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Ball A, Mansfield A, Taylor B, Sheerin F, Wickins J, Akhtar Z, Bhangu A, Karandikar S. COVID-19 opens the door for right iliac fossa pain treatment pathway. Ann R Coll Surg Engl 2021; 104:302-307. [PMID: 34882012 DOI: 10.1308/rcsann.2021.0213] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has increased the risks of surgery and management of common surgical conditions has changed, with greater reliance on imaging and conservative management. The negative appendectomy rate (NAR) in the UK has previously remained high. The aim of this study was to quantify pandemic-related changes in the management of patients with suspected appendicitis, including the NAR. METHODS A retrospective study was performed at a single high volume centre of consecutive patients aged over five years presenting to general surgery with right iliac fossa pain in two study periods: for two months before lockdown and for four months after lockdown. Pregnant patients and those with previous appendectomy, including right colonic resection, were excluded. Demographic, clinical, imaging and histological data were captured, and risk scores were calculated, stratifying patients into higher and lower risk groups. Data were analysed by age, sex and risk subgroups. RESULTS The mean number of daily referrals with right iliac fossa pain or suspected appendicitis reduced significantly between the study periods, from 2.92 before lockdown to 2.07 after lockdown (p<0.001). Preoperative computed tomography (CT) rates increased significantly from 22.9% to 37.2% (p=0.002). The NAR did not change significantly between study periods (25.5% prior to lockdown, 11.1% following lockdown, p=0.159). Twelve (75%) out of sixteen negative appendectomies were observed in higher risk patients aged 16-45 years who did not undergo preoperative CT. The NAR in patients undergoing CT was 0%. CONCLUSIONS Greater use of preoperative CT should be considered in risk stratified patients in order to reduce the NAR.
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Affiliation(s)
- A Ball
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A Mansfield
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - B Taylor
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - F Sheerin
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - J Wickins
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - Z Akhtar
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A Bhangu
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - S Karandikar
- University Hospitals Birmingham NHS Foundation Trust, UK
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Bond L, Carroll R, Mulryan N, O'Dwyer M, O'Connell J, Monaghan R, Sheerin F, McCallion P, McCarron M. Biopsychosocial factors associated with depression and anxiety in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. J Intellect Disabil Res 2020; 64:368-380. [PMID: 32215976 DOI: 10.1111/jir.12724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/11/2020] [Accepted: 03/04/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Depression and anxiety are amongst the most prevalent mental health disorders in the older population with intellectual disability (ID). There is a paucity of research that pertains to associative biopsychosocial factors for depression and anxiety in this population. The aim of this study is to determine the biopsychosocial factors associated with depression and anxiety in a population of older adults with ID in Ireland. METHODS The study was part of 'The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing'. Depressive symptoms were assessed using the Glasgow Depression Scale for people with a Learning Disability. Anxiety symptoms were measured using the Glasgow Anxiety Scale for people with a Learning Disability. The cross-sectional associations of depression and anxiety with biopsychosocial parameters were measured using a variety of self-report and proxy-completed questionnaires. RESULTS For the study population, 9.97% met the criteria for depression, and 15.12% met the criteria for an anxiety disorder. Participants meeting criteria for depression were more likely to be taking regular mood stabiliser medications and to exhibit aggressive challenging behaviour. Participants meeting criteria for anxiety were more likely to have sleep difficulties and report loneliness. Participants meeting criteria for either/both depression and anxiety were more likely to report loneliness. CONCLUSIONS This study identified both treatable and modifiable, as well as unmodifiable, biopsychosocial factors associated with depression and/or anxiety in older adults with ID. A longitudinal study follow-up will further develop our knowledge on the causality and direction of associated biopsychosocial factors with depression and anxiety in older adults with ID and better inform management strategies, prevention policies and funding of services.
