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Bell G, El Baou C, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Fearn C, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Predictors of primary care psychological therapy outcomes for depression and anxiety in people living with dementia: evidence from national healthcare records in England. Br J Psychiatry 2024:1-8. [PMID: 38328941 DOI: 10.1192/bjp.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown. AIMS To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD. METHOD National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored. RESULTS People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08-8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15-7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92-0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04-2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96-0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51-0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10-3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09-1.16, P < 0.001) were associated with worse therapy outcomes in PLWD. CONCLUSIONS Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and iCope Psychological Therapies Service, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, UK
| | - Caroline Fearn
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | - Elisa Aguirre
- Redbridge Talking Therapies Service, North East London NHS Foundation Trust, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, University College London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
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El Baou C, Bell G, Saunders R, Buckman JEJ, Mandy W, Dagnan D, O'Nions E, Pender R, Clements H, Pilling S, Richards M, John A, Stott J. Effectiveness of primary care psychological therapy services for treating depression and anxiety in autistic adults in England: a retrospective, matched, observational cohort study of national health-care records. Lancet Psychiatry 2023; 10:944-954. [PMID: 37977697 DOI: 10.1016/s2215-0366(23)00291-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Autistic adults report a higher prevalence of anxiety and depression than adults without identified autism but have poorer access to appropriate mental health care. Evidence-based psychological therapies are recommended in treatment guidelines for autistic adults, but no study has investigated their effectiveness in large samples representative of the autistic population accessing routine care. This study aimed to examine therapy outcomes for autistic adults in a primary care service. METHODS In this retrospective, matched, observational cohort study of national health-care records, we used the MODIFY dataset that used linked electronic health-care records, including national data, for individuals who accessed psychological therapy in primary care in Improving Access to Psychological Therapies (IAPT) services in 211 clinical commissioning group areas in England, UK. All adults aged 18 years or older who had completed a course of IAPT in 2012-19 were eligible, and were propensity score matched (1:1) with a comparison group without identified autism. Exact matching was used, when possible, for a range of sociodemographic factors. Primary outcomes were routine metrics that have been nationally defined and used to evaluate IAPT treatments: reliable improvement, reliable recovery, and reliable deterioration. Secondary outcomes were calculated pre-post treatment changes in scores for Patient Health Questionnaire-9, Generalised Anxiety Disorder Assessment-7, and Work and Social Adjustment Scale measures. Subgroup analyses investigated differential effects across a range of sociodemographic factors. FINDINGS Of 2 515 402 adults who completed at least two sessions of IAPT in 2012-19, 8761 had an autism diagnosis (5054 [57·7%] male and 3707 [42·3%] female) and 1 918 504 did not (631 606 [32·9%] male and 1 286 898 [67·0%] female). After propensity score matching, 8593 autistic individuals were matched with an individual in the comparison group. During IAPT treatment, symptoms of depression and generalised anxiety disorder decreased for most autistic adults, but symptoms were less likely to improve in the autism group than in the comparison group (4820 [56·1%] of 8593 autistic adults had reliable improvement vs 5304 [61·7%] of 8593 adults in the matched group; adjusted odds ratio [ORadj] 0·75, 95% CI 0·70-0·80; p<0·0001) and symptoms were more likely to deteriorate (792 [9·2%] vs 619 [7·2%]; ORadj 1·34, 1·18-1·48; p<0·0001). In the comparison group, improved outcomes were associated with employment and belonging to a higher socioeconomic deprivation category, but this was not the case for autistic adults. INTERPRETATION Evidence-based psychological therapy for depression or anxiety might be effective for autistic adults but less so than for adults without identified autism. Treatment moderators appear different for autistic individuals, so more research is needed to allow for better targeted and personalised care. FUNDING Alzheimer's Society.
