1
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Safford B, Api AM, Barratt C, Comiskey D, Daly EJ, Ellis G, McNamara C, O'Mahony C, Robison S, Smith B, Thomas R, Tozer S. Corrigendum to "Use of an aggregate exposure model to estimate consumer exposure to fragrance ingredients in personal care and cosmetic products" [Regul. Toxicol. Pharmacol. 72 3 (2015) 673-68]. Regul Toxicol Pharmacol 2024; 147:105545. [PMID: 38177031 DOI: 10.1016/j.yrtph.2023.105545] [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: 01/06/2024]
Affiliation(s)
- B Safford
- B-Safe Toxicology Consulting, 31 Hayway, Rushden, Northants, NN10 6AG, United Kingdom
| | - A M Api
- Research Institute for Fragrance Materials, 50 Tice Boulevard, Woodcliff Lake, NJ, 07677, United States.
| | - C Barratt
- Unilever, Safety and Environmental Assurance Centre, Colworth Park, Sharnbrook, Beds, MK44 1LQ, United Kingdom
| | - D Comiskey
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - E J Daly
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - G Ellis
- Givaudan International S.A., 5 chemin de la parfumerie, CH1214, Vernier, Switzerland
| | - C McNamara
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland.
| | - C O'Mahony
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - S Robison
- The Procter and Gamble Company, Mason Business Center, 8700 Mason Montgomery Rd, Mason, OH, 45040, United States
| | - B Smith
- Firmenich Inc., P.O. Box 5880, Princeton, NJ, 08543, United States
| | - R Thomas
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - S Tozer
- Procter&Gamble, Surrey, TW20 9NW, United Kingdom
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2
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Wong S, Sehgal R, Birks T, Allen D, Goyal A, Kucheria R, Ajayi L, Ellis G. 1191 The Use of CT Urography to Diagnose Upper Tract Urothelial Carcinomas (UTUC); Managing Surgical Resources During The COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Upper tract urothelial carcinomas (UTUC) account for 5-10% of urothelial malignancies. Rapid diagnosis is essential as 60% are invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines recommend CT urography (CTU) for initial diagnosis and staging of UTUCs. Diagnostic ureteroscopy (URS) is used second line where diagnosis is unclear. The COVID-19 pandemic has limited theatre access and may delay diagnosis of suspected UTUC. Our aim was to evaluate specific CTU findings in predicting UTUC to aid prompt diagnosis and risk stratification in a tertiary centre.
Method
A retrospective analysis was performed on 122 patients who underwent CTU with diagnostic URS over two years from 2018-2019 for possible UTUC. Data including demographics, imaging and histology were collected from our electronic database.
Results
57 patients had confirmed UTUC, all had CT changes. CTU had an overall positive predictive value (PPV) of 45%. CT findings were divided into: hydronephrosis; filling defect/lesion; urothelial thickening; normal; or other. The PPV was highest for filling defects/lesions at 60%, hydronephrosis was 38%, urothelial thickening was 30%, and other was 33%. Of those with high-grade histology, 61% had evidence of filling defects/lesions and 24% had hydronephrosis.
Conclusions
A specific CTU finding of filling defect/lesion in combination with cytology can aid diagnosis and risk stratification of UTUC. This may enable us to reduce use of diagnostic URS, as well as associated risks of intravesical seeding, necessary in the COVID-19 pandemic. With other CTU findings of hydronephrosis or urothelial thickening, a diagnostic URS may be required.
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Affiliation(s)
- S Wong
- Royal Free Hospital, London, United Kingdom
| | - R Sehgal
- Royal Free Hospital, London, United Kingdom
| | - T Birks
- Royal Free Hospital, London, United Kingdom
| | - D Allen
- Royal Free Hospital, London, United Kingdom
| | - A Goyal
- Royal Free Hospital, London, United Kingdom
| | - R Kucheria
- Royal Free Hospital, London, United Kingdom
| | - L Ajayi
- Royal Free Hospital, London, United Kingdom
| | - G Ellis
- Royal Free Hospital, London, United Kingdom
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Sehgal R, Wong S, Abu-Ghanem Y, Birks T, Kucheria R, Allen D, Goyal A, Singh P, Ajayi L, Ellis G. What part does ureteroscopy play in the diagnostic pathway of upper tract urothelial carcinoma? A two-year review in a high volume institution. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01175-1] [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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4
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Da Silva E, Hickey C, Ellis G, Hougaard K, Sørli J. In vitro prediction of clinical signs of respiratory toxicity in rats following inhalation exposure. Curr Res Toxicol 2021; 2:204-209. [PMID: 34345862 PMCID: PMC8320621 DOI: 10.1016/j.crtox.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022] Open
Abstract
To date there are no OECD validated alternative approaches to study toxicity following inhalation exposure to airborne chemicals. The available OECD test guidelines for acute inhalation toxicity aim to estimate a value of the lethal air concentration of the test chemical leading to the death of 50% of the exposed animals (LC50), to satisfy hazard classification and labelling requirements. This paper explores the view that alternative approaches must compare to outcomes of existing guideline methods to become accepted and implemented in a regulatory context. This case study describes the initiatives taken to validate the lung surfactant bioassay, an in vitro cell-free method, and discusses the challenges faced. While the lung surfactant bioassay could not predict the GHS classification for acute inhalation toxicity of 26 chemicals, the assay successfully predicted the clinical signs of respiratory toxicity observed during or shortly after exposure in vivo as reported in registration dossiers. The lung surfactant bioassay is a promising alternative approach to assess the potential of chemicals to cause changes to respiration remaining after exposure (indicating decreased lung function), and can be combined with other test methods in an integrated approach to testing and assessment of inhaled substances.
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Affiliation(s)
- E. Da Silva
- Technical University of Denmark, Kgs. Lyngby, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - C. Hickey
- Firmenich Incorporated, United States
| | | | - K.S. Hougaard
- National Research Centre for the Working Environment, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - J.B. Sørli
- National Research Centre for the Working Environment, Copenhagen, Denmark
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5
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Mayer LS, Orlowski RJ, Giles J, Benci JL, Ellis G, Deng G, Attanasio J, Chen Z, Bengsch B, Kahn O, Manne S, Herati RS, Ngiow S, George SM, Faustman DL, Gilliland G, Mick R, Xu W, McGettigan S, Xu X, Amaravadi RK, Karakousis GC, Schuchter LM, Mitchell TC, Riley JL, Huang AC, Minn A, Tomov V, Wherry EJ. Targeting TNFR2 to overcome acquired adaptive resistance to immune checkpoint blockade. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.165.42] [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
Overcoming acquired adaptive immune resistance to anti-PD-1 therapy is imperative for enhancing the efficacy of immune checkpoint blockade (ICB) in solid tumors. Regulatory T cells (Tregs) play a prominent role in the suppressive tumor microenvironment (TME) and are major contributors to adaptive immune resistance. Tregs limit CD8+ T cell reinvigoration and are a promising target for combination therapy. While the clinical efficacy of anti-CTLA4 may be partially explained by restriction of Tregs, its co-administration with anti-PD1 causes significant toxicity. Thus, safer approaches to limit Treg activity are needed. To elucidate the dynamic changes in immuno-regulatory circuits within the TME during ICB, we performed deep immune profiling of peripheral blood and tumors from patients with advanced melanoma prior to (n=7) and after 1 cycle of anti-PD-1 therapy with pembrolizumab (n=9). Tregs were abundant in the TME and retained their immunosuppressive phenotype and functionality following anti-PD-1. Epigenetic, transcriptomic, and proteomic analysis of Tregs after ICB identified tumor necrosis factor receptor 2 (TNFR2) signaling as a possible driver of CD8+ T cell suppression. TNFR2 was preferentially expressed by Tregs in the TME (mean 18.03 %, SD +/− 10.13 %) relative to CD8+ T cells (mean 0.64 %, SD +/− 0.82 %) and peripheral Tregs (mean 3.16 %, SD +/− 3.21 %), suggesting it might be a safe and effective target for combination therapy. Indeed, dual blockade of TNFR2 and PD-1 led to potent CD8+ T cell expansion in two mouse tumor models, and restored sensitivity to ICB in a resistant murine model of melanoma. Our data suggest that anti-TNFR2 might synergize with current ICB by countering the development of adaptive immune resistance.