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Affiliation(s)
- L Bond
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, Daughters of Charity Disability Support Services, Dublin, Ireland
| | - R Carroll
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - N Mulryan
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, Daughters of Charity Disability Support Services, Dublin, Ireland
| | - M O'Dwyer
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - J O'Connell
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - R Monaghan
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - F Sheerin
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Temple School of Social Work, Temple University, Philadelphia, PA, US
| | - M McCarron
- The Trinity Centre for Ageing and Intellectual Disability (TCAID), The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Msayib Y, Harston GWJ, Sheerin F, Blockley NP, Okell TW, Jezzard P, Kennedy J, Chappell MA. Partial volume correction for quantitative CEST imaging of acute ischemic stroke. Magn Reson Med 2019; 82:1920-1928. [PMID: 31199009 PMCID: PMC6771886 DOI: 10.1002/mrm.27872] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 11/12/2022]
Abstract
Purpose Contributions of cerebrospinal fluid (CSF) have not been previously taken into account in the quantification of APT CEST effects, and correction for the dilution of CEST effects by CSF may allow for more robust measurement of CEST signals. The objective of this study was to compare the robustness of a partial volume (PV) correction model against a standard (4‐pool) multi‐pool model as far as their ability to quantify CEST effects in healthy, normal, and pathological tissue. Methods MRI data from 12 patients presenting with ischemic stroke, and 6 healthy subjects, were retrospectively analyzed. CEST signals derived from a 4‐pool model and a PV correction model were compared for repeatability and pathological tissue contrast. The effect of PV correction (PVC) was assessed within 3 ranges of tissue PV estimate (PVE): high PVE voxels, low PVE voxels, and the whole slice. Results In voxels with a high tissue PVE, PV correction did not make a significant difference to absolute APTR*. In low PVE voxels, the PVC model exhibited a significantly decreased ischemic core signal. The PVC measures exhibited higher repeatability between healthy subjects (4 pools: 3.4%, PVC: 2.4%) while maintaining a similar ischemic core CNR (0.7) to the 4‐pool model. In whole slice analysis it was found that both models exhibited similar results. Conclusions PV correction yielded a measure of APT effects that was more repeatable than standard 4‐pool analysis while achieving a similar CNR in pathological tissue, suggesting that PV‐corrected analysis was more robust at low values of tissue PVE.
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Affiliation(s)
- Y Msayib
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - G W J Harston
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - F Sheerin
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - N P Blockley
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - T W Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - P Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - J Kennedy
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - M A Chappell
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Bond L, Carroll R, Mulryan N, O'Dwyer M, O'Connell J, Monaghan R, Sheerin F, McCallion P, McCarron M. The association of life events and mental ill health in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. J Intellect Disabil Res 2019; 63:454-465. [PMID: 30697858 DOI: 10.1111/jir.12595] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Exposures to life events are associated with emotional, psychological and behavioural problems in those with intellectual disability (ID). Older adults with ID may experience different life events given differences in living circumstances, cognitive decline, greater dependency on others and less autonomy. This study examines the relationship of life events and mental ill health in an older ID population in Ireland. METHODS The study was part of 'The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing'. The frequency of life events was assessed using a 20-item checklist, and the level of stress experienced was assessed using a three-point Likert scale measuring the burden of the life event. The associations of life events with factors associated with mental ill health were measured using a variety of self-report and proxy completed questionnaires. RESULTS For the study population, 88.1% had been exposed to at least one life event in the preceding 12 months and 64.5% to two or more life events. Frequency and burden of life events were significantly higher in individuals living in institutional settings and in individuals with any current psychiatric condition, increased depressive and anxiety symptoms, challenging behaviour and reported poorer self-rated mental and physical health. More life events were significantly associated with new psychiatric diagnoses as well as initiation and increased dosage of mood stabilising, hypnotic and sedative medications. CONCLUSIONS Life events are significantly associated with mental ill health in the older ID population. Service providers must focus on limiting the exposure to these events and, in situations where they cannot be avoided, should support and manage individuals compassionately and effectively, prioritising their mental and physical well-being.