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Affiliation(s)
- Céline El Baou
- Adapt Lab, University College London, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Georgia Bell
- Adapt Lab, University College London, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rob Saunders
- Adapt Lab, University College London, London, UK; CORE Data Lab, Centre for Outcomes Research and Effectiveness, University College London, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, University College London, London, UK; iCope, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - William Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Dave Dagnan
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Community Learning Disability Services, Lillyhall, Workington, UK
| | - Elizabeth O'Nions
- Adapt Lab, University College London, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Richard Pender
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Henry Clements
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, University College London, London, UK; Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Amber John
- Adapt Lab, University College London, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- Adapt Lab, University College London, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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John A, Saunders R, Desai R, Bell G, Fearn C, Buckman JEJ, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, Richards M, Stott J. Associations between psychological therapy outcomes for depression and incidence of dementia. Psychol Med 2023; 53:4869-4879. [PMID: 36106698 PMCID: PMC10476047 DOI: 10.1017/s0033291722002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological therapy and the subsequent incidence of dementia. METHODS National psychological therapy data were linked with hospital records of dementia diagnosis for 119808 people aged 65+. Participants received a course of psychological therapy treatment in Improving Access to Psychological Therapies (IAPT) services between 2012 and 2019. Cox proportional hazards models were run to test associations between improvement in depression following psychological therapy and incidence of dementia diagnosis up to eight years later. RESULTS Improvements in depression following treatment were associated with reduced rates of dementia diagnosis up to 8 years later (HR = 0.88, 95% CI 0.83-0.94), after adjustment for key covariates. Strongest effects were observed for vascular dementia (HR = 0.86, 95% CI 0.77-0.97) compared with Alzheimer's disease (HR = 0.91, 95% CI 0.83-1.00). CONCLUSIONS Reliable improvement in depression across psychological therapy was associated with reduced incidence of future dementia. Results are consistent with at least two possibilities. Firstly, psychological interventions to improve symptoms of depression may have the potential to contribute to dementia risk reduction efforts. Secondly, psychological therapies may be less effective in people with underlying dementia pathology or they may be more likely to drop out of therapy (reverse causality). Tackling the under-representation of older people in psychological therapies and optimizing therapy outcomes is an important goal for future research.
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Affiliation(s)
- Amber John
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Rob Saunders
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
| | - Roopal Desai
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Georgia Bell
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Caroline Fearn
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Joshua E. J. Buckman
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
- iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Barbara Brown
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Shirley Nurock
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Stewart Michael
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | - Paul Ware
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
| | | | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Queen Mary University of London, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Josh Stott
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London
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Stott J, Saunders R, Desai R, Bell G, Fearn C, Buckman JEJ, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, Richards M, John A. Associations between psychological intervention for anxiety disorders and risk of dementia: a prospective cohort study using national health-care records data in England. Lancet Healthy Longev 2023; 4:e12-e22. [PMID: 36509102 PMCID: PMC10570142 DOI: 10.1016/s2666-7568(22)00242-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Meta-analyses support an association between anxiety in older adulthood and dementia. The aim of this study was to use routinely collected health data to test whether treatment of anxiety disorders through psychological intervention is associated with a lower incidence of dementia. METHODS In this prospective cohort study, data from nationally provided psychological therapy services in England termed Improving Access to Psychological Therapies from 2012 to 2019 were linked to medical records, including dementia diagnoses as defined by the tenth edition of the International Classification of Diseases, up to 8 follow-up years later. Inclusion criteria were as follows: (1) patients who were aged 65 years and older; (2) patients with a probable anxiety disorder; and (3) those with no previous or current diagnosis of dementia. Cox proportional hazards models were constructed to test whether reliable improvement in anxiety following psychological intervention was associated with future dementia incidence. The primary outcome was all-cause dementia and cases were identified using ICD-10 dementia codes from Hospital Episode Statistics, Mental Health Services Dataset, and mortality data. For main analyses, hazards ratios (HRs) are presented. FINDINGS Data from 128 077 people aged 65 years and older attending a nationally provided psychological intervention service in England were linked to medical records. 88 019 (69·0%) of 127 064 participants with available gender data were women and 39 585 (31·0%) were men. 111 225 (95·9%) of 115 989 with available ethnicity data were of White ethnicity. The mean age of the sample was 71·55 years (SD 5·69). Fully adjusted models included data from 111 958 people after 16 119 were excluded due to missing data on key variables or covariates. 4510 (4·0%) of 111 958 participants had a dementia diagnosis. The remaining 107 448 (96·0%) were censored either at date of death or when the final follow-up period available for analyses was reached. People who showed reliable improvement in anxiety had lower rates of later dementia diagnosis (3·9%) than those who did not show reliable improvement (5·1%). Reliable improvement in anxiety following psychological intervention was associated with reduced incidence of all-cause dementia (HR 0·83 [95% CI 0·78-0·88]), Alzheimer's disease (HR 0·85 [0·77-0·94]), and vascular dementia (HR 0·80 [0·71-0·90]). Effects did not differ depending on anxiety disorder diagnosis. INTERPRETATION Results showed that reliable improvement in anxiety from psychological therapy was associated with reduced incidence of future dementia. There are multiple plausible explanations for this finding and further research is needed to distinguish between these possibilities. Missing data in the sample limit reliability of findings. FUNDING Alzheimer's Society, Medical Research Council, Wellcome Trust, and UCLH National Institute for Health and Care Research Biomedical Research Centre.