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Affiliation(s)
- Lena Sophie Mayer
- 1Univ. of Pennsylvania Perelman Sch. of Med
- 2Univ. of Freiburg, Fac. of Med., Germany
| | - Robert J. Orlowski
- 1Univ. of Pennsylvania Perelman Sch. of Med
- 3Merck & Co
- 4Univ. of Pennsylvania
| | - Josephine Giles
- 1Univ. of Pennsylvania Perelman Sch. of Med
- 4Univ. of Pennsylvania
| | - Joseph L. Benci
- 1Univ. of Pennsylvania Perelman Sch. of Med
- 4Univ. of Pennsylvania
- 5Bristol-Myers-Squibb
| | | | | | | | - Zeyu Chen
- 1Univ. of Pennsylvania Perelman Sch. of Med
| | - Bertram Bengsch
- 1Univ. of Pennsylvania Perelman Sch. of Med
- 2Univ. of Freiburg, Fac. of Med., Germany
- 4Univ. of Pennsylvania
| | - Omar Kahn
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
- 7Parker Institute for Cancer Immunotherapy at University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
| | - Sasikanth Manne
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
| | - Ramin S. Herati
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
- 7Parker Institute for Cancer Immunotherapy at University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
| | - Shin Ngiow
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
- 7Parker Institute for Cancer Immunotherapy at University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
| | - Sangeeth M. George
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
| | - Denise L. Faustman
- 9Immunobiology Laboratories, Massachusetts General Hospital and Harvard Medical School
| | - Gary Gilliland
- 10Fred Hutchinson Cancer Research Center, University of Washington
| | - Rosemarie Mick
- 11Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Wei Xu
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
- 13Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Suzanne McGettigan
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
| | - Xiaowei Xu
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
- 14Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Ravi K. Amaravadi
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
- 13Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Giorgos C. Karakousis
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
- 15Department of Surgery, Perelman School of Medicine, University of Pennsylvania
| | - Lynn M. Schuchter
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
- 13Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Tara C. Mitchell
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
- 13Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - James L. Riley
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
| | - Alexander C. Huang
- 7Parker Institute for Cancer Immunotherapy at University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
- 12Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania
- 13Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Andy Minn
- 7Parker Institute for Cancer Immunotherapy at University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
- 16Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| | - Vesselin Tomov
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
- 13Department of Medicine, Perelman School of Medicine, University of Pennsylvania
- 17Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania
| | - E. John Wherry
- 6Department of Microbiology, Perelman School of Medicine, University of Pennsylvania
- 7Parker Institute for Cancer Immunotherapy at University of Pennsylvania
- 8Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
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6
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Yu H, Bettini M, Ellis G, Riley JL, Collins J, Preston-Hurlburt P, Korah M, Mallone R, Deng S, Wang X, Fremont DH, Spiegel D, Cresswell P, Herold KC. Use of CART cells to selectively target autoantigen-specific T cells for the treatment of autoimmune diabetes. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.238.8] [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
Previous clinical trials using biologics-based broad-spectrum T cell- and B cell-depleting molecules for the treatment of autoimmune diabetes have shown promising, yet mixed, results. Their varied extent of success may be due to their non-specific action and failure to permanently and completely remove the pathogenic subpopulations. As CD8+ T cells, the most dominant cell type in human insulitis, are thought to be the primary mediator of β-cells damage, we thus designed a strategy by adapting chimeric antigen receptor engineered T (CART) technology to directly target these pathogenic T cells.
The newly generated CAR construct maintains original transmembrane and intracellular components, while the extracellular scFv antigen-binding domain was replaced with HLA-A2/β2-microglobulin (B2M) complex that is linked with either diabetes-associated immunodominant peptide zinc transporter 8(ZnT8)186–194 or negative control peptide HIV Gag77–85. We have shown that HLA-A2/B2M complexes were correctly folded and presenting right peptide epitopes on CART cells. The CAR signaling was also sustained, as the expression levels of CD25 and CD69 were significantly elevated only on CAR-transduced Jurkat cells presenting ZnT8186–194 peptide co-cultured with a T-cell line that expresses TCRs recognizing the same peptide. To determine the killing ability of CART cells, we further engineered primary human T cells to express our CAR construct and demonstrated that CART cells can selectively deplete human antigen-specific CD8+ T cells in vitro. Therefore, our results have provided proof-of-principle for the development of a novel immunotherapy for disease treatment.
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Affiliation(s)
- Hua Yu
- 1Department of Immunobiology, Yale University School of Medicine
| | | | - Gavin Ellis
- 3Perelman School of Medicine, University of Pennsylvania
| | - James L Riley
- 3Perelman School of Medicine, University of Pennsylvania
| | - Jesse Collins
- 1Department of Immunobiology, Yale University School of Medicine
| | | | - Maria Korah
- 1Department of Immunobiology, Yale University School of Medicine
| | | | - Songyan Deng
- 1Department of Immunobiology, Yale University School of Medicine
| | - Xiaoli Wang
- 5Department of Pathology and Immunology, Washington University School of Medicine, St Louis
| | - Daved H. Fremont
- 5Department of Pathology and Immunology, Washington University School of Medicine, St Louis
| | | | - Peter Cresswell
- 1Department of Immunobiology, Yale University School of Medicine
| | - Kevan C Herold
- 1Department of Immunobiology, Yale University School of Medicine
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7
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Sehgal R, Birks T, Pindoria N, Grant L, Ajayi L, Ellis G. Computed tomography urography (CTU) findings as a predictor of the presence and grade of upper tract urothelial cancer (UTUC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Sehgal R, Birks T, Pindoria N, Kucheria R, Allen D, Goyal A, Singh P, Ajayi L, Ellis G. The vital role of diagnostic ureteroscopy in the diagnosis of upper tract urothelial carcinoma: Review of a high-volume centre over a 12-month period. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30090-2] [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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9
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Word A, Broadway P, Liang Y, Newcomb H, Burdick Sanchez N, Capik S, Littlejohn B, Holland B, Ellis G, Fuselier J, Hutcheson J, Ballou M, Carroll J. PSVIII-19 Acute metabolic responses to a combined viral-bacterial respiratory disease challenge in heifers administered transdermal flunixin meglumine. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.065] [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: 11/14/2022] Open
Affiliation(s)
- A Word
- Texas Tech University,Canyon, TX, United States
| | | | - Y Liang
- Texas Tech University,Canyon, TX, United States
| | - H Newcomb
- Merck Animal Health,Amarillo, TX, United States
| | | | - S Capik
- Texas A&M AgriLife Research and Department of Veterinary Pathobiology at Texas A&M College of Veterinary Medicine,College Station, TX, United States
| | - B Littlejohn
- Texas A&M Universtiy,College Station, TX, United States
| | - B Holland
- Cactus Research,Canyon, TX, United States
| | - G Ellis
- Merck Animal Health,Amarillo, TX, United States
| | - J Fuselier
- Merck Animal Health,Amarillo, TX, United States
| | - J Hutcheson
- Merck Animal Health,Amarillo, TX, United States
| | - M Ballou
- Texas Tech University,Canyon, TX, United States
| | - J Carroll
- USDA-ARS, Livestock Issues Research Unit,Lubbock, TX, Lubbock, TX, United States
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10