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Affiliation(s)
- L Bond
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Daughters of Charity Disability Support Services, Dublin, Ireland
| | - R Carroll
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - N Mulryan
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Daughters of Charity Disability Support Services, Dublin, Ireland
| | - M O'Dwyer
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - J O'Connell
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - R Monaghan
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - F Sheerin
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Temple School of Social Work, Temple University, Philadelphia, PA, USA
| | - M McCarron
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Msayib Y, Harston GWJ, Tee YK, Sheerin F, Blockley NP, Okell TW, Jezzard P, Kennedy J, Chappell MA. Quantitative CEST imaging of amide proton transfer in acute ischaemic stroke. Neuroimage Clin 2019; 23:101833. [PMID: 31063943 PMCID: PMC6503165 DOI: 10.1016/j.nicl.2019.101833] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Amide proton transfer (APT) imaging may help identify the ischaemic penumbra in stroke patients, the classical definition of which is a region of tissue around the ischaemic core that is hypoperfused and metabolically stressed. Given the potential of APT imaging to complement existing imaging techniques to provide clinically-relevant information, there is a need to develop analysis techniques that deliver a robust and repeatable APT metric. The challenge to accurate quantification of an APT metric has been the heterogeneous in-vivo environment of human tissue, which exhibits several confounding magnetisation transfer effects including spectrally-asymmetric nuclear Overhauser effects (NOEs). The recent literature has introduced various model-free and model-based approaches to analysis that seek to overcome these limitations. OBJECTIVES The objective of this work was to compare quantification techniques for CEST imaging that specifically separate APT and NOE effects for application in the clinical setting. Towards this end a methodological comparison of different CEST quantification techniques was undertaken in healthy subjects, and around clinical endpoints in a cohort of acute stroke patients. METHODS MRI data from 12 patients presenting with ischaemic stroke were retrospectively analysed. Six APT quantification techniques, comprising model-based and model-free techniques, were compared for repeatability and ability for APT to distinguish pathological tissue in acute stroke. RESULTS Robustness analysis of six quantification techniques indicated that the multi-pool model-based technique had the smallest contrast between grey and white matter (2%), whereas model-free techniques exhibited the highest contrast (>30%). Model-based techniques also exhibited the lowest spatial variability, of which 4-pool APTR∗ was by far the most uniform (10% coefficient of variation, CoV), followed by 3-pool analysis (20%). Four-pool analysis yielded the highest ischaemic core contrast-to-noise ratio (0.74). Four-pool modelling of APT effects was more repeatable (3.2% CoV) than 3-pool modelling (4.6% CoV), but this appears to come at the cost of reduced contrast between infarct growth tissue and normal tissue. CONCLUSION The multi-pool measures performed best across the analyses of repeatability, spatial variability, contrast-to-noise ratio, and grey matter-white matter contrast, and might therefore be more suitable for use in clinical imaging of acute stroke. Addition of a fourth pool that separates NOEs and semisolid effects appeared to be more biophysically accurate and provided better separation of the APT signal compared to the 3-pool equivalent, but this improvement appeared be accompanied by reduced contrast between infarct growth tissue and normal tissue.
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Affiliation(s)
- Y Msayib
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
| | - G W J Harston
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Y K Tee
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Malaysia
| | - F Sheerin
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - N P Blockley
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - T W Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - P Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - J Kennedy
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - M A Chappell
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK; Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
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Harston GWJ, Rane N, Shaya G, Thandeswaran S, Cellerini M, Sheerin F, Kennedy J. Imaging biomarkers in acute ischemic stroke trials: a systematic review. AJNR Am J Neuroradiol 2015; 36:839-43. [PMID: 25634718 DOI: 10.3174/ajnr.a4208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/24/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Imaging biomarkers are increasingly used to provide a better understanding of the pathophysiology of acute ischemic stroke. However, this approach of routinely using imaging biomarkers to inform treatment decisions has yet to be translated into successful randomized trials. The aim of this study was to systematically review the use of imaging biomarkers in randomized controlled trials in patients with acute ischemic stroke, exploring the purposes for which the imaging biomarkers were used. MATERIALS AND METHODS We performed a systematic review of imaging biomarkers used in randomized controlled trials of acute ischemic stroke, in which a therapeutic intervention was trialed within 48 hours of symptom onset. Data bases searched included MEDLINE, EMBASE, strokecenter.org, and the Virtual International Stroke Trials Archive (1995-2014). RESULTS Eighty-four studies met the criteria, of which 49 used imaging to select patients; 31, for subgroup analysis; and 49, as an outcome measure. Imaging biomarkers were broadly used for 8 purposes. There was marked heterogeneity in the definitions and uses of imaging biomarkers and significant publication bias among post hoc analyses. CONCLUSIONS Imaging biomarkers offer the opportunity to refine the trial cohort by minimizing participant variation, to decrease sample size, and to personalize treatment approaches for those who stand to benefit most. However, within imaging modalities, there has been little consistency between stroke trials. Greater effort to prospectively use consistent imaging biomarkers should help improve the development of novel treatment strategies in acute stroke and improve comparison between studies.