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Affiliation(s)
| | - Rob Saunders
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | | | | | | | - Joshua E J Buckman
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK; iCope-Camden and Islington Psychological Therapies Services, St Pancras Hospital, London, UK
| | | | | | | | | | | | | | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Queen Mary University of London, London, UK
| | - Stephen Pilling
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK; Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
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Bell G, Singham T, Saunders R, Buckman JEJ, Charlesworth G, Richards M, John A, Stott J. Positive psychological constructs and cognitive function: A systematic review and meta-analysis. Ageing Res Rev 2022; 82:101745. [PMID: 36210034 DOI: 10.1016/j.arr.2022.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/04/2022] [Indexed: 01/31/2023]
Abstract
AIM To synthesise evidence regarding the association between positive psychological constructs (PPCs) and cognitive function in adults aged 50 +. METHODS Literature searches: Medline, PsycINFO, and Scopus (inception to February 2022). Studies were included if they reported on the association between at least one PPC and one objective measure of cognitive function in people aged 50 + without cognitive impairment at baseline. Where at least two studies reported on the same PPC and cognitive outcome, estimates were pooled through meta-analysis. FINDINGS In total, 37 studies were included. There was evidence of cross-sectional associations for 'meaning in life' (verbal fluency: b = 0.09, 95 %CI [0.07, 0.11], p < .001; memory: b = 0.10, 95 %CI [0.08, 0.12], p < .001), 'purpose in life' (verbal fluency: b = 0.07, 95 %CI [0.05, 0.08], p < .001; memory: r = 0.13, 95 %CI [0.08, 0.18], p < .001), and positive affect (cognitive state: r = 0.25, 95 %CI [0.14, 0.36], p < .001; memory: r = 0.05, 95 %CI [0.02, 0.08], p < .001) with various domains of cognitive function. However, no significant results were found for life satisfaction (p = .13) or longitudinal studies investigating positive affect and memory (p = .48). Other PPCs were included in narrative syntheses only. IMPLICATIONS Purpose and meaning in life may be sensible primary targets for interventions to promote healthy cognitive aging. More longitudinal and causal inference research is needed to better understand this association and its implications for clinical practice.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Timothy Singham
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; iCope - Camden & Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
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Bell G, Baou CE, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Brown B, Nurock S, Michael S, Ware P, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England. EClinicalMedicine 2022; 52:101692. [PMID: 36313148 PMCID: PMC9596302 DOI: 10.1016/j.eclinm.2022.101692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia. Methods National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration). Findings Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia. Interpretation Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes. Funding This work was supported by the Alzheimer's Society.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E. J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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Telfort J, Lickert C, Xie L, Bell G, Ansani N, Kim R. P-739 Social and treatment characteristics of women with Uterine Fibroid (UF) with/without Heavy Menstrual Bleeding (HMB), in a commercially insured US population. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.685] [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: 11/15/2022] Open
Abstract
Abstract
Study question
Are there differences in patient’s social demographic, clinical and treatment characteristics among patients diagnosed with HMB and/or UF?
Summary answer
Baseline characteristics were similar across all UF-status defined-groups. Differences were observed in education, net-worth and 12-monthfollow-up characteristics. Nearly 60% were prescribed pain meds pre-diagnosis.
What is known already
Uterine leiomyomas (or fibroids) are benign neoplasm that affect women of reproductive age1. In the US, treatment for UF is individualized, dependent on size and location of the fibroids, patient profile, symptom severity and type of diagnosis. Patients may be diagnosed with HMB before UF (HMB-UF), diagnosed with UF first and then HMB (UF-HMB), diagnosed with only HMB (HMB-Only) or UF only (UF-Only). Previous studies indicated that the majority (70%) of women received no prescription medications regardless of surgery status and 40% had pain at time of diagnosis.2,3
Study design, size, duration
Our retrospective real-world observational study included 295,400 women across four cohorts between 10/1/2012 -12/31/2020. The majority (96,961; 44%) had HMB-Only, 46,763 (21%) UF-Only, 35,421 (16%) HMB-UF, and 40,806 (19%) UF-HMB. Patients required 12 months continuous enrollment before index date (earlier of HMB or UF diagnosis date based on cohorts) and 12-months of follow-up unless hysterectomy was observed before 12 months. Surgical and pharmacologic agents explored were based on ACOG guidelines for UF.