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Word A, Broadway P, Liang Y, Newcomb H, Burdick Sanchez N, Capik S, Littlejohn B, Holland B, Ellis G, Fuselier J, Hutcheson J, Ballou M, Carroll J. 242 Transdermal flunixin meglumine minimally alters neutrophil functionality in beef heifers administered a respiratory disease challenge. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.055] [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: 11/15/2022] Open
Affiliation(s)
- A Word
- Texas Tech University,Canyon, TX, United States
| | | | - Y Liang
- Texas Tech University,Lubbock, TX, United States
| | - H Newcomb
- Merck Animal Health,Amarillo, TX, United States
| | | | - S Capik
- Texas A&M AgriLife Research and Department of Veterinary Pathobiology at Texas A&M College of Veterinary Medicine,College Station, TX, United States
| | - B Littlejohn
- Texas A&M Universtiy,College Station, TX, United States
| | - B Holland
- Cactus Research,Canyon, TX, United States
| | - G Ellis
- Merck Animal Health,Amarillo, TX, United States
| | - J Fuselier
- Merck Animal Health,Amarillo, TX, United States
| | - J Hutcheson
- Merck Animal Health,Amarillo, TX, United States
| | - M Ballou
- Texas Tech University,Lubbock, TX, United States
| | - J Carroll
- USDA-ARS, Livestock Issues Research Unit,Lubbock, TX, Lubbock, TX, United States
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11
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Natsch A, Emter R, Haupt T, Ellis G. Deriving a no expected sensitization induction level for fragrance ingredients without animal testing: Specific case studies assessed with different approaches. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.061] [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: 10/28/2022]
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12
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Taylor-Rowan M, Quinn T, Smith P, Ellis G, Keir R, McAlpine C, Marsh G, Murtagh J, McElroy M, Mitchell L, Waddell G, Williams A, Duffy L, Oswald S, Myles A, Bann A, Rodger K, Reid J, Kellichan L, Docharty D, Marshall T, McGurn B, Ritchie C, Wells A, Talbot A, McInnes C, Reynish E, Coleman D, Flynn B, Scott A, Coull A, Dingwall L. 53ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE HIS “THINK FRAILTY” TOOL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T Quinn
- New Lister Building, Glasgow Royal Infirmary
| | - P Smith
- New Lister Building, Glasgow Royal Infirmary
| | - G Ellis
- New Lister Building, Glasgow Royal Infirmary
| | - R Keir
- New Lister Building, Glasgow Royal Infirmary
| | - C McAlpine
- New Lister Building, Glasgow Royal Infirmary
| | - G Marsh
- New Lister Building, Glasgow Royal Infirmary
| | - J Murtagh
- New Lister Building, Glasgow Royal Infirmary
| | - M McElroy
- New Lister Building, Glasgow Royal Infirmary
| | - L Mitchell
- New Lister Building, Glasgow Royal Infirmary
| | - G Waddell
- New Lister Building, Glasgow Royal Infirmary
| | - A Williams
- New Lister Building, Glasgow Royal Infirmary
| | - L Duffy
- New Lister Building, Glasgow Royal Infirmary
| | - S Oswald
- New Lister Building, Glasgow Royal Infirmary
| | - A Myles
- New Lister Building, Glasgow Royal Infirmary
| | - A Bann
- New Lister Building, Glasgow Royal Infirmary
| | - K Rodger
- New Lister Building, Glasgow Royal Infirmary
| | - J Reid
- New Lister Building, Glasgow Royal Infirmary
| | - L Kellichan
- New Lister Building, Glasgow Royal Infirmary
| | - D Docharty
- New Lister Building, Glasgow Royal Infirmary
| | - T Marshall
- New Lister Building, Glasgow Royal Infirmary
| | - B McGurn
- New Lister Building, Glasgow Royal Infirmary
| | - C Ritchie
- New Lister Building, Glasgow Royal Infirmary
| | - A Wells
- New Lister Building, Glasgow Royal Infirmary
| | - A Talbot
- New Lister Building, Glasgow Royal Infirmary
| | - C McInnes
- New Lister Building, Glasgow Royal Infirmary
| | - E Reynish
- New Lister Building, Glasgow Royal Infirmary
| | - D Coleman
- New Lister Building, Glasgow Royal Infirmary
| | - B Flynn
- New Lister Building, Glasgow Royal Infirmary
| | - A Scott
- New Lister Building, Glasgow Royal Infirmary
| | - A Coull
- New Lister Building, Glasgow Royal Infirmary
| | - L Dingwall
- New Lister Building, Glasgow Royal Infirmary
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13
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Szakmany T, Pugh R, Kopczynska M, Lundin RM, Sharif B, Morgan P, Ellis G, Abreu J, Kulikouskaya S, Bashir K, Galloway L, Al-Hassan H, Grother T, McNulty P, Seal ST, Cains A, Vreugdenhil M, Abdimalik M, Dennehey N, Evans G, Whitaker J, Beasant E, Hall C, Lazarou M, Vanderpump CV, Harding K, Duffy L, Guerrier Sadler A, Keeling R, Banks C, Ng SWY, Heng SY, Thomas D, Puw EW, Otahal I, Battle C, Minik O, Lyons RA, Hall JE. Defining sepsis on the wards: results of a multi-centre point-prevalence study comparing two sepsis definitions. Anaesthesia 2017; 73:195-204. [DOI: 10.1111/anae.14062] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- T. Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
- Anaesthetic Directorate; Aneurin Bevan University Health Board; Royal Gwent Hospital; Newport Gwent UK
| | - R. Pugh
- Anaesthetic Department; Glan Clywdd Hospital; Betsi Cadwaladar University Health Board; Bodelwyddan Rhyl UK
| | - M. Kopczynska
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - R. M. Lundin
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - B. Sharif
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - P. Morgan
- Critical Care Directorate; University Hospital of Wales; Cardiff and Vale University Health Board; Cardiff UK
| | - G. Ellis
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
- Critical Care Directorate; University Hospital of Wales; Cardiff and Vale University Health Board; Cardiff UK
| | - J. Abreu
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. Kulikouskaya
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - K. Bashir
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - L. Galloway
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - H. Al-Hassan
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - T. Grother
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - P. McNulty
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. T. Seal
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - A. Cains
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - M. Vreugdenhil
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - M. Abdimalik
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - N. Dennehey
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - G. Evans
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - J. Whitaker
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - E. Beasant
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - C. Hall
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - M. Lazarou
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - C. V. Vanderpump
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - K. Harding
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - L. Duffy
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - A. Guerrier Sadler
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - R. Keeling
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - C. Banks
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. W. Y. Ng
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. Y. Heng
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - D. Thomas
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - E. W. Puw
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - I. Otahal
- Anaesthetic Department; Glangwili General Hospital; Hywel Dda University Health Board; Carmarthen UK
| | - C. Battle
- Critical Care Directorate; Morriston Hospital; Abertawe Bro Morgannwg University Health Board; Heol Maes Eglwys; Swansea UK
| | - O. Minik
- ACT Directorate; Royal Glamorgan Hospital; Cwm Taf University Health Board; Ynysmaerdy Llantrisant UK
| | - R. A. Lyons
- Farr Institute; Data Science Building; Swansea University Medical School; Swansea UK
| | - J. E. Hall
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
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Abstract
The British Thoracic Society audit of non-invasive ventilation has shown that mortality rates are higher than expected and increasing. The National Confidential Enquiry into Patient Outcome and Death undertook a detailed analysis of data from 432 patients treated with acute non-invasive ventilation to identify how clinical aspects of non-invasive ventilation treatment could be improved. The study 'Inspiring Change' was published in July 2017. This review summarizes some of the important findings and associated recommendations that will improve treatment of patients and help to reduce mortality rates.
