This study sought to understand unique person-centred insights into health and wellbeing during the restrictive measures in the United Kingdom and to enable us to remember and give testimony to these lived experiences. Using photo-methods, participants from a larger cohort study which tracked people's behaviours during the pandemic were invited to share photographs and short text to visually illustrate their ephemeral and unique COVID-19 experiences. In total 197 participants shared 398 photographs. Using a critical realist approach in our design and analysis, we sought to gain an alternative viewpoint on what 'lockdown' and the pandemic meant. Our major findings revealed starkly contrasting experiences illustrated in our two major themes. Firstly loss, including ambiguous losses and a sense of loss, loss of freedoms and death. Secondly, salutogenesis (what makes us well) whereby participants were able to draw on assets which helped to keep them well by maintaining social connection, 'making the best of it', reconnecting with nature and appreciating the outdoors, creativity for pleasure and faith. Our findings illuminate widely differing experiences and indicate the powerful effect of assets that were perceived by our participants to protect their wellbeing. Understanding differential vulnerability will be essential going forward to target resources appropriately to those who have the least control over their lives, those with the greatest vulnerabilities and least assets which in turn could support a self-perpetuating recovery.
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Affiliation(s)
- S Hanson
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, NR2 7TJ, UK.
| | - P Belderson
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR2 7TJ, UK
| | - E Ward
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR2 7TJ, UK
| | - F Naughton
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, NR2 7TJ, UK
| | - C Notley
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR2 7TJ, UK
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Ward E, Dawkins L, Holland R, Pope I, Notley C. Medicalisation of vaping in the UK? E-cigarette users' perspectives on the merging of commercial and medical routes to vaping. Perspect Public Health 2023:17579139231185481. [PMID: 37544328 DOI: 10.1177/17579139231185481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND In the UK, most smokers choosing e-cigarettes to quit smoking will access vaping via commercial routes. In recent years, however, a shift towards medicalisation of vaping has become apparent, with public health guidance supporting e-cigarettes for smoking cessation and increased partnership working between healthcare professionals and the vaping industry. To achieve the UK's Smokefree 2030 target, the UK Government has set out measures to use e-cigarettes in National Health Service (NHS) settings and to move towards streamlining processes to make e-cigarettes available to a million smokers. This article aims to understand acceptability of different approaches by seeking perspectives of people with lived experience of e-cigarette use for smoking cessation. METHODS Mixed methods data collected between March 2018 and March 2019 as part of a broader study of e-cigarette use trajectories (ECtra study). Data here relate to the views of partnership working and medicalisation of vaping extracted from 136 interviews/extended surveys of people who had used e-cigarettes to try to stop smoking. Qualitative data were thematically analysed. Participant ratings of interventions were presented descriptively, and differences in participant characteristics and ratings were reported. RESULTS Three qualitative themes were identified: pro-partnership, anti-partnership and medicalisation dissonance. Medicalisation was discussed for its potential to reassure smokers about e-cigarette harms and its potential to reach smokers from disadvantaged backgrounds. Concerns were raised about cost-effectiveness, quality of support, conflicts of interest and limiting product choice. Most participants rated interventions involving partnership working as potentially helpful in switching from smoking to vaping. There were no statistically significant associations between age, gender and socioeconomic status, and helpfulness ratings. CONCLUSION Both commercial and medical routes to vaping offer perceived benefits to vapers and may complement and reinforce each other to support smoking cessation.
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Affiliation(s)
- E Ward
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - L Dawkins
- London South Bank University, London, UK
| | - R Holland
- University of Leicester, Leicester, UK
| | - I Pope
- University of East Anglia, Norwich, UK
| | - C Notley
- University of East Anglia, Norwich, UK
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Carrilero L, Urwin L, Ward E, Choudhury NR, Monk IR, Turner CE, Stinear TP, Corrigan RM. Stringent Response-Mediated Control of GTP Homeostasis Is Required for Long-Term Viability of Staphylococcus aureus. Microbiol Spectr 2023; 11:e0044723. [PMID: 36877013 PMCID: PMC10101089 DOI: 10.1128/spectrum.00447-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/07/2023] Open
Abstract
Staphylococcus aureus is an opportunistic bacterial pathogen that often results in difficult-to-treat infections. One mechanism used by S. aureus to enhance survival during infection is the stringent response. This is a stress survival pathway that utilizes the nucleotides (p)ppGpp to reallocate bacterial resources, shutting down growth until conditions improve. Small colony variants (SCVs) of S. aureus are frequently associated with chronic infections, and this phenotype has previously been linked to a hyperactive stringent response. Here, we examine the role of (p)ppGpp in the long-term survival of S. aureus under nutrient-restricted conditions. When starved, a (p)ppGpp-null S. aureus mutant strain ((p)ppGpp0) initially had decreased viability. However, after 3 days we observed the presence and dominance of a population of small colonies. Similar to SCVs, these small colony isolates (p0-SCIs) had reduced growth but remained hemolytic and sensitive to gentamicin, phenotypes that have been tied to SCVs previously. Genomic analysis of the p0-SCIs revealed mutations arising within gmk, encoding an enzyme in the GTP synthesis pathway. We show that a (p)ppGpp0 strain has elevated levels of GTP, and that the mutations in the p0-SCIs all lower Gmk enzyme activity and consequently cellular GTP levels. We further show that in the absence of (p)ppGpp, cell viability can be rescued using the GuaA inhibitor decoyinine, which artificially lowers the intracellular GTP concentration. Our study highlights the role of (p)ppGpp in GTP homeostasis and underscores the importance of nucleotide signaling for long-term survival of S. aureus in nutrient-limiting conditions, such as those encountered during infections. IMPORTANCE Staphylococcus aureus is a human pathogen that upon invasion of a host encounters stresses, such as nutritional restriction. The bacteria respond by switching on a signaling cascade controlled by the nucleotides (p)ppGpp. These nucleotides function to shut down bacterial growth until conditions improve. Therefore, (p)ppGpp are important for bacterial survival and have been implicated in promoting chronic infections. Here, we investigate the importance of (p)ppGpp for long-term survival of bacteria in nutrient-limiting conditions similar to those in a human host. We discovered that in the absence of (p)ppGpp, bacterial viability decreases due to dysregulation of GTP homeostasis. However, the (p)ppGpp-null bacteria were able to compensate by introducing mutations in the GTP synthesis pathway that led to a reduction in GTP build-up and a rescue of viability. This study therefore highlights the importance of (p)ppGpp for the regulation of GTP levels and for long-term survival of S. aureus in restricted environments.