Participants/materials, setting, methods
Optum® Socio-Economic Status claims database was used to identify newly diagnosed women 18-55 years old with UF and/or HMB claims, without history of conservative/radical surgery or non-dermatological cancers.
Descriptive analyses were performed for patients’ social demographics and treatment characteristics during pre- and post-index period.
Main results and the role of chance
Across all cohorts,
During the 12-month follow-up, nearly 80% of patients used at least 1 prescribed pain medication compared to nearly 60% at baseline. The increase in pain medication use was mainly driven by increase in NSAIDs, opioids, analgesics, and anti-migraine in all cohorts except HMB-O (Opioids: baseline 24-30% to follow up 41-55%; NSAIDs: 20-21% to 44-53%; analgesics: 6-8% to 19%-33%; anti-migraine: 8-11% to 16-29%).
Limitations, reasons for caution
True incidence of index claims are difficult to estimate. Over-the-counters medications or claims made outside the study period are not captured. Pain medication may be unrelated to UF-associated pain.
Findings only reflect the commercially insured population and may not be generalizable. Claims data provide limited clinical profile and prescribing rationales.
Wider implications of the findings
The majority of the patients in these cohorts experienced pain and were prescribed opioids. Determining the link between the use of pain medication and symptoms of UF and HMB is important, as pain medications do not address HMB.
Trial registration number
Not applicable
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Affiliation(s)
- J Telfort
- Pfizer Inc, Patient & Health and Impact , New York, U.S.A
| | - C Lickert
- Myovant Sciences Inc., Medical Managed Markets & RWE , Brisbane, U.S.A
| | - L Xie
- Pfizer Inc, Patient & Health and Impact , New York, U.S.A
| | - G Bell
- Pfizer Inc, Global Product Development , New York, U.S.A
| | - N Ansani
- Pfizer Inc, Internal Medicine - North America Medical Affairs , New York, U.S.A
| | - R Kim
- Pfizer Inc, Patient & Health and Impact , New York, U.S.A
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Bell G, Singham T, Saunders R, John A, Stott J. Positive psychological constructs and association with reduced risk of mild cognitive impairment and dementia in older adults: A systematic review and meta-analysis. Ageing Res Rev 2022; 77:101594. [PMID: 35192960 DOI: 10.1016/j.arr.2022.101594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
Understanding factors associated with dementia risk is important for informing future interventions aimed at dementia prevention. There is accumulating evidence for the association between depression and risk of dementia, however less is known about the association between positive psychological factors and dementia incidence. This review aims to synthesise evidence regarding the association between positive psychological constructs (PPCs) and later risk of MCI and dementia in adults aged 50 and over. Literature searches were conducted in Medline, PsycINFO, and Scopus until March 2021. Papers reporting on the association between at least one PPC and later risk of MCI or dementia in people aged 50 + without cognitive impairment at baseline were included. Results from the meta-analyses revealed that purpose in life was significantly associated with a reduced risk of dementia (HR = 0.81, 95% CI [0.78, 0.85], p < .001), however results for positive affect were non-significant (HR = 0.94, 95% CI [0.76, 1.15], p = .54). Results for other PPCs are described narratively. Mixed findings for different PPCs highlight the importance of investigating these factors individually. Understanding which factors may play a protective role in their association with risk of mild cognitive impairment and dementia could have important implications for informing dementia prevention interventions.
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9
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Singham T, Bell G, Saunders R, Stott J. Widowhood and cognitive decline in adults aged 50 and over: A systematic review and meta-analysis. Ageing Res Rev 2021; 71:101461. [PMID: 34534681 DOI: 10.1016/j.arr.2021.101461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/02/2021] [Accepted: 09/11/2021] [Indexed: 01/21/2023]
Abstract
While widowhood is known to be associated with poorer physical and mental health outcomes, studies examining the association of widowhood with cognition have yielded mixed results. This review aimed to elucidate the link between widowhood and cognitive decline. A systematic search of Medline, Embase, PsycInfo, CINAHL and Scopus (until December 2020) was conducted to identify studies on the association between widowhood (vs. being married) and cognition in cognitively healthy adults aged 50 +. A cross-sectional meta-analysis (of 10 studies; n = 24,668) found a significant association of widowhood with cognition (g = - 0.36, 95% CI [- 0.47, - 0.25], p = < 0.001). Meta-regressions suggested that study design, cognitive domain measured, sample age, difference in mean age between widowed and married groups, and study continent did not account for observed heterogeneity. A longitudinal meta-analysis (of 3 studies; n = 10,378) found that the "continually widowed" group (from baseline to follow-up) showed significantly steeper declines in cognition compared to the "continually married" group (g = - 0.15, 95%CI [- 0.19, - 0.10], p = < 0.001). Findings indicate that widowhood may be a risk factor for cognitive decline. As there are no effective treatments for cognitive impairment, studying mechanisms by which widowhood might be associated with poorer cognition could inform prevention programs for those who have experienced spousal bereavement.