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Affiliation(s)
- M C Juniper
- Clinical Co-ordinator, National Confidential Enquiry into Patient Outcome and Death, London
| | - G Ellis
- Clinical Co-ordinator, National Confidential Enquiry into Patient Outcome and Death, London
| | - K L Protopapa
- Researcher, National Confidential Enquiry into Patient Outcome and Death, London
| | - Nce Smith
- Deputy Chief Executive, National Confidential Enquiry into Patient Outcome and Death, London EC1M 4DZ
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Yousef I, Ribó L, Crisol A, Šics I, Ellis G, Ducic T, Kreuzer M, Benseny-Cases N, Quispe M, Dumas P, Lefrançois S, Moreno T, García G, Ferrer S, Nicolas J, Aranda M. MIRAS: The Infrared Synchrotron Radiation Beamline at ALBA. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/08940886.2017.1338410] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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)
| | - L. Ribó
- ALBA Synchrotron, Barcelona, Spain
| | | | - I. Šics
- ALBA Synchrotron, Barcelona, Spain
| | - G. Ellis
- CSIC, Institute of Polymer Science & Technology, Madrid, Spain
| | - T. Ducic
- ALBA Synchrotron, Barcelona, Spain
| | | | | | | | - P. Dumas
- Synchrotron SOLEIL, Gif-sur-Yvette, France
| | | | - T. Moreno
- Synchrotron SOLEIL, Gif-sur-Yvette, France
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16
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Comiskey D, Api A, Barrett C, Ellis G, McNamara C, O'Mahony C, Robison S, Rose J, Safford B, Smith B, Tozer S. Integrating habits and practices data for soaps, cosmetics and air care products into an existing aggregate exposure model. Regul Toxicol Pharmacol 2017; 88:144-156. [DOI: 10.1016/j.yrtph.2017.05.017] [Citation(s) in RCA: 1034] [Impact Index Per Article: 147.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/08/2017] [Accepted: 05/23/2017] [Indexed: 12/11/2022]
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17
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Safford B, Api A, Barratt C, Comiskey D, Ellis G, McNamara C, O'Mahony C, Robison S, Rose J, Smith B, Tozer S. Application of the expanded Creme RIFM consumer exposure model to fragrance ingredients in cosmetic, personal care and air care products. Regul Toxicol Pharmacol 2017; 86:148-156. [DOI: 10.1016/j.yrtph.2017.02.021] [Citation(s) in RCA: 1014] [Impact Index Per Article: 144.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
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18
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Cho E, Wu Q, Rubinstein L, Linden H, Gralow J, Specht J, Gadi V, Ellis G. Abstract P5-14-10: Weekly doxorubicin and daily oral cyclophosphamide followed by nab-paclitaxel for adjuvant therapy of high-risk localized breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-14-10] [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
BACKGROUND: The addition of taxanes to anthracycline-based adjuvant chemotherapy has improved disease free survival (DFS) in women with high-risk early-stage breast cancer. Many studies have sought to optimize the dose intensity and density of these agents to produce improvements in outcome and tolerability. The purpose of this study was to assess the use of metronomic doxorubicin plus daily oral cyclophosphamide (AC) for 12 weeks followed by nab-paclitaxel (nP) for 12 weeks in this population. Those patients with Her2 positive disease were also given adjuvant trastuzumab.
METHODS: A non-randomized phase II clinical trial was designed to (1) test the DFS at 2 years compared to historical controls, (2) assess dose intensity delivered, (3) assess use of nP in the adjuvant setting, and (4) evaluate toxicities associated with the regimen. Overall survival (OS) was a secondary outcome. The dosing of A was 24mg/m2 IV qweek and C was 60mg/m2 oral daily; nP, 100mg/m2 IV qweek.
RESULTS: Sixty patients were enrolled on the study with a median follow-up of 6 years and a median age of 50 (range 30-69). 58% of patients had node positive disease. Receptor categories included hormone receptor positive (ER positive or PR positive) and HER2 negative (n=24; 40%); ER negative, PR negative, and HER2 negative (triple negative; n=19; 32%); or HER2 positive (n=17; 28%). DFS at 2 years was 93% (1 death, 3 recurrence) and at 6 years was 82%, comparable to historical controls. OS at 2 years and 6 years was 98% and 88%, respectively. Mean dose intensity was greater than 90% for AC and 88% for nP. Treatment was well-tolerated with the most common grade ≥3 toxicity being neutropenia and a 2% incidence of febrile neutropenia.
Disease-free survival and overall survival at 2 and 6 years 2 year 6 year DFS %OS %DFS %OS %All patients93988288ER+ or PR+, HER2-921007979Triple negative89957989HER2+10010088100
CONCLUSSIONS: Patients achieved similar DFS to that seen in historical controls with similar rates of adverse events. Since nP dosing was 100 mg/m2, even with 88% dose intensity, the delivered taxane dose is greater than standard weekly paclitaxel. Notably disease control was particularly impressive in the triple negative subtype, which has been shown to benefit from nP over standard paclitaxel in the neoadjuvant setting in the GeparSepto (GBG 69) trial. Metronomic AC followed by nP is a safe, effective option for delivery of adjuvant chemotherapy for high-risk patients.
Citation Format: Cho E, Wu Q, Rubinstein L, Linden H, Gralow J, Specht J, Gadi V, Ellis G. Weekly doxorubicin and daily oral cyclophosphamide followed by nab-paclitaxel for adjuvant therapy of high-risk localized 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 P5-14-10.
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Affiliation(s)
- E Cho
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Q Wu
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - L Rubinstein
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - H Linden
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - J Gralow
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - J Specht
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - V Gadi
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - G Ellis
- Palo Alto Medical Foundation, Sunnyvale, CA; Seattle Cancer Care Alliance, Seattle, WA; University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
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Affiliation(s)
- G. Ellis
- Dept. Chemical Pathology, Royal Hospital, Sheffield
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20
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Affiliation(s)
- D. M. Goldberg
- Department of Clinical Pathology, Royal Hospital. Sheffield S1 3SR
| | - G. Ellis
- Department of Clinical Pathology, Royal Hospital. Sheffield S1 3SR
| | - A. R. Wilcock
- Department of Clinical Pathology, Royal Hospital. Sheffield S1 3SR
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Abstract
INTRODUCTION The super-elderly population is a small but expanding group of patients who will pose a significant challenge to future healthcare resources. A snapshot audit was completed of all emergency and elective urological nonagenarian activity in a UK general hospital, including surgical outcomes in this group of patients. METHODS Prospective and retrospective databases and clinical records were examined to identify all patients aged 90-99 years who had patient episodes between January 2006 and August 2012. Patient outcomes were compared with those for a similar cohort of 80-89-year-olds during the same time period. RESULTS A total of 653 nonagenarian patient episodes were identified (including 138 emergency admissions, 25 emergency surgical procedures, 71 elective surgical procedures, 173 local anaesthetic procedures and 270 outpatient visits). The in-hospital mortality rate for emergency admissions was 10%. The mean length of hospital stay was significantly longer for nonagenarians than for octogenarians (14.4 vs 6.5 days, p<0.00001). The postoperative mortality rate following emergency and elective surgery was 16% and 1% for nonagenarians and octogenarians respectively. CONCLUSIONS Nonagenarian patients often have complex medical co-morbidities and challenging social circumstances that contribute to delayed recovery from acute illness and surgery as well as long periods of hospitalisation. Adopting a multidisciplinary approach with formal input from specialist geriatric surgical services may improve patient outcomes and allow patients to be discharged to their former places of residence.