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Affiliation(s)
- Laura Carrilero
- The Florey Institute, School of Biosciences, University of Sheffield, Sheffield, United Kingdom
| | - Lucy Urwin
- The Florey Institute, School of Biosciences, University of Sheffield, Sheffield, United Kingdom
| | - Ezra Ward
- The Florey Institute, School of Biosciences, University of Sheffield, Sheffield, United Kingdom
| | - Naznin R. Choudhury
- The Florey Institute, School of Biosciences, University of Sheffield, Sheffield, United Kingdom
| | - Ian R. Monk
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire E. Turner
- The Florey Institute, School of Biosciences, University of Sheffield, Sheffield, United Kingdom
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca M. Corrigan
- The Florey Institute, School of Biosciences, University of Sheffield, Sheffield, United Kingdom
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Ward E, Brownsett S, McMahon K, Hartwigsen G, Mascelloni M, de Zubicaray G. Online transcranial magnetic stimulation reveals differential effects of transitivity in left inferior parietal cortex but not premotor cortex during action naming. Neuropsychologia 2022; 174:108339. [DOI: 10.1016/j.neuropsychologia.2022.108339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
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Suresh A, Theodoraki A, Ward E, Feher MD. PCSK9 inhibitor therapy and guideline treatment targets for cardiovascular disease and familial hypercholesterolaemia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Updated trial data on the benefits of low-density lipoprotein cholesterol (LDL-C) reduction on cardiovascular outcomes have been incorporated into 2019 ESC/EAS guidelines and 2020 UK-based NICE guidance. Treatment targets for secondary cardiovascular disease (CVD) prevention are LDL-C <1.4mmol/L (ESC/EAS) and non-high-density lipoprotein <2.5mmol/L (equates to LDL-C <1.8mmol/L; NICE). Guidelines also recommend ≥50% LDL-C reduction in patients with CVD or Familial Hypercholesterolaemia (FH). Targets are often not achieved with oral statin +/− ezetimibe due to reduced efficacy or tolerability, warranting a switch to PCSK9 inhibitor therapy. However, there is limited data on whether this achieves LDL-C targets for both CVD and FH in real world clinical practice.
Purpose
To assess attainment of LDL-C treatment targets using PCSK9 inhibitor mono- or combination therapy in routine clinical care for patients with FH or CVD.
Methods
Observational study in a single specialist lipid clinic, using retrospective case note review of patients prescribed PCSK9 inhibitor therapy according to NICE guidelines until February 2021. Anonymised clinical, demographic and biochemical data before and after commencement of PCSK9 inhibitor therapy were collected. Primary outcomes were attainment of guideline-defined LDL-C treatment targets: LDL-C <1.8 mmol/L, LDL-C <1.4mmol/L and ≥50% LDL-C reduction.
Results
A total of 55 patients (mean age 60.8±12.9 years, 58% male) on PCSK9 inhibitor therapy (98% alirocumab, 2% evolocumab; mean treatment duration 1.7±1.3 years) were identified. PCSK9 inhibitor therapy was commenced due to drug intolerance to statins (89%), ezetimibe (36%) and fenofibrate (25%). In patients with FH (n=18), 78%, 56% and 33% of patients achieved targets of ≥50% LDL-C reduction, LDL-C <1.8 mmol/L and LDL-C <1.4 mmol/L on treatment, respectively. In CVD patients (n=49), 84%, 51% and 27% achieved the same targets respectively (Table 1). In patients on PCSK9 inhibitor monotherapy (n=19), 21% and 5% achieved LDL-C targets <1.8 mmol/L and <1.4 mmol/L respectively, whereas in those on PCSK9 inhibitor + two or more additional oral lipid-lowering therapies, 87% and 60% achieved the same targets respectively (Table 2).