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10
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Bell G, John A, Gaysina D. Affective symptoms across the life course and resilience in cognitive function. Ann Hum Biol 2020; 47:116-124. [DOI: 10.1080/03014460.2020.1745886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Georgia Bell
- School of Psychology, University of Sussex, Brighton, UK
| | - Amber John
- School of Psychology, University of Sussex, Brighton, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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Goel V, Islam MS, Yunus M, Ali MT, Khan AF, Alam N, Faruque ASG, Bell G, Sobsey M, Emch M. Deep tubewell microbial water quality and access in arsenic mitigation programs in rural Bangladesh. Sci Total Environ 2019; 659:1577-1584. [PMID: 31096367 PMCID: PMC6724724 DOI: 10.1016/j.scitotenv.2018.12.341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/10/2018] [Revised: 12/06/2018] [Accepted: 12/22/2018] [Indexed: 05/31/2023]
Abstract
The objective of this paper is to determine whether deep tubewells installed through arsenic mitigation efforts in rural Bangladesh provide better drinking water microbial quality compared to shallow tubewells. We conducted a stratified random cross-sectional survey of 484 households to assess microbial contamination of deep tubewell water at source and at point of use (POU) compared to shallow tubewell water using the Compartment Bag Test. In addition, we measured storage time, distance, travel time and ownership status among both sets of users to assess deep tubewell efficacy and under what conditions they offer poorer or better water quality. Differences in tubewell characteristics were compared using non-parametric Mann-Whitney U tests and two-proportion Z-tests. Prevalence ratios of microbial contamination stratified by water quality, storage time and distance to tubewells and ownership were estimated using unadjusted Mantel-Haenszel tests. There was no significant difference in microbial contamination between shallow and deep tubewells at source. The presence of POU water microbial contamination in storage containers in deep tubewell households was 1.11 times the prevalence in shallow tubewell storage containers (95% CI = 0.97-1.27). Deep tubewell users stored water longer and walked significantly farther to obtain water compared to shallow tubewell users. Among deep tubewell households, those residing farther away from the source were 1.24 times as likely to drink contaminated water from storage containers compared to those located nearby (95% CI = 1.04-1.48). Our findings suggest that deep tubewells have comparable water quality to shallow tubewells at source, but increasing distance from the household exacerbates risk of microbial contamination at POU.
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Affiliation(s)
- V Goel
- Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, USA.
| | - M S Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M T Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A F Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - N Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A S G Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - G Bell
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, USA
| | - M Sobsey
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, USA
| | - M Emch
- Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, USA; Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, USA.
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McCann ME, Withington DE, Arnup SJ, Davidson AJ, Disma N, Frawley G, Morton NS, Bell G, Hunt RW, Bellinger DC, Polaner DM, Leo A, Absalom AR, von Ungern-Sternberg BS, Izzo F, Szmuk P, Young V, Soriano SG, de Graaff JC. Differences in Blood Pressure in Infants After General Anesthesia Compared to Awake Regional Anesthesia (GAS Study-A Prospective Randomized Trial). Anesth Analg 2017; 125:837-845. [PMID: 28489641 DOI: 10.1213/ane.0000000000001870] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The General Anesthesia compared to Spinal anesthesia (GAS) study is a prospective randomized, controlled, multisite, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment at 5 years of age. A secondary aim obtained from the blood pressure data of the GAS trial is to compare rates of intraoperative hypotension after anesthesia and to identify risk factors for intraoperative hypotension. METHODS A total of 722 infants ≤60 weeks postmenstrual age undergoing inguinal herniorrhaphy were randomized to either bupivacaine regional anesthesia (RA) or sevoflurane GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born at <26 weeks of gestation. Moderate hypotension was defined as mean arterial pressure measurement of <35 mm Hg. Any hypotension was defined as mean arterial pressure of <45 mm Hg. Epochs were defined as 5-minute measurement periods. The primary outcome was any measured hypotension <35 mm Hg from start of anesthesia to leaving the operating room. This analysis is reported primarily as intention to treat (ITT) and secondarily as per protocol. RESULTS The relative risk of GA compared with RA predicting any measured hypotension of <35 mm Hg from the start of anesthesia to leaving the operating room was 2.8 (confidence interval [CI], 2.0-4.1; P < .001) by ITT analysis and 4.5 (CI, 2.7-7.4, P < .001) as per protocol analysis. In the GA group, 87% and 49%, and in the RA group, 41% and 16%, exhibited any or moderate hypotension by ITT, respectively. In multivariable modeling, group assignment (GA versus RA), weight at the time of surgery, and minimal intraoperative temperature were risk factors for hypotension. Interventions for hypotension occurred more commonly in the GA group compared with the RA group (relative risk, 2.8, 95% CI, 1.7-4.4 by ITT). CONCLUSIONS RA reduces the incidence of hypotension and the chance of intervention to treat it compared with sevoflurane anesthesia in young infants undergoing inguinal hernia repair.