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Safford B, Api AM, Barratt C, Comiskey D, Daly EJ, Ellis G, McNamara C, O'Mahony C, Robison S, Smith B, Thomas R, Tozer S. Use of an aggregate exposure model to estimate consumer exposure to fragrance ingredients in personal care and cosmetic products. Regul Toxicol Pharmacol 2015; 72:673-82. [PMID: 26071898 DOI: 10.1016/j.yrtph.2015.05.017] [Citation(s) in RCA: 1399] [Impact Index Per Article: 155.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/07/2015] [Accepted: 05/13/2015] [Indexed: 11/26/2022]
Abstract
Ensuring the toxicological safety of fragrance ingredients used in personal care and cosmetic products is essential in product development and design, as well as in the regulatory compliance of the products. This requires an accurate estimation of consumer exposure which, in turn, requires an understanding of consumer habits and use of products. Where ingredients are used in multiple product types, it is important to take account of aggregate exposure in consumers using these products. This publication investigates the use of a newly developed probabilistic model, the Creme RIFM model, to estimate aggregate exposure to fragrance ingredients using the example of 2-phenylethanol (PEA). The output shown demonstrates the utility of the model in determining systemic and dermal exposure to fragrances from individual products, and aggregate exposure. The model provides valuable information not only for risk assessment, but also for risk management. It should be noted that data on the concentrations of PEA in products used in this article were obtained from limited sources and not the standard, industry wide surveys typically employed by the fragrance industry and are thus presented here to illustrate the output and utility of the newly developed model. They should not be considered an accurate representation of actual exposure to PEA.
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Affiliation(s)
- B Safford
- B-Safe Toxicology Consulting, 31 Hayway, Rushden, Northants NN10 6AG, United Kingdom
| | - A M Api
- Research Institute for Fragrance Materials, 50 Tice Boulevard, Woodcliff Lake, NJ 07677, United States.
| | - C Barratt
- Unilever, Safety and Environmental Assurance Centre, Colworth Park, Sharnbrook, Beds MK44 1LQ, United Kingdom
| | - D Comiskey
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - E J Daly
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - G Ellis
- Givaudan International S.A., 5 chemin de la parfumerie, CH1214 Vernier, Switzerland
| | - C McNamara
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - C O'Mahony
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - S Robison
- The Procter and Gamble Company, Mason Business Center, 8700 Mason Montgomery Rd, Mason, OH 45040, United States
| | - B Smith
- Firmenich Inc., P.O. Box 5880, Princeton, NJ 08543, United States
| | - R Thomas
- Creme Global Ltd, The Tower, Trinity Enterprise Centre, Grand Canal Quay, Dublin 2, Ireland
| | - S Tozer
- Procter&Gamble, Surrey TW20 9NW, United Kingdom
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23
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Szakmany T, Ellis G, Lundin RM, Pignatelli I, Sharif B, Joshi S, Donoghue D, Morgan P, Hall JE. Sepsis in Wales on the general wards: results of a feasibility pilot. Br J Anaesth 2015; 114:1000-1. [PMID: 25991742 DOI: 10.1093/bja/aev133] [Citation(s) in RCA: 6] [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: 11/13/2022] Open
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24
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Ellis G, Pridgeon S, Lamb BW, Awsare NS, Osaghae S, Smith SG, McNicholas TA, Green JSA. Psychological distress in out-patients undergoing flexible cystoscopy for the investigation of bladder cancer. Journal of Clinical Urology 2014. [DOI: 10.1177/2051415814551821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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
Objectives: Flexible cystoscopy can cause patients significant psychological distress, especially when utilised in the diagnostic pathway for suspected bladder cancer. We aimed to assess the prevalence of general anxiety and depression, as well as procedure-related worry and pain in patients undergoing local anaesthetic flexible cystoscopy and to determine whether these conditions occur more frequently in subsets of the population. Patients and methods: Patients referred for flexible cystoscopy were invited to participate. Patients were asked to complete a questionnaire containing the Hospital Anxiety and Depression Scale (HADS), a worry score and a question regarding the most stressful event in the diagnostic pathway. Following the procedure patients were also asked to complete a pain score. Results: A total of 175 patients participated in the study. The prevalence of significant anxiety was 15% and depression 3.5%. This was higher in younger, female and unmarried patients. Procedure-related worry and pain were generally low. Conclusions: We found the prevalence of anxiety and depression in patients undergoing flexible cystoscopy to be raised compared to a similar cohort of patients undergoing TRUS-guided prostate biopsy. We have identified subgroups more likely to experience these symptoms and have also identified the sections of the diagnostic pathway that are most likely to cause anxiety and depression. By doing this we can target those patients who are more likely to suffer during the diagnostic process and aim to improve their experience. We can also implement targeted changes to the pathway to reduce the impact it may have on patients’ mental health.
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Affiliation(s)
- G Ellis
- Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, UK
| | - S Pridgeon
- Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, UK
| | - BW Lamb
- Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, UK
| | - NS Awsare
- Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, UK
| | - S Osaghae
- Department of Urology, East and North Herts NHS Trust, UK
| | - SG Smith
- Department of Psychology, University College London, UK
| | - TA McNicholas
- Department of Urology, East and North Herts NHS Trust, UK
| | - JSA Green
- Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, UK
- Department of Health and Social Care, London South Bank University, UK
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Yue HB, Fernandez-Blazquez JP, Shuttleworth PS, Cui YD, Ellis G. Thermomechanical relaxation and different water states in cottonseed protein derived bioplastics. RSC Adv 2014. [DOI: 10.1039/c4ra01794c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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26
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Patlewicz G, Kuseva C, Mehmed A, Popova Y, Dimitrova G, Ellis G, Hunziker R, Kern P, Low L, Ringeissen S, Roberts DW, Mekenyan O. TIMES-SS--recent refinements resulting from an industrial skin sensitisation consortium. SAR QSAR Environ Res 2014; 25:367-391. [PMID: 24785905 DOI: 10.1080/1062936x.2014.900520] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The TImes MEtabolism Simulator platform for predicting Skin Sensitisation (TIMES-SS) is a hybrid expert system, first developed at Bourgas University using funding and data from a consortium of industry and regulators. TIMES-SS encodes structure-toxicity and structure-skin metabolism relationships through a number of transformations, some of which are underpinned by mechanistic 3D QSARs. The model estimates semi-quantitative skin sensitisation potency classes and has been developed with the aim of minimising animal testing, and also to be scientifically valid in accordance with the OECD principles for (Q)SAR validation. In 2007 an external validation exercise was undertaken to fully address these principles. In 2010, a new industry consortium was established to coordinate research efforts in three specific areas: refinement of abiotic reactions in the skin (namely autoxidation) in the skin, refinement of the manner in which chemical reactivity was captured in terms of structure-toxicity rules (inclusion of alert reliability parameters) and defining the domain based on the underlying experimental data (study of discrepancies between local lymph node assay Local Lymph Node Assay (LLNA) and Guinea Pig Maximisation Test (GPMT)). The present paper summarises the progress of these activities and explains how the insights derived have been translated into refinements, resulting in increased confidence and transparency in the robustness of the TIMES-SS predictions.