Conclusions
Most patients with FH or CVD achieve an LDL-C reduction of ≥50% from baseline with PCSK9 inhibitor therapy, however fewer achieve the LDL-C targets of <1.8 mmol/L or <1.4 mmol/L. Patients on PCSK9 inhibitor monotherapy are unlikely to reach LDL-C <1.8 mmol/L and <1.4mmol/L targets, whereas PCSK9 inhibitor combination therapies are more likely to do so. Additional lipid-lowering drugs are required with PCSK9 inhibitor therapy in most patients to reach guideline LDL-C targets.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Suresh
- Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - A Theodoraki
- Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - E Ward
- Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - M D Feher
- Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
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Goebeler M, Bata-Csörgo Z, de Simone C, Didona B, Remenyik E, Reznichenko N, Schmidt E, Stoevesandt J, Ward E, Parys W, de Haard H, Dupuy P, Verheesen P, Joly P. LB773 Treating pemphigus vulgaris (PV) and foliaceus (PF) by inhibiting the neonatal Fc receptor: Phase 2 multicentre open-label trial with efgartigimod. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Kavoussi M, Bhanvadia R, VanDyke M, Baumgarten A, Ortiz N, Khouri R, Ward E, Hudak S, Morey A. 162 Explantation of High Submuscular Reservoirs: Safety and Practical Considerations. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.017] [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: 11/28/2022]
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9
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Wolfe A, Bhanvadia R, Khouri R, Yi Y, Dropkin B, Joice G, Ward E, Hudak S, Morey A. 112 Male Stress Urinary Incontinence is Underreported in One-Third of Cases: A Comparison of Patient History and Physical Exam Findings. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kusin S, Khouri R, Dietrich P, Dropkin B, Joice G, Ward E, Baumgarten A, Kansal J, Guise A, Morey A. 055 Minimally Invasive vs. Degloving Plication for Correction of Congenital Penile Curvature. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Caldwell K, Shakir N, Ward E, Ortiz N, Morey A. 325 Does Urethral Repair Prevent Complications from AUS Cuff Erosions? A Decade of Experience. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rodgers L, Ward E, Mckillop A. ACUTE ADMISSIONS IN OLDER CANCER PATIENTS: THE IMPACT OF INCREASING AGE ON ACUTE ONCOLOGY SERVICES. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stone D, Bogaardt H, Linnstaedt SD, Martin-Harris B, Smith AC, Walton DM, Ward E, Elliott JM. Whiplash-Associated Dysphagia: Considerations of Potential Incidence and Mechanisms. Dysphagia 2019; 35:403-413. [PMID: 31377863 DOI: 10.1007/s00455-019-10039-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/09/2019] [Accepted: 07/20/2019] [Indexed: 12/14/2022]
Abstract
Non-specific self-reports of dysphagia have been described in people with whiplash-associated disorders (WAD) following motor vehicle collision (MVC); however, incidence and mechanistic drivers remain poorly understood. Alterations in oropharyngeal dimensions on magnetic resonance imaging (MRI), along with heightened levels of stress, pain, and changes in stress-dependent microRNA expression (e.g., miR-320a) have been also associated with WAD, suggesting multi-factorial issues may underpin any potential swallowing changes. In this exploratory paper, we examine key biopsychosocial parameters in three patients with persistent WAD reporting swallowing change and three nominating full recovery after whiplash with no reported swallowing change. Parameters included (1) oropharyngeal volume with 3D MRI, (2) peritraumatic miR-320a expression, and (3) psychological distress. These factors were explored to highlight the complexity of patient presentation and propose future considerations in relation to a potential deglutition disorder following WAD. The three participants reporting changes in swallowing all had smaller oropharyngeal volumes at < 1 week and at 3 months post injury and lower levels of peritraumatic miR-320a. At 3 months post MVC, oropharyngeal volumes between groups indicated a large effect size (Hedge's g = 0.96). Higher levels of distress were reported at both time points for those with persistent symptomatology, including self-reported dysphagia, however, this was not featured in those nominating recovery. This paper considers current evidence for dysphagia as a potentially under-recognized feature of WAD and highlights the need for future, larger-scaled, multidimensional investigation into the incidence and mechanisms of whiplash-associated dysphagia.
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Affiliation(s)
- D Stone
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
- Neuromuscular Imaging Research Laboratory, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.
- Speech Pathology Department, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - H Bogaardt
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - S D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A C Smith
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - D M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - E Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Services, Brisbane, QLD, Australia
| | - J M Elliott
- Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
- Neuromuscular Imaging Research Laboratory, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Richardson A, Haridass SA, Ward E, Ayres J, Baskind NE. Investigation and treatment of premature ovarian insufficiency: A multi-disciplinary review of practice. Post Reprod Health 2018; 24:155-162. [PMID: 30392440 DOI: 10.1177/2053369118811233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess compliance with the European Society for Human Reproduction and Embryology (ESHRE) guidelines on the investigation and management of women with premature ovarian insufficiency at the Leeds Teaching Hospitals NHS Trust (LTHT) and to determine whether this varies depending on the clinical setting in which the women present. STUDY DESIGN A retrospective review of all females diagnosed with premature ovarian insufficiency between 1 July 2016 and 30 June 2017, presenting to one of the following clinics: reproductive medicine, specialist menopause, general gynaecology, oncology long-term follow-up, general endocrinology or paediatric endocrinology. MAIN OUTCOME MEASURES Proportion of patients who had the necessary investigations performed and relevant treatment options discussed. RESULTS 103 women were included in the study. Overall, 40.6% had a karyotype. Screening for the Fragile-X pre-mutation, thyroid peroxidase and 21-hydroxylase antibodies occurred in 7.4%, 11.1% and 13.6% of women, respectively. Only 35.9% had their bone mineral density measured. There was significant variation in the performance of a karyotype (p < 0.001) and thyroid peroxidase antibodies (p < 0.01) between the different clinical settings. Overall, lifestyle advice was offered to 30.1%. Estrogen replacement, contraception, fertility options and bone protection were discussed with 76.0%, 38.4%, 59.0% and 75.0%, respectively. Psychological support was offered to 25.2%. There was significant variation for all apart from contraception. CONCLUSION The investigation and treatment of women with premature ovarian insufficiency at the LTHT is not consistent with the ESHRE guidelines and requires improvement. Furthermore, there is significant variation in management depending on the department to which the patient initially presents.