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Affiliation(s)
- G W J Harston
- From the Radcliffe Department of Medicine (G.W.J.H., G.S., S.T., J.K.), University of Oxford, Oxford, United Kingdom
| | - N Rane
- Department of Neuroradiology (N.R., M.C., F.S.), Oxford University Hospitals NHS Trust, Oxford, United Kingdom Neurointervention Service (N.R.), Royal Melbourne Hospital, Melbourne Health, Victoria, Australia
| | - G Shaya
- From the Radcliffe Department of Medicine (G.W.J.H., G.S., S.T., J.K.), University of Oxford, Oxford, United Kingdom
| | - S Thandeswaran
- From the Radcliffe Department of Medicine (G.W.J.H., G.S., S.T., J.K.), University of Oxford, Oxford, United Kingdom
| | - M Cellerini
- Department of Neuroradiology (N.R., M.C., F.S.), Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - F Sheerin
- Department of Neuroradiology (N.R., M.C., F.S.), Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - J Kennedy
- From the Radcliffe Department of Medicine (G.W.J.H., G.S., S.T., J.K.), University of Oxford, Oxford, United Kingdom
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Tee YK, Harston GWJ, Blockley N, Okell TW, Levman J, Sheerin F, Cellerini M, Jezzard P, Kennedy J, Payne SJ, Chappell MA. Comparing different analysis methods for quantifying the MRI amide proton transfer (APT) effect in hyperacute stroke patients. NMR Biomed 2014; 27:1019-29. [PMID: 24913989 PMCID: PMC4737232 DOI: 10.1002/nbm.3147] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 05/08/2023]
Abstract
Amide proton transfer (APT) imaging is a pH mapping method based on the chemical exchange saturation transfer phenomenon that has potential for penumbra identification following stroke. The majority of the literature thus far has focused on generating pH-weighted contrast using magnetization transfer ratio asymmetry analysis instead of quantitative pH mapping. In this study, the widely used asymmetry analysis and a model-based analysis were both assessed on APT data collected from healthy subjects (n = 2) and hyperacute stroke patients (n = 6, median imaging time after onset = 2 hours 59 minutes). It was found that the model-based approach was able to quantify the APT effect with the lowest variation in grey and white matter (≤ 13.8 %) and the smallest average contrast between these two tissue types (3.48 %) in the healthy volunteers. The model-based approach also performed quantitatively better than the other measures in the hyperacute stroke patient APT data, where the quantified APT effect in the infarct core was consistently lower than in the contralateral normal appearing tissue for all the patients recruited, with the group average of the quantified APT effect being 1.5 ± 0.3 % (infarct core) and 1.9 ± 0.4 % (contralateral). Based on the fitted parameters from the model-based analysis and a previously published pH and amide proton exchange rate relationship, quantitative pH maps for hyperacute stroke patients were generated, for the first time, using APT imaging.
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Affiliation(s)
- Y. K. Tee
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
- Centre for Doctoral Training in Healthcare InnovationUniversity of OxfordOxfordUK
| | | | - N. Blockley
- Oxford Centre of Functional MRI of the Brain, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Thomas W. Okell
- Oxford Centre of Functional MRI of the Brain, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - J. Levman
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
| | - F. Sheerin
- Department of NeuroradiologyOxford University Hospitals NHS TrustOxfordUK
| | - M. Cellerini
- Department of NeuroradiologyOxford University Hospitals NHS TrustOxfordUK
| | - P. Jezzard
- Oxford Centre of Functional MRI of the Brain, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - J. Kennedy
- Acute Stroke ProgrammeRadcliffe Department of MedicineOxfordUK
| | - S. J. Payne
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
| | - M. A. Chappell
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
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Chandra J, Sheerin F, Lopez de Heredia L, Meagher T, King D, Belci M, Hughes RJ. MRI in acute and subacute post-traumatic spinal cord injury: pictorial review. Spinal Cord 2011; 50:2-7. [PMID: 22064660 DOI: 10.1038/sc.2011.107] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Pictorial review. OBJECTIVES To illustrate MRI signs of acute and subacute injury with emphasis on evidence-based links to clinical outcome and implications for treatment. METHODS Description of important aspects of MRI techniques and illustration of critical MRI signs important in the assessment of spinal cord injury following trauma, in the acute and subacute stages. CONCLUSIONS Familiarity with cord MRI appearances has an important impact on planning the management of the acutely spinal cord injured patient and also identifying complications in the subacute phase particularly in the presence of neurological deterioration.