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Affiliation(s)
- G Patlewicz
- a DuPont Haskell Global Centers for Health and Environmental Sciences , Newark DE , USA
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27
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Hill E, Whitehead M, MacInnes B, Ellis G, Talbot A, Brodie F, Hughes N, Beggs S, Barber M. The first 100 thrombolysis cases in a novel Scottish mesh telestroke system. Scott Med J 2013; 58:213-6. [DOI: 10.1177/0036933013507868] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke thrombolysis has been a major driver for change within stroke services. However, until recently its widespread application has been limited to tertiary centres. Transfer to tertiary care can lead to significant delays in thrombolysis. We developed a novel mesh telestroke network, which allows stroke specialists to make videoconference-based thrombolysis decisions either from one of three stroke units or from home. We report data on the first 100 patients treated using this model and retrospectively review the first 100 strokes thrombolysed with tissue plasminogen activator across three stroke units. Prospectively collected data were extracted from the Stroke Audit In Lanarkshire database. Case notes were retrieved for clarification when necessary. Outcome measures were timings from symptom onset to infusion, post-thrombolysis symptomatic intracerebral haemorrhage and death. Fifty-one percent of cases were assessed by telestroke link. Median symptom onset to thrombolysis was 160 min (IQR 125–190). There were two symptomatic intracerebral haemorrhages, both in patients assessed face-to-face. Overall mortality was 14%. Our experience of tissue plasminogen activator is comparable to UK data extracted from SITS-MOST in overall timings and complication rates. This model of telemedicine could be replicated to provide safe thrombolysis to areas with challenging infrastructure, geography or insufficient stroke specialist cover.
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Affiliation(s)
- E Hill
- Specialty Trainee in Geriatric Medicine, West of Scotland Rotation, UK
| | - M Whitehead
- Consultant Geriatrician, NHS Lanarkshire, UK
| | - B MacInnes
- Consultant Geriatrician, NHS Lanarkshire, UK
| | - G Ellis
- Consultant Geriatrician, NHS Lanarkshire, UK
| | - A Talbot
- Consultant Geriatrician, NHS Lanarkshire, UK
| | - F Brodie
- Consultant Geriatrician, NHS Lanarkshire, UK
| | - N Hughes
- Consultant Geriatrician, NHS Glasgow and Clyde, UK
| | - S Beggs
- Core Medical Trainee, West of Scotland Rotation, UK
| | - M Barber
- Consultant Geriatrician, NHS Lanarkshire, UK
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Abdullah A, Omar AN, Mulcahy R, Clapp A, Tullo E, Carrick-Sen D, Newton J, Hirst B, Krishnaswami V, Foster A, Vahidassr D, Chavan T, Matthew A, Trolan CP, Steel C, Ellis G, Ahearn DJ, Lotha K, Shukla P, Bourne DR, Mathur A, Musarrat K, Patel A, Nicholson G, Nelson E, McNicholl S, McKee H, Cuthbertson J, Nelson E, Nicholson G, McNicholl S, McKee H, Cuthbertson J, Lunt E, Lee S, Okeke J, Daniel J, Naseem A, Ramakrishna S, Singh I, Barker JR, Weatherburn AJ, Thornton L, Daniel J, Okeke J, Holly C, Jones J, Varanasi A, Verma A, Singh I, Foster JAH, Carmichael C, Cawston C, Homewood S, Leitch M, Martin J, McDicken J, Lonnen J, Bishop-Miller J, Beishon LC, Harrison JK, Conroy SP, Gladman JRF, Sim J, Byrne F, Currie J, Ollman S, Brown S, Wilkinson M, Manoj A, Hussain F, Druhan A, Thompson M, Tsang J, Soh J, Offiah C, Coughlan T, O'Brien P, McCabe DJH, Murphy S, McManus J, O'Neill D, Collins DR, Warburton K, Maini N, Cunnington AL, Mathew P, Hoyles K, Lythgoe M, Brewer H, Western-Price J, Colquhoun K, Ramdoo K, Bowen J, Dale OT, Corbridge R, Chatterjee A, Gosney MA, Richardson L, Daunt L, Ali A, Harwood R, Beveridge LA, Harper J, Williamson LD, Bowen JST, Gosney MA, Wentworth L, Wardle K, Ruddlesdin J, Baht S, Roberts N, Corrado O, Morell J, Baker P, Whiller N, Wilkinson I, Barber M, Maclean A, Frieslick J, Reoch A, Thompson M, Tsang J, McSorley A, Crawford A, Sarup S, Niruban A, Edwards JD, Bailey SJ, May HM, Mathieson P, Jones H, Ray R, Prettyman R, Gibson R, Heaney A, Hull K, Manku B, Bellary S, Ninan S, Chhokar G, Sweeney D, Nivatongs W, Wong SY, Aung T, Kalsi T, Babic-Illman G, Harari D, Aljaizani M, Pattison AT, Pattison AT, Aljaizani M, Fox J, Reilly S, Chauhan V, Azad M, Youde J, Lagan J, Cooper H, Komrower D, Price V, von Stempel CB, Gilbert B, Bouwmeester N, Jones HW, Win T, Weekes C, Hodgkinson R, Walker S, Le Ball K, Muir ZN. Clinical effectiveness. Age Ageing 2013. [DOI: 10.1093/ageing/aft096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Older people represent the fastest growing sector of society and a growing proportion of those undergoing elective surgery. Older people are at the highest risk of increased length of stay and postoperative complications. We evaluated the development of a nurse-led multidimensional preoperative assessment for older people. An older people's preassessment nurse reviewed consecutive patients undergoing elective surgery who met the inclusion criteria. In the first five months control phase, assessment was not acted on. Following the intervention, patients were referred to appropriate specialties for input. A total of 141 patients were reviewed before and 172 patients reviewed after the introduction of the pilot. Length of stay was reduced from 8.9 to 4.9 days after the introduction of the pilot ( P < 0.001). Delays were reduced from 9.9% to 2.3% ( P = 0.004) and fewer procedures were cancelled at pre-assessment (17.7% before, 5.2% after; P < 0.001). Serious postoperative complications were reduced from 8.5% to 2.3% ( P = 0.01). Coordinated multidisciplinary preoperative assessment in the elderly may reduce complications and length of stay.
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Affiliation(s)
- G Ellis
- Monklands Hospital, Airdrie, Scotland, UK
| | - M Spiers
- Monklands Hospital, Airdrie, Scotland, UK
| | - S Coutts
- Edinburgh Royal Infirmary, Edinburgh, Scotland, UK
| | - P Fairburn
- Monklands Hospital, Airdrie, Scotland, UK
| | - L Mccracken
- Victoria Infirmary, Mansionhouse Unit, Glasgow, Scotland, UK
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Affiliation(s)
- V Asopa
- Whittington Hospital NHS Trust, UK.