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Affiliation(s)
- A Richardson
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S A Haridass
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Ward
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Ayres
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N E Baskind
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Gretebeck K, Green-Harris G, Ward E, Houston S, Skora T, Brown M, Means J, Gretebeck R. CULTURAL ADAPTATION OF A LIFESTYLE EXERCISE INTERVENTION FOR OLDER AFRICAN AMERICANS: RESEARCH RESULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - E Ward
- University of Wisconsin-Madison
| | - S Houston
- Wisconsin Alzheimer’s Institute, UW School of Medicine and Public Health
| | | | - M Brown
- Wisconsin Women’s Health Foundation
| | - J Means
- Ascension Columbia St. Mary’s
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Ryan C, Ward E, Jones M. Recruitment and retention of trainee physicians: a retrospective analysis of the motivations and influences on career choice of trainee physicians. QJM 2018; 111:313-318. [PMID: 29452409 DOI: 10.1093/qjmed/hcy032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Across the UK, there are vacant physician posts at every level. This increases workload and stress for those who remain, in turn making substantive jobs less attractive. AIM To understand the influences on career choice and retention in training of current trainee physicians. METHODS An online survey, with a combination of closed and free text questions, was developed to assess factors that affected career choices. This was sent to all core and higher specialty trainees in Scotland and Associate or Collegiate members of the Royal College of Physicians Edinburgh not training in Scotland. RESULTS A total of 846 trainees responded, 231 of whom were trainee physicians; 161 (70%) of trainee physicians stated that experience prior to their current role had a very positive impact on career choice, particularly positive role modelling and informal career advice. Core trainees were less likely to report enjoying their job than higher specialty trainees with 31 (50%) found to enjoy their job 'always' or 'most of the time' in comparison to 114 (79%). About 181 (78%) of trainees selected through national recruitment of which 77 (42%) were moderately satisfied and 32 (8%) completely satisfied with the process. Uncertainty of job location and inability to demonstrate professional ability were the main complaints. CONCLUSIONS Career choices are influenced by role models and informal careers advice. Efforts must be made to improve the experience trainees, particularly those in core training. Current physicians, both trainees and consultants, have an important role in recruiting the next generation of trainee physicians-this must be supported.
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Affiliation(s)
- C Ryan
- From the Royal College of Physicians Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ, UK
| | - E Ward
- From the Royal College of Physicians Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ, UK
| | - M Jones
- From the Royal College of Physicians Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ, UK
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Ward E, Gillies J, Armstrong D, Grant L, Elder A, Burton J, Ryan C, Quinn C. Cultivating Compassionate Care: Why Does it Matter and What Can We Do to Promote It? J R Coll Physicians Edinb 2018; 48:71-77. [DOI: 10.4997/jrcpe.2018.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - J Gillies
- Co-Director University of Edinburgh Compassion initiative
| | | | - L Grant
- Global Health Academy Co-Director Global Compassion Initiative
| | - A Elder
- Consultant Physician, NHS Lothian
| | - J Burton
- Geriatric Medicine, University of Edinburgh
| | - C Ryan
- Speciality Registrar Geriatric and General Medicine West of Scotland
| | - C Quinn
- Speciality Registrar Medicine of the Elderly, NHS Lothian
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Buckley R, Reilly CM, Kelly S, Ward E, O'Connor C, Carter S, Gallagher CG, McKone EF. Corrigendum to "WS04.1 The effect of Orkambi® on exercise capacity and muscle strength" [J Cyst Fibros, volume 16, supplement 1, June 2017, pages S6-S7]. J Cyst Fibros 2017; 16:S1569-1993(17)30771-3. [PMID: 28826587 DOI: 10.1016/j.jcf.2017.06.003] [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: 10/19/2022]
Affiliation(s)
- R Buckley
- St. Vincent's University Hospital, Dublin, Ireland.
| | - C M Reilly
- St. Vincent's University Hospital, Dublin, Ireland
| | - S Kelly
- St. Vincent's University Hospital, Dublin, Ireland
| | - E Ward
- St. Vincent's University Hospital, Dublin, Ireland
| | - C O'Connor
- St. Vincent's University Hospital, Dublin, Ireland
| | - S Carter
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - E F McKone
- St. Vincent's University Hospital, Dublin, Ireland
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Kent L, Grant R, Watts G, Morton D, Ward E. The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum hdl subfraction levels – a cohort study. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Buckley R, Reilly C, Kelly S, Ward E, Gallagher C, McKone E. WS04.1 The effect of Orkambi® on exercise capacity and muscle strength. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Ryan C, Ward E, Jones M. The state of medical training: refocusing our narrative. J R Coll Physicians Edinb 2017; 47:5-7. [PMID: 28569274 DOI: 10.4997/jrcpe.2017.102] [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: 11/19/2022] Open
Affiliation(s)
- C Ryan
- C Ryan, Royal College of Physicians of Edinburgh, 9 Queen St, Edinburgh, EH2 1JQ.
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Ward E, Varešlija D, Fagan A, Hill A, Young L. Abstract P3-04-17: Global transcriptional repression by the coactivator SRC-1 mediates disease progression in treatment-resistant breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-04-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite the effectiveness of endocrine therapy in treating estrogen receptor (ER) positive breast cancer, nearly 40% of breast cancer patients may develop resistance which can lead to metastatic disease progression. Steroid receptor co-activator-1 (SRC-1), a key regulator of ER signalling, is overexpressed in 35% of breast cancer patients and is strongly associated with the development of endocrine resistant metastasis(1). Recent studies highlighted the ability of SRC-1 to also act as transcriptional repressor. SRC-1 can therefore bi-directionally regulate gene expression to promote the resistant phenotype (2).