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Affiliation(s)
- J Chandra
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
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Balan A, Hoey ETD, Sheerin F, Lakkaraju A, Chowdhury FU. Multi-technique imaging of sarcoidosis. Clin Radiol 2010; 65:750-60. [PMID: 20696303 DOI: 10.1016/j.crad.2010.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 03/16/2010] [Accepted: 03/22/2010] [Indexed: 01/12/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology. The diagnosis is suggested on the basis of wide ranging clinical and radiological manifestations, and is supported by the histological demonstration of non-caseating granulomas in affected tissues. This review highlights the multisystem radiological features of the disease across a variety of imaging methods including multidetector computed tomography (CT), magnetic resonance imaging (MRI) as well as functional radionuclide techniques, particularly 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT). It is important for the radiologist to be aware of the varied radiological manifestations of sarcoidosis in order to recognize and suggest the diagnosis in the appropriate clinical setting.
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Affiliation(s)
- A Balan
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Chowdhury F, Sheerin F, Bradley K, Gleeson F. Re: Sarcoid-like reaction to malignancy on whole-body integrated (18)F-FDG PET/CT: prevalence and disease pattern—a reply. Clin Radiol 2010. [DOI: 10.1016/j.crad.2009.09.007] [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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Chowdhury F, Sheerin F, Bradley K, Gleeson F. Sarcoid-like reaction to malignancy on whole-body integrated 18F-FDG PET/CT: prevalence and disease pattern. Clin Radiol 2009; 64:675-81. [DOI: 10.1016/j.crad.2009.03.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Revised: 03/16/2009] [Accepted: 03/20/2009] [Indexed: 10/20/2022]
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Sheerin F, Collison K, Quaghebeur G. Magnetic resonance imaging of acute intramedullary myelopathy: radiological differential diagnosis for the on-call radiologist. Clin Radiol 2009; 64:84-94. [DOI: 10.1016/j.crad.2008.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 06/30/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
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Sheerin F, Pretorius P, Briley D, Meagher T. Differential diagnosis of restricted diffusion confined to the cerebral cortex. Clin Radiol 2008; 63:1245-53. [DOI: 10.1016/j.crad.2007.12.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 12/09/2007] [Accepted: 12/20/2007] [Indexed: 02/03/2023]
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Abstract
Unlike many other countries, Ireland does not have a pathway to facilitate rapid transfer to its national spinal injuries unit. This retrospective study investigated the effect of this on the incidence of pressure ulceration in new admissions to the unit.
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Affiliation(s)
- F Sheerin
- School of Nursing and Midwifery, University College Dublin, Ireland.
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Abstract
Parenting by learning disabled persons is a highly emotive issue, eliciting arguments from both extremes. Many of the arguments against such parenting have their basis in eugenic theory, whereas those in favour, often cite human rights declarations, and philosophies such as 'normalization'. This review of the literature describes the chronological development of theory on the subject, spanning 1900 to the present day. It has become clear that, whereas parents with learning difficulties may be more predisposed to having problems, they can indeed perform as adequate parents, given appropriate training and support. This paper traces the development of current theory, through an in-depth discussion of the available literature.
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Affiliation(s)
- F Sheerin
- Stewart's Hospital, Palmerstown, Dublin, Ireland
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Sheerin F. Stoma care management in the 1990s. Ir Med J 1997; 90:91-2. [PMID: 9183085] [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: 02/04/2023]
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