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Ellis G, Pridgeon S, Graham S. A technique for optimal manipulation of rotation of the flexible ureterorenoscope. Ann R Coll Surg Engl 2012. [PMID: 22943244 PMCID: PMC3954390 DOI: 10.1308/003588412x13373405385214j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- G Ellis
- Whipps Cross University Hospital NHS Trust, UK
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Steel C, Ellis G. Age specialist services emergency team (ASSET): Initial results of a new clinical service. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ellis G, Pridgeon S, Graham S. A technique for optimal manipulation of rotation of the flexible ureterorenoscope. Ann R Coll Surg Engl 2012; 94:365-6. [DOI: 10.1308/rcsann.2012.94.5.365a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - S Graham
- Whipps Cross University Hospital NHS TrustUK
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Draper N, Dickson T, Fryer S, Blackwell G, Winter D, Scarrott C, Ellis G. Plasma Cortisol Concentrations and Perceived Anxiety in Response to On-Sight Rock Climbing. Int J Sports Med 2011; 33:13-7. [DOI: 10.1055/s-0031-1284348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schneider S, Richardson T, Triner W, Roback N, Ellis G, Bienkowski R, Moscati R, Wojak S, Grant W, Crane P. 175 Use of Non-Veteran Administration Medical Emergency Departments by Military Veterans. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.203] [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: 10/17/2022]
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Draper N, Dickson T, Blackwell G, Priestley S, Fryer S, Marshall H, Shearman J, Hamlin M, Winter D, Ellis G. Sport-specific power assessment for rock climbing. J Sports Med Phys Fitness 2011; 51:417-425. [PMID: 21904280] [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: 05/31/2023]
Abstract
AIM The popularity of rock climbing has resulted in a growing research base for the sport. However, at present there is a lack of sport-specific measures of performance in the field. The aim of this study was to examine the use of the powerslap test as a sport specific power measure. METHODS The participants in this study were categorised into four different ability groups (novice, intermediate, advanced and elite) based on self reported lead grade. Two separate experiments were conducted to determine validity and reliability. The powerslap test was conducted on a revolution board with two variations - wide and narrow grip, for both sides of the body. The test started with the climber hanging at full extension from two holds from which a pull up movement was made releasing one hand to slap a scaled score board above. RESULTS There was a significant relationship between powerslap scores and climbing ability (Left Wide: r=0.7, P<0.0005; right wide: r=0.69, P<0.0005; left narrow: r=0.73, P<0.0005; right narrow: r =0.72, P<0.0005). Further to this, scores on the powerslap narrow test were significantly differentiated by climber ability (LEFT: F(3,37)=15.74, P<0.0005; right: F(3,37)=12.16, P<0.0005). Limits of agreement and intra-class correlation indicated that the powerslap test is a reliable performance measure. CONCLUSION According to the present findings the narrow grip variation of the powerslap test is a useful sport-specific power test that is related to climbing performance.
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Affiliation(s)
- N Draper
- School of Sciences and Physical Education, University of Canterbury, Christchurch, Canterbury, New Zealand.
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Affiliation(s)
- T J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
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Díez J, Barral L, Bellas R, Bouza R, López J, Marco C, Ellis G. Microstructure, morphology, and mechanical properties of styrene-butadiene rubber/organoclay nanocomposites. POLYM ENG SCI 2011. [DOI: 10.1002/pen.21950] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Comparisons of capillary blood lactate concentrations pre and post climb have featured in the protocols of many rock climbing studies, with most researchers obtaining samples from the fingertip. The nature of rock climbing, however, places a comparatively high physiological loading on the foreaand fingertips. Indeed, the fingertips are continually required for gripping and this makes pre-climb sampling at this site problematic. The purpose of our study was to examine differences in capillary blood lactate concentrations from samples taken at the fingertip and first (big) toe in a rock climbing context. 10 participants (9 males and 1 female) completed climbing bouts at 3 different angles (91°, 100° and 110°). Capillary blood samples were taken simultaneously from the fingertip and first toe pre and post climb. A limit of agreement plot revealed all data points to be well within the upper and lower bounds of the 95% population confidence interval. Subsequent regression analysis revealed a strong relationship (R (2)=0.94, y=0.940x + 0.208) between fingertip and first toe capillary blood lactate concentrations. Findings from our study suggest that the toe offers a valid alternative site for capillary blood lactate concentration analysis in a rock climbing context.
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Affiliation(s)
- S Fryer
- School of Sciences and Physical Education, University of Canterbury, Christchurch, New Zealand
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Jones C, Badger S, Ellis G. The role of microwave ablation in the management of hepatic colorectal metastases. Surgeon 2011; 9:33-7. [DOI: 10.1016/j.surge.2010.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/16/2010] [Accepted: 07/20/2010] [Indexed: 12/22/2022]
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Naffakh M, Marco C, Gómez MA, Ellis G, Maser WK, Benito A, Martínez MT. Crystalline transformations in nylon-6/single-walled carbon nanotube nanocomposites. J Nanosci Nanotechnol 2009; 9:6120-6126. [PMID: 19908503 DOI: 10.1166/jnn.2009.1558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Nylon-6/single-walled carbon nanotube (SWNT) nanocomposites with different SWNTs loadings were prepared by melt-blending. An efficient dispersion of SWNTs into the nylon-6 matrix was confirmed by scanning electron microscopy. DSC and time-resolved synchrotron X-ray diffraction were used to provide detailed information on the effect of SWNTs on the crystalline phase transition of nylon-6 in the nanocomposites. The incorporation of SWNTs accelerated the crystallization rate of nylon-6 due to a nucleating effect. The variable-temperature WAXS experiments, in both neat nylon-6 and nylon-6 nanocomposites, showed that the crystallization from the melt occured through the formation of the pseudo-hexagonal crystal form (gamma) and its transformation to the monoclinic form (alpha) on cooling. Additionally, this crystalline transition was reversible as observed upon heating. The alpha-gamma crystalline transformation temperature of nylon-6 was dependent on heating rate and, more importantly, on the SWNT content.
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Affiliation(s)
- M Naffakh
- Departamento de Física e Ingeniería de Polímeros, Instituto de Ciencia y Tecnología de Polímeros, CSIC, c/Juan de la Cierva, 3, 28006, Madrid, Spain
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Díez-Pascual AM, Naffakh M, Gómez MA, Marco C, Ellis G, González-Domínguez JM, Ansón A, Martínez MT, Martínez-Rubi Y, Simard B, Ashrafi B. The influence of a compatibilizer on the thermal and dynamic mechanical properties of PEEK/carbon nanotube composites. Nanotechnology 2009; 20:315707. [PMID: 19597256 DOI: 10.1088/0957-4484/20/31/315707] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The effect of polyetherimide (PEI) as a compatibilizing agent on the morphology, thermal, electrical and dynamic mechanical properties of poly(ether ether ketone) (PEEK)/single-walled carbon nanotube (SWCNT) nanocomposites, has been investigated for different CNT loadings. After a pre-processing step based on ball milling and pre-mixing under mechanical treatment in ethanol, the samples were prepared by melt extrusion. A more homogeneous distribution of the CNTs throughout the matrix is found for composites containing PEI, as revealed by scanning electron microscopy. Thermogravimetric analysis demonstrates an increase in the matrix degradation temperatures under dry air and nitrogen atmospheres with the addition of SWCNTs; the level of thermal stability of these nanocomposites is maintained when PEI is incorporated. Both differential scanning calorimetry and synchrotron x-ray scattering studies indicate a slight decrease in the crystallization temperatures of the compatibilized samples, and suggest the existence of reorganization phenomena during the heating, which are favoured in the composites incorporating the compatibilizer, due to their smaller crystal size. Dynamic mechanical studies show an increase in the glass transition temperature of the nanocomposites upon the addition of PEI. Furthermore, the presence of PEI causes an enhancement in the storage modulus, and hence in the rigidity of these systems, attributed to an improved interfacial adhesion between the reinforcement and the matrix. The electrical and thermal conductivities of these composites decrease with the incorporation of PEI. Overall, the compatibilized samples exhibit improved properties and are promising for their use in industrial applications.
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Affiliation(s)
- A M Díez-Pascual
- Departamento de Física e Ingeniería de Polímeros, Instituto de Ciencia y Tecnología de Polímeros, CSIC, c/Juan de la Cierva 3, 28006 Madrid, Spain.