This study employed a genome-wide multi-omics sequencing approach to determine the SRC-1 repression signature in endocrine resistance and elucidate the mechanism by which SRC-1 mediates this repression. RNA-sequencing identified 736 genes significantly downregulated by SRC-1, with common functional pathways such as differentiation, cell morphogenesis and extracellular matrix enriched in the gene set. Parallel global methylation sequencing analysis revealed distinct differentially methylated regions specific to SRC-1 repressed target genes. Mechanistic studies in endocrine resistant cells revealed a role for methylation proteins, DNMTs and MBD, in SRC-1 directed repression. Through combined analysis of our global sequencing data we identified a network hub of five differentiation genes directly repressed by SRC-1. High expression of this signature predicts enhanced recurrence free survival in tamoxifen treated patients (n=335, p=0.032). A reduction in expression of these genes was shown to have functional output on proliferation, migration and mammosphere formation. Finally, we use tumour explant models to show that targeting DNA methylation can be used to reverse the SRC-1 driven suppression of this differentiation hub.
Here we report a novel mechanism by which SRC-1 may be driving endocrine resistant tumorigenesis. Our genome-wide discovery approach revealed a global epigenetic re-programming pathway whereby concerted differential DNA methylation is potentiated by the activation of SRC-1 in the presence of tamoxifen in the endocrine resistant setting. This study suggests that therapeutic strategies of combined targeted epigenetic therapy with estrogen deprivation could be a successful strategy to prevent acquired resistance to endocrine therapy.
Citation Format: Ward E, Varešlija D, Fagan A, Hill A, Young L. Global transcriptional repression by the coactivator SRC-1 mediates disease progression in treatment-resistant breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-04-17.
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Affiliation(s)
- E Ward
- Royal College of Surgeons, Dublin, Ireland; Beaumont Hospital
| | - D Varešlija
- Royal College of Surgeons, Dublin, Ireland; Beaumont Hospital
| | - A Fagan
- Royal College of Surgeons, Dublin, Ireland; Beaumont Hospital
| | - A Hill
- Royal College of Surgeons, Dublin, Ireland; Beaumont Hospital
| | - L Young
- Royal College of Surgeons, Dublin, Ireland; Beaumont Hospital
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Panchal R, Ward E, Marvin V, Newsom-Davis T, Bower M, Bendle M. 110: Drug interactions with systemic anti-cancer therapy in lung cancer patients. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Harris M, Ward E, Gore C. Finding the undiagnosed: a qualitative exploration of hepatitis C diagnosis delay in the United Kingdom. J Viral Hepat 2016; 23:479-86. [PMID: 26924296 DOI: 10.1111/jvh.12513] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/14/2016] [Indexed: 01/31/2023]
Abstract
Hepatitis C virus (HCV)-related morbidity and mortality will continue to rise unless HCV testing and treatment uptake increases. In the European region, an estimated nine million people live with HCV, yet only 10-40% are diagnosed. Over 100 000 undiagnosed people live with HCV in the United Kingdom (UK). For some, a late diagnosis can come too late. The aim of this qualitative study was to explore the context of a diagnosis delay among people living with HCV in the UK. Participants were recruited through two London Hospitals and The Hepatitis C Trust. Eligible participants identified a recent (<3 years) HCV diagnosis and a historical HCV transmission risk period (>15 years). The primary method of data collection was in-depth interviews (12 participants) and focus groups (16 participants). Analysis was informed by grounded theory principles. The sample, 17 men and 11 women, reported an average gap of 28 years between their HCV-risk period and first HCV test. Forty per cent had cirrhosis at HCV diagnosis. Diagnosis delay was attributed to limited HCV relevance, felt wellness, stigma, compartmentalization of former injecting practices, unexplained symptoms and general practitioner inaction. Diagnosis context involved a change of health care providers or a chance medical encounter. Trust in providers was impacted by a delayed diagnosis, with implications for future engagement in care. These data indicate that risk awareness does not necessarily result in action. A multipronged approach is needed to increase HCV case finding in the UK, particularly among 'hidden populations' such as former injectors and transfusion recipients.
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Affiliation(s)
- M Harris
- London School of Hygiene & Tropical Medicine, London, UK
| | - E Ward
- The Hepatitis C Trust, London, UK
| | - C Gore
- The Hepatitis C Trust, London, UK.,The World Hepatitis Alliance, London, UK
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Ward E, Chun M. Neural coding of perceptual features is enhanced when they are task relevant. J Vis 2014. [DOI: 10.1167/14.10.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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O'Connell T, Ward E, Chun M. Temporal consistency of multi-voxel patterns for repeated scenes. J Vis 2014. [DOI: 10.1167/14.10.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Page H, Sarna A, Watts L, Ward E, Hodgson C, McKenzie M. The recovery of semen from bathwater using the Evidence Recovery System (ERS). Sci Justice 2014; 54:89-94. [PMID: 24438783 DOI: 10.1016/j.scijus.2013.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 06/24/2013] [Accepted: 09/09/2013] [Indexed: 11/28/2022]
Abstract
Sexual offences are under-reported and ascertaining accurate offence numbers is difficult. Any methods which could increase the ability to obtain biological evidence or reduce the additional distress associated with reporting a sexual offence may result in an increase in reporting this crime type. The Evidence Recovery System (ERS) is designed to collect trace evidence, including hairs, fibres and biological evidence, from bath or shower water in a non-invasive manner. Initially, samples of semen were placed in baths filled with water, and washing was simulated using a range of body wash products. The water was then drained through the ERS before its filters were subjected to acid phosphatase testing and haematoxylin and eosin staining of spermatozoa. Recovered spermatozoa were then graded accordingly. Following this, the experiment was repeated with the addition of dirt/dust particulates during the washing stage, to simulate recovery of biological evidence in a more realistic environment. The results showed that spermatozoa considered 'easy to find' could regularly be obtained from bathwater using the ERS. It appeared that this recovery was not affected by the presence of different body wash products. When dust/dirt particles were added, the number of spermatozoa recovered increased at two of the evidence collection stages. The difference in recovery was considered to be statistically significant. This study provides evidence to suggest the feasibility of use of the ERS as a method to collect semen evidence from individuals subjected to sexual offences. The recovery of spermatozoa does not appear to be affected by the presence of a body wash, but does appear to be improved when skin cells, hair and other debris are transferred into the water, as would be likely during a bath/shower. Further to this, the possibility of obtaining spermatozoa from the home bath or shower of a victim following a post-offence bathing experience is implied.