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Affiliation(s)
- M E McCann
- From the *Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; †Department of Anesthesia, Montreal Children's Hospital, Montreal, Canada; ‡Department of Anesthesia, McGill University, Montreal, Canada; §Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; ‖Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; ¶Department of Anaesthesia and Pain Management, the Royal Children's Hospital, Melbourne, Victoria, Australia; #Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; **Department of Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy; ††Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, United Kingdom; ‡‡Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, United Kingdom; §§Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia; ‖‖Neonatal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; ¶¶Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; ##Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; ***Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; †††Departments of Anesthesiology and Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; ‡‡‡Department of Anaesthesia, Royal Children's Hospital, Melbourne, Australia; §§§University Medical Center Groningen, Groningen University, the Netherlands; ‖‖‖Pharmacology, Pharmacy, Anaesthesiology Unit, School of Medicine and Pharmacology, the University of Western Australia, Perth, Western Australia, Australia; ¶¶¶Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; ###Department of Anaesthesiology and Intensive Care, Paediatric Intensive Care Unit Children Hospital 'Vittore Buzzi', Milano, Italy; ****Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health Medical Center, Dallas, Texas; ††††Outcome Research Consortium, Cleveland, Ohio; ‡‡‡‡Department of Anaesthesiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; §§§§Brain Center Rudolph Magnus, University Medical Centre Utrecht, the Netherlands; and ‖‖‖‖Department of Anesthesia, Sophia Children's Hospital, Erasmus Medical Center Rotterdam, the Netherlands
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Lachapelle J, Colegrave N, Bell G. The effect of selection history on extinction risk during severe environmental change. J Evol Biol 2017; 30:1872-1883. [PMID: 28718986 DOI: 10.1111/jeb.13147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 11/27/2022]
Abstract
Environments rarely remain the same over time, and populations are therefore frequently at risk of going extinct when changes are significant enough to reduce fitness. Although many studies have investigated what attributes of the new environments and of the populations experiencing these changes will affect their probability of going extinct, limited work has been directed towards determining the role of population history on the probability of going extinct during severe environmental change. Here, we compare the extinction risk of populations with a history of selection in a benign environment, to populations with a history of selection in one or two stressful environments. We exposed spores and lines of the green alga Chlamydomonas reinhardtii from these three different histories to a range of severe environmental changes. We found that the extinction risk was higher for populations with a history of selection in stressful environments compared to populations with a history of selection in a benign environment. This effect was not due to differences in initial population sizes. Finally, the rates of extinction were highly repeatable within histories, indicating strong historical contingency of extinction risk. Hence, information on the selection history of a population can be used to predict their probability of going extinct during environmental change.
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Affiliation(s)
- J Lachapelle
- Department of Biology, University of Toronto Mississauga, Mississauga, ON, Canada.,School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - N Colegrave
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - G Bell
- Department of Biology, McGill University, Montreal, QC, Canada
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14
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Ley S, Bell G. Draw-over or push over during manual ventilation with the Tri-Service Anaesthetics Apparatus? Anaesthesia 2016; 71:474-5. [DOI: 10.1111/anae.13422] [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: 11/30/2022]
Affiliation(s)
- S. Ley
- Queen Elizabeth University Hospital; Glasgow UK
| | - G. Bell
- Royal Hospital for Children; Glasgow UK
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Affiliation(s)
- K W Tan
- Royal Hospital for Sick Children, Glasgow, UK.