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Doshi A, Love C, Daoud E, Augostini R, Kalbfleisch S, Weiss R, Houmsse M, Hummel J, Patangay A, Siejko KZ, Da Cunha D, Pedraza A, Hamlin R, Binner L, Bodky J, Szendey I, Maunz M, Trautmann M, Kaltofen G, Eber B, Steiner A, Hero M, Guenoun M, Biffi M, Bertini M, Salomoni M, Bonfatti F, Balbo M, Martignani C, Ziacchi M, Boriani G, Choo WK, Tilling L, Gupta S, Adachi M, Igawa O, Yano A, Miake J, Inoue Y, Ogura K, Kato M, Iitsuka K, Freeman P, Huish J, Brooks V, Johns M, Ellis G, Bleasdale R, Galley D, Hoffmann E, Spitali G, Marras E, Prades E, Davy JM, Volkov D, Polivenok I, Shovkun S, Smirnov V, Boyko V, Tassin A, Vitali L, Treguer F, Breard G, Gaggini G, Kobeissi A, Furber A, Dupuis JM, Tassin A, Vitali L, Treguer F, Breard G, Gaggini G, Kobeissi A, Furber A, Dupuis JM, Hashizume K, Takahashi R, Inoue Y, Tsutsumi K, Suzuki S, Ishikawa N, Arie T, Stevenson RA, Dabney WS, Schaerf R, Develle R, Dalal Y, Snell JD, Bharmi R, Snell JR, Rooke R, Korsun N, Fatemi S, Morley B, Beynon RP, Pearce KA, Hill LM, Argyle RA, Ray SG, Davidson NC. Poster session 3: Pacemaker and sensor algorithm. Europace 2009. [DOI: 10.1093/europace/euq228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Smith MR, Ellis G, Saad F, Tammela T, Bone H, Egerdie B, Ke C, Jun S, Dansey R, Goessl C. Effect of denosumab on bone mineral density (BMD) in women with breast cancer (BC) and men with prostate cancer (PC) undergoing hormone ablation therapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9520 Background: Hormone ablation therapies, including adjuvant aromatase inhibitor (AI) therapy and androgen deprivation therapy (ADT), improve recurrence-free survival in patients (pts) with BC and PC, respectively. However, these treatments increase bone resorption, leading to bone loss and fractures. RANKL is a key mediator of osteoclast-mediated bone resorption. In this 24 month (mo) comparison, we investigated the effects of denosumab, a fully human monoclonal antibody against RANKL, on preserving BMD across both populations. Methods: Two trials were conducted: a 24-mo BC study and a 36-mo PC study. Postmenopausal women with low BMD receiving AI therapy for nonmetastatic BC and men receiving ADT for nonmetastatic PC (with low BMD or history of osteoporotic fracture if < 70 yrs) were randomized to receive placebo or denosumab 60mg subcutaneously every 6 mos. All pts in both studies were prescribed calcium and vitamin D supplements. The primary endpoint was % change from baseline in lumbar spine (LS) BMD at 12 mos for the BC study and at 24 mos for the PC study. Herein, we present changes in BMD at 24 mos at LS, total hip (TH), and 1/3 radius from both studies. Power calculations were based on enrollment of at least 208 patients in the BC study (for primary endpoint only) and 1226 in the PC study (for primary and key secondary endpoints). The actual numbers randomized were 252 and 1468, respectively. Results: Denosumab increased BMD of the LS, TH, and 1/3 radius compared with placebo at 24 mos in both pt populations ( Table ). In both studies, differences between denosumab and placebo at each skeletal site were consistent, and the effects of denosumab were statistically significantly different from placebo as early as 1 month at the LS in both studies. The overall safety profile was similar to placebo in each study. Conclusions: Denosumab consistently increased BMD at all 3 skeletal sites compared with placebo in both women with BC undergoing AI therapy and in men with PC undergoing ADT. [Table: see text] [Table: see text]
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Affiliation(s)
- M. R. Smith
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - G. Ellis
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - F. Saad
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - T. Tammela
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - H. Bone
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - B. Egerdie
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - C. Ke
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - S. Jun
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - R. Dansey
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
| | - C. Goessl
- Massachusetts General Hospital Cancer Center, Boston, MA; Seattle Cancer Care Alliance, Seattle, WA; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Tampere University Hospital, Tampere, Finland; Michigan Bone and Mineral Clinic, Detroit, MI; Urology Associates Urologic Medical Research, Kitchener, ON, Canada; Amgen, Inc., Thousand Oaks, CA
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Burns T, Catty J, White S, Clement S, Ellis G, Jones IR, Lissouba P, McLaren S, Rose D, Wykes T. Continuity of care in mental health: understanding and measuring a complex phenomenon. Psychol Med 2009; 39:313-323. [PMID: 18570700 DOI: 10.1017/s0033291708003747] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness. METHOD A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care. RESULTS Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model. CONCLUSIONS We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.
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Affiliation(s)
- T Burns
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
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Specht JM, Partridge S, Dunnwald L, Doot R, Schubert E, Kurland B, Gralow J, Linden H, Gadi V, Ellis G, Mankoff D. DCE-MRI and dynamic FDG PET to monitor breast cancer response to neoadjuvant sunitinib in patients with locally-advanced breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-6006] [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
Abstract #6006
Background: We are enrolling patients with locally-advanced (LABC) or inflammatory breast cancer on a phase II trial of neoadjuvant sunitinib and metronomic chemotherapy. The addition of sunitinib is hypothesized to increase rate of pathologic complete response (pCR) via its effect on tumor vasculature. Measurement of FDG PET and MRI parameters of metabolism and blood flow (BF) after a one week run-in of sunitinib alone provides an opportunity to evaluate in vivo pharmacodynamics of sunitinib which may be predictive of response and provide insight into mechanism of sunitinib activity. Materials and Methods: Patients with HER2 negative LABC participated in an imaging trial with pre-therapy [18F]-FDG PET and DCE-MRI (T0) followed by a one-week run-in of sunitinib 37.5 mg orally daily with a second PET and MRI on day 7 (T1). FDG metabolic rate (MRFDG), transport (FDG K1) and MR indices of tumor perfusion (peak enhancement (PE), signal enhancement ratio (SER), and washout volume(WV)) were assessed. Results: Metabolism and perfusion parameters are available for the first 3 patients treated on this trial. All patients presented with grade 3, HER2 negative LABC. DCI-MRI (left) and PET images (right) pre-therapy (T0, top) and after one week sunitinib (T1, bottom) are illustrated in Figure 1. DCE-MRI studies show gray-scale images with color-coded regional perfusion (SER) superimposed; red indicates high levels of perfusion and blue lower levels. Three different responses were observed and expressed as percent change T0 to T1: patient 1 had no significant change in metabolism (MRFDG) or perfusion (K1,SER, PE); patient 2 showed a decline in perfusion with decreases in K1 (-55%), SER (-19%), PE (-10%), and WV (-56%), but minimal change in MRFDG (+ 5.9%); while patient 3 had marked declines in perfusion K1 (-41%), SER (-25%), WV (-78%) and MRFDG (-59%). Discussion: These early data demonstrate the ability to measure changes in tumor metabolism and blood flow by PET and MRI and illustrate heterogeneity in tumor response to sunitinib. As patients complete neoadjuvant chemotherapy (NC), metabolism and perfusion parameters from mid-therapy (T2) and end-therapy (T3) imaging will be evaluated in the context of pCR versus other with the goal of exploiting functional imaging parameters to predict response to NC and elucidate mechanism of response to sunitinib and metronomic chemotherapy. Supported by grant from NCCN, SI11.
 

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6006.
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Affiliation(s)
- JM Specht
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - S Partridge
- 2 Radiology, Univ. of Washington, Seattle, WA
| | - L Dunnwald
- 3 Nuclear Medicine, Univ. of Washington, Seattle, WA
| | - R Doot
- 5 Bioengineering, Univ. of Washington, Seattle, WA
| | - E Schubert
- 3 Nuclear Medicine, Univ. of Washington, Seattle, WA
| | - B Kurland
- 4 Clinical Statistics, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - J Gralow
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - H Linden
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - V Gadi
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - G Ellis
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - D Mankoff
- 3 Nuclear Medicine, Univ. of Washington, Seattle, WA
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