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Affiliation(s)
- H Page
- Centre for Forensic Investigation, School of Science and Engineering, Teesside University, Borough Road, Middlesbrough TS1 3BA, UK.
| | - A Sarna
- Centre for Forensic Investigation, School of Science and Engineering, Teesside University, Borough Road, Middlesbrough TS1 3BA, UK.
| | - L Watts
- Centre for Forensic Investigation, School of Science and Engineering, Teesside University, Borough Road, Middlesbrough TS1 3BA, UK.
| | - E Ward
- Centre for Forensic Investigation, School of Science and Engineering, Teesside University, Borough Road, Middlesbrough TS1 3BA, UK.
| | - C Hodgson
- Centre for Forensic Investigation, School of Science and Engineering, Teesside University, Borough Road, Middlesbrough TS1 3BA, UK.
| | - M McKenzie
- Centre for Forensic Investigation, School of Science and Engineering, Teesside University, Borough Road, Middlesbrough TS1 3BA, UK.
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Ward E, Scholl B. Making the switch: Transient unconscious cues can disambiguate bistable images. J Vis 2013. [DOI: 10.1167/13.9.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Riley F, Ward E, Highton L, Shenjere P, Mowatt D. 127. Cutaneous sarcomatoid carcinoma – A tertiary cancer centre case series and review of the literature. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Veeratterapillay R, Veeratterapillay S, Ward E, Khout H, Fasih T. Adenoid cystic carcinoma of the breast: case report and review of literature. Ann R Coll Surg Engl 2012; 94:e137-8. [PMID: 22613278 PMCID: PMC5827221 DOI: 10.1308/003588412x13171221499829] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2011] [Indexed: 11/22/2022] Open
Abstract
We report the case of a patient who presented with a painful breast lump that turned out to be an adenoid cystic carcinoma of the breast. The literature is reviewed, highlighting the good prognosis associated with this rare condition and the current preferred treatment modalities.
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Ligocki A, Rounds W, Li M, Courtney A, Frohman E, Greenberg B, Stowe A, Ward E, Monson N. Antigen reactivity of B cells from patients at risk to develop Multiple Sclerosis demonstrates a specific somatic mutation pattern. (159.28). The Journal of Immunology 2012. [DOI: 10.4049/jimmunol.188.supp.159.28] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Multiple Sclerosis (MS) is the leading disease of the central nervous system and a significant, costly cause of disability in young adults. Patients at risk for MS often present with a single demyelinating event, typically called a “clinically isolated syndrome” (CIS). A CIS can occur in the brain, spinal cord (Acute Partial Transverse Myelitis, APTM), or optic nerve (Optic Neuritis, ON). Our laboratory discovered a unique pattern of antibody gene mutation accumulation (i.e. antibody gene signature, or “AGS”) that is exclusive to B cells from the cerebrospinal fluid (CSF) and brain lesions of MS patients and CIS patients that develop MS in the future. Our goal for this study was to determine whether CIS and MS patient B cells that carry this pattern of somatic hypermutation accumulation in their antibody genes react to brain tissue. Thirty-four antibody genes of B cells isolated from the CSF of MS and CIS patients carrying this AGS pattern were cloned into antibody expression vectors to generate recombinant full-length human antibodies (rhAbs). Preliminary DAB staining using a subgroup of these rhAbs on cryo-sectioned mouse brain demonstrates binding to CNS tissue. Cortical staining of varied intensities was found among the rhAbs tested. Patterns of staining and details of antigen reactivity will be presented. This result provides promise in continuing to identify the auto-antigens that are recognized by the AGS B cells shared among patients at risk to convert to MS.
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Affiliation(s)
- Ann Ligocki
- 1Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - William Rounds
- 1Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Min Li
- 1Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ardith Courtney
- 1Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Elliot Frohman
- 1Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ann Stowe
- 1Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - E. Ward
- 2Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nancy Monson
- 1Neurology, University of Texas Southwestern Medical Center, Dallas, TX
- 3Immunology, University of Texas Southwestern Medical Center, Dallas, TX
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Coyne PE, Kenny L, Barnes E, Westley R, Ward E, Jain M, Iwuchukwu O. Isolated metastatic primary peritoneal carcinoma to the breast: a rare site of disease recurrence. Ann R Coll Surg Engl 2012; 94:e57-9. [PMID: 22391350 DOI: 10.1308/003588412x13171221502068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Primary breast carcinoma is a common pathology in the UK. It can present with metastatic deposits but it is rare that lesions in the breast are the sole primary or secondary presentation for metastatic cancer from other sources. We present a case of a primary peritoneal cancer recurring after optimal treatment with a new breast lesion and the diagnostic difficulties that this can cause.
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Affiliation(s)
- P E Coyne
- City Hospitals Sunderland NHS Foundation Trust, Tyne and Wear, UK.