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Forbes S, Kennedy M, Boule N, Bell G. Determination of the Optimal Load Setting for Arm Crank Anaerobic Testing in Men and Women. Int J Sports Med 2014; 35:835-9. [DOI: 10.1055/s-0034-1368789] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. Forbes
- Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - M. Kennedy
- Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - N. Boule
- Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - G. Bell
- Physical Education, University of Alberta, Edmonton, Canada
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Bell G, Anderson A, Harry R, Diboll J, McColl E, Dickinson A, Hilkens C, Isaacs JD. A1.43 Autologous tolerogenic dendritic cells in rheumatoid and inflammatory arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.42] [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: 11/03/2022]
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Abstract
The management of medical emergencies is clearly of vital importance in dental practice. The starting point of training in this area is the undergraduate dental degree programme. The aim of this study was to examine the opinions of final-year dental students at Newcastle School of Dental Sciences in relation to their undergraduate training in medical emergency management. Overall the responses were positive but the need for further practical training in the use of emergency drugs and equipment was highlighted.
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Abstract
Patient inflating valves combined with self-inflating bags are known to all anaesthetists as resuscitation devices and are familiar as components of draw-over anaesthesia systems. Their variants are also commonplace in transfer and home ventilators. However, the many variations in structure and function have led to difficulties in their optimal use, definition and classification. After reviewing the relevant literature, we defined a patient inflating valve as a one-way valve that closes an exit port to enable lung inflation, also permitting exhalation and spontaneous breathing, the actions being automatic. We present a new classification based on the mechanism of valve opening/closure; namely elastic recoil of a flexible flap/diaphragm, sliding spindle opened by a spring/magnet or a hollow balloon collapsed by external pressure. The evolution of these valves has been driven by the difficulties documented in critical incidents, which we have used along with information from modern International Organization for Standardization standards to identify 13 ideal properties, the top six of which are non-jamming, automatic, no bypass effect, no rebreathing or air entry at patient end, low resistance, robust and easy to service. The Ambu and the Laerdal valves have remained popular due to their simplicity and reliability. Two new alternatives, the Fenton and Diamedica valves, offer the benefits of location away from the patient while retaining a small functional dead space. They also offer the potential for greater use of hybrid continuous flow/draw-over systems that can operate close to atmospheric pressure. The reliable application of positive end-expiratory pressure/continuous positive airway pressure remains a challenge.
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Affiliation(s)
- P M Fenton
- Department of Anaesthesia, College of Medicine, Blantyre, Malawi, Africa.
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Faine B, Bell G, Denning G. 127 A Pilot Comparison of the Efficacy of a 3-day Course of Nitrofurantoin versus 3-day Ciprofloxacin in Females With Uncomplicated Bacterial Cystitis in the Emergency Department. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bell G, Green S, Cox T, Naylor S, Bennett P, Dudley S, Martin J, Parsons S, Rothwell J, Allen D, Beckett W. P34 Partner notification for HIV: a regional outcome audit: Abstract P34 Table 1. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.34] [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: 11/03/2022]
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Mercer C, Bell G, Low N, Estcourt CS, Brook G, Cassell JA. P38 Quantifying the public health value of provider-led partner notification using an evidence-based algorithm with routinely-collected data. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Bowman CA, Bell G, Ellam H, Tunbridge A, Slack S, Atkin A, Evans C, Shutt A, Joseph E, Naylor S, Herman S, Green S, Kudesia G, Pryce A. P6 Cultural differences in the acceptability of home sampling for HIV infection. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.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: 11/03/2022]
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24
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Bell G, Devey T, Cope A, Evans C, Hughes C, Naylor S, Greig JM, Tunbridge AJ, Lagundoye O, McNaught R. P35 A collaborative approach to controlling an HIV outbreak among intravenous drug users. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grover S, Srinivasan G, Bell G, Edwards C, Huang S, Leong D, Bridgman C, Chakrabathy A, Figtree G, Selvanayagam J. Inter-observer Variability for Assessment of Infarct Size in a Multi-centre Study: PROTECTION AMI CMR Substudy. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.520] [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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Grover S, Bell G, Edwards C, Huang S, Leong D, Joerg L, Madsen P, Bridgman C, Low S, Chakrabathy A, Figtree G, Selvanayagam J. Correlation of CMR and Biochemical Markers of Myocardial Injury in a Multi-centre Study: PROTECTION AMI CMR Substudy. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.092] [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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Grover S, Leong D, Joerg L, Madsen P, Chakrabathy A, Bell G, Selvanayagam J. Comparison of Left Ventricular Ejection Fraction with Multiple-Gated Acquisition Scan and Cardiac Magnetic Resonance in Anterior Myocardial Infarcts. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.478] [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: 11/25/2022]
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Faine B, Bell G, Denning G. 127 Addressing Antibiotic Resistance: A Randomized, Controlled Trial Comparing Short-Course Nitrofurantion versus Ciprofloxacin for the Treatment of Acute Uncomplicated Cystitis. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.154] [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: 11/25/2022]
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Affiliation(s)
- I Simms
- HIV & STI Department, Health Protection Services Colindale, Health Protection Agency, London
| | - G Bell
- Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK
| | - G Hughes
- HIV & STI Department, Health Protection Services Colindale, Health Protection Agency, London
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Abstract
This paper, in discussing oro-antral fistulae and fractured tuberosities, aims to guide the dentist through the assessment and reduction of risk when removing maxillary molar teeth that are closely related to the maxillary sinus. However, complications are inevitable and the management of these will also be discussed.
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Affiliation(s)
- G Bell
- Dumfries & Galloway Royal Infirmary, Dumfries, DG1 4AP.
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Turner K, Adams E, Grant A, Macleod J, Bell G, Clarke J, Horner P. P1-S4.17 Interactive demonstration of a model to calculate costs and cost effectiveness of different strategies for chlamydia screening and partner notification. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hansen G, Blanchard C, Rodgers W, Bell G. Efficacy of Prescribing Endurance Training Intensity Using the Ventilatory Equivalents for Oxygen and Carbon Dioxide in Untrained Men and Women. Res Sports Med 2011. [DOI: 10.1080/0308349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
We exposed the strains of Chlamydomonas isolated from an outbred laboratory population to a range of concentrations of salt (NaCl) up to an extirpative level that the base population could not tolerate. The genetic variance of yield increased with stress over the first half of this range before collapsing to nearly zero. The genetic correlation decreased with environmental distance, whether measured as a difference in dosage or as an environmental variance. This result is consistent with previous studies and provides a basis for interpreting adaptation to a deteriorating environment and the process of evolutionary rescue.
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Affiliation(s)
- C Moser
- Biology Department, McGill University, Montreal, QC, Canada
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Abstract
Morbidity and mortality from pneumonia is increased in patients with rheumatoid arthritis. Factors contributing to this have been recently identified and a number of recommendations have been implemented in an attempt to reverse this trend. The present paper shows that these measures have combined to produce a fourfold reduction in both admissions and case fatality rates. In the study population, immunisation rates against influenza and pneumococcus have improved to 86% and 65%, oral steroid consumption has halved and disease modifying drugs were usually appropriately suspended during acute infection. These measures may now merit more widespread adoption.
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Affiliation(s)
- MM Housden
- Departments of Medicine and Rheumatology, Queen Elizabeth Foundation Hospital Trust, Gateshead
| | - G Bell
- Departments of Medicine and Rheumatology, Queen Elizabeth Foundation Hospital Trust, Gateshead
| | - CR Heycock
- Departments of Medicine and Rheumatology, Queen Elizabeth Foundation Hospital Trust, Gateshead
| | - J Hamilton
- Departments of Medicine and Rheumatology, Queen Elizabeth Foundation Hospital Trust, Gateshead
| | - V Saravanan
- Departments of Medicine and Rheumatology, Queen Elizabeth Foundation Hospital Trust, Gateshead
| | - CA Kelly
- Departments of Medicine and Rheumatology, Queen Elizabeth Foundation Hospital Trust, Gateshead
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Gleick PH, Adams RM, Amasino RM, Anders E, Anderson DJ, Anderson WW, Anselin LE, Arroyo MK, Asfaw B, Ayala FJ, Bax A, Bebbington AJ, Bell G, Bennett MVL, Bennetzen JL, Berenbaum MR, Berlin OB, Bjorkman PJ, Blackburn E, Blamont JE, Botchan MR, Boyer JS, Boyle EA, Branton D, Briggs SP, Briggs WR, Brill WJ, Britten RJ, Broecker WS, Brown JH, Brown PO, Brunger AT, Cairns J, Canfield DE, Carpenter SR, Carrington JC, Cashmore AR, Castilla JC, Cazenave A, Chapin FS, Ciechanover AJ, Clapham DE, Clark WC, Clayton RN, Coe MD, Conwell EM, Cowling EB, Cowling RM, Cox CS, Croteau RB, Crothers DM, Crutzen PJ, Daily GC, Dalrymple GB, Dangl JL, Darst SA, Davies DR, Davis MB