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Smith K, Straker L, Kerr D, Davis M, Fielding A, Ward E, McManus A. The beginnings of CAFAP—A family centred, multi-disciplinary program for overweight and obese adolescents, and their families. Obes Res Clin Pract 2011. [DOI: 10.1016/j.orcp.2011.08.098] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Burns K, Heslin J, Crowley B, Thornton L, Laoi BN, Kelly E, Ward E, Doody B, Hickey MM. Nosocomial outbreak of hepatitis B virus infection involving two hospitals in the Republic of Ireland. J Hosp Infect 2011; 78:279-83. [PMID: 21530000 DOI: 10.1016/j.jhin.2011.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 02/25/2011] [Indexed: 11/25/2022]
Abstract
The routes of nosocomial hepatitis B virus (HBV) transmission have changed over the years. Initiatives to prevent transfusion-associated HBV and healthcare worker-to-patient transmission have had a positive impact on these transmission routes. Recent reports of outbreaks of nosocomial HBV have implicated breaches in standard precautions as important causes of HBV transmission. This report describes a nosocomial outbreak of HBV infection in the Republic of Ireland, which occurred between January 2005 and March 2006. The outbreak was detected following identification of a case of acute HBV infection in a patient whose only risk factor was a recent surgical procedure. The extensive multi-agency investigation that followed revealed that the patient was one of five cases of acute HBV infection and that four separate transmission events between infectious cases had occurred in two different hospitals over a 15-month period. A definitive cause for each transmission event was not identified, although lapses in adherence to standard precautions, safe injection and phlebotomy practices could not be ruled out. Two secondary cases of acute HBV infection in community contacts of two of the nosocomial cases were identified. Phylogenetic analysis proved a useful tool in confirming infection with a pre-core HBV mutant and viral transmission between the seven patients. A patient notification exercise involving 1028 potentially exposed patients found no evidence of additional cases of nosocomial HBV infection. These findings highlight the importance of consistent application of standard precautions.
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Affiliation(s)
- K Burns
- Department of Clinical Microbiology, Waterford Regional Hospital, Waterford, Ireland.
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Ward E, Beard D, Mills J. Thomas John Phillips. West J Med 2011. [DOI: 10.1136/bmj.d1404] [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: 11/04/2022]
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Ward E, Coleman A, van As-Brooks C, Kerle S. Rehabilitation of olfaction post-laryngectomy: a randomised control trial comparing clinician assisted versus a home practice approach. Clin Otolaryngol 2010; 35:39-45. [PMID: 20447161 DOI: 10.1111/j.1749-4486.2009.02050.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine (i) the prevalence of impaired olfaction in a group of individuals post-laryngectomy, and (ii) whether intensive, clinician-supported training of the Nasal Airflow Inducing Manoeuvre (NAIM) was more effective at improving olfactory acuity than intensive, home practice over a 6-week period. DESIGNS Cohort study followed by a randomised control trial of two treatments over a 6-week period with a 3-month review. PARTICIPANTS Olfactory acuity was evaluated in 43 laryngectomy patients. Results revealed 95% had impaired olfactory acuity (anosmic or hyposmic). From this group 40 eligible participants with reduced olfactory acuity were then randomly assigned into either the clinician-supported or home practice treatment group. MAIN OUTCOME MEASURES Olfactory acuity and functional impact measures relating to olfactory acuity (participation restriction, wellbeing/distress). RESULTS Although olfactory acuity significantly improved in both treatment groups following 6 weeks of therapy, results indicated significantly greater improvement in the clinician-assisted group immediately post-treatment. By 3 months, post-treatment effects were maintained. Both modes of treatment improved levels of patient wellbeing, however, only the clinician-assisted mode made a significant positive effect on levels of perceived participation restriction. CONCLUSION Reduced olfactory acuity is prevalent post-laryngectomy. Olfactory acuity can be significantly improved using either 6 weeks of clinician-assisted or home practice using the NAIM manoeuvre, although the current data suggest that intensive clinician-assisted treatment can assist patients to improve more rapidly and have a positive impact on functional state.
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Affiliation(s)
- E Ward
- Division of Speech Pathology, The University of Queensland, St Lucia, Qld, Australia.
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Métraux JP, Signer H, Ryals J, Ward E, Wyss-Benz M, Gaudin J, Raschdorf K, Schmid E, Blum W, Inverardi B. Increase in salicylic Acid at the onset of systemic acquired resistance in cucumber. Science 2010; 250:1004-6. [PMID: 17746926 DOI: 10.1126/science.250.4983.1004] [Citation(s) in RCA: 426] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In an effort to identify the signal compound that mediates systemic acquired resistance (SAR), changes in the content of phloem sap were monitored in cucumber plants inoculated with either tobacco necrosis virus or the fungal pathogen Colletotrichum lagenarium. The concentration of a fluorescent metabolite was observed to increase transiently after inoculation, with a peak reached before SAR was detected. The compound was purified and identified by gas chromatography-mass spectrometry as salicylic acid, a known exogenous inducer of resistance. The data suggest that salicylic acid could function as the endogenous signal in the transmission of SAR in cucumber.
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Delaney TP, Uknes S, Vernooij B, Friedrich L, Weymann K, Negrotto D, Gaffney T, Gut-Rella M, Kessmann H, Ward E, Ryals J. A central role of salicylic Acid in plant disease resistance. Science 2010; 266:1247-50. [PMID: 17810266 DOI: 10.1126/science.266.5188.1247] [Citation(s) in RCA: 874] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Transgenic tobacco and Arabidopsis thaliana expressing the bacterial enzyme salicylate hydroxylase cannot accumulate salicylic acid (SA). This defect not only makes the plants unable to induce systemic acquired resistance, but also leads to increased susceptibility to viral, fungal, and bacterial pathogens. The enhanced susceptibility extends even to host-pathogen combinations that would normally result in genetic resistance. Therefore, SA accumulation is essential for expression of multiple modes of plant disease resistance.
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Gaffney T, Friedrich L, Vernooij B, Negrotto D, Nye G, Uknes S, Ward E, Kessmann H, Ryals J. Requirement of salicylic Acid for the induction of systemic acquired resistance. Science 2010; 261:754-6. [PMID: 17757215 DOI: 10.1126/science.261.5122.754] [Citation(s) in RCA: 853] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
It has been proposed that salicylic acid acts as an endogenous signal responsible for inducing systemic acquired resistance in plants. The contribution of salicylic acid to systemic acquired resistance was investigated in transgenic tobacco plants harboring a bacterial gene encoding salicylate hydroxylase, which converts salicylic acid to catechol. Transgenic plants that express salicylate hydroxylase accumulated little or no salicylic acid and were defective in their ability to induce acquired resistance against tobacco mosaic virus. Thus, salicylic acid is essential for the development of systemic acquired resistance in tobacco.
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Browning DM, Comeau M, Kishimoto S, Varrin P, Ward E, Rider A, Meyer EC. Parents as practitioners in pediatrics. Med Teach 2010; 32:620. [PMID: 20684060] [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: 05/29/2023]
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Ward E, McCartney T, Arscott-Mills S, Gordon N, Grant A, McDonald AH, Ashley DE. The Jamaica Injury Surveillance System: a profile of the intentional and unintentional injuries in Jamaican hospitals. W INDIAN MED J 2010; 59:7-13. [PMID: 20931906] [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: 05/30/2023]
Abstract
BACKGROUND Injuries in Jamaica are a major public health problem as demonstrated by a hospital based computerized injury surveillance system established in 1999 that provides a risk profile for injuries. SUBJECTS AND METHOD Injury data from 2004 were selected to provide an annual profile, as comprehensive injury data were available from nine public hospitals. These nine public hospitals provide care for 70% of the Jamaicans admitted to hospitals annually. RESULTS Data are presented on unintentional injuries where falls caused 44%, lacerations 27% and accidental blunt injuries were 17% of these. For motor vehicle related injuries, 55% were sustained while commuting by motorcars, 17% while riding motorbikes/bicycles and 16% of those injured were pedestrians. Most violence related injuries were due to fights (76%) with acquaintances (47%) who used sharp objects (40%) to inflict the injury. CONCLUSION The Jamaica Injury Surveillance System (JISS) data, augmented by data collected on injuries from the health centres and the sentinel surveillance system, give a measure of the magnitude of the impact of injuries on the health services. The JISS provides data on the profile of injuries seen and treated at health facilities in Jamaica. In collaboration with police data and community-based surveys, it can be used to complete the risk profiles for different types of injuries. The data generated at the parish, regional and national levels form the basis for the design and monitoring of prevention programmes, as well as serve to support and evaluate policy, legislative control measures and measures that impact on interventions.
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Affiliation(s)
- E Ward
- Ministry of Health, Kingston, Jamaica.
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Ward E, McCartney T, Brown DW, Grant A, Butchart A, Taylor M, Bhoorasingh P, Wong H, Morris C, Deans-Clarke AM, East J, Valentine C, Dundas S, Pinnock C. Results of an exercise to estimate the costs of interpersonal violence in Jamaica. W INDIAN MED J 2009; 58:446-451. [PMID: 20441064] [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: 05/29/2023]
Abstract
UNLABELLED This report describes the application of a draft version of the World Health Organization (WHO)/ United States Centers for Disease Control and Prevention (CDC) Manual for estimating the economic costs of injuries due to interpersonal and self-directed violence to measure costs of injuries from interpersonal violence. METHODS Fatal incidence data was obtained from the Jamaica Constabulary Force. The incidence of nonfatal violence-related injuries that required hospitalization was estimated using data obtained from patients treated at and/or admitted to three Type A government hospitals in 2006. RESULTS During 2006, direct medical cost (J$2.1 billion) of injuries due to interpersonal violence accounted for about 12% of Jamaica's total health budget while productivity losses due to violence-related injuries accounted for approximately J$27.5 billion or 160% of Jamaica's total health expenditure and 4% of Jamaica's Gross Domestic Product. CONCLUSIONS The availability of accurate and reliable data of the highest quality from health-related information systems is critical for providing useful data on the burden of violence and injury to decision-makers. As Ministries of Health take a leading role in violence and injury prevention, data collection and information systems must have a central role. This study describes the results of one approach to examining the economic burden of interpersonal violence in developing countries where the burden of violence is heaviest. The WHO-CDC manual also tested in Thailand and Brazil is a first step towards generating a reference point for resource allocation, priority setting and prevention advocacy.
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Affiliation(s)
- E Ward
- Violence Prevention Alliance, Jamaica, The University of the West Indies, Kingston 7, Jamaica, West Indies.
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McNeill G, Ward E, Halpenny D, Snow A, Torreggiani W. Ultrasound appearances of Implanon implanted contraceptive devices. JBR-BTR 2009; 92:259-260. [PMID: 19999332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Subdermal contraceptive devices represent a popular choice of contraception. Whilst often removed without the use of imaging, circumstances exist where imaging is required. Ultrasound is the modality of choice. The optimal technique and typical sonographic appearances are detailed in this article.
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Affiliation(s)
- G McNeill
- Department of Radiology, AMNCH Tallaght, Dublin 24, Ireland
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Shah S, Silva J, Ward E, Rumoro D. 175: Emergency Department Inpatient Bed Management Inventory System. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ward E, Killeen R, Doody O, Torreggiani W. Re: Imaging appearances and endovascular management of uncommon pseudoaneurysms. Clin Radiol 2009; 64:742-3. [DOI: 10.1016/j.crad.2009.02.010] [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] [Received: 01/20/2009] [Accepted: 02/13/2009] [Indexed: 11/26/2022]
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Ward E, Browne R, Torreggiani WC. The decline of hysterectomy for benign disease. Ir Med J 2009; 102:236. [PMID: 19772014] [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: 05/28/2023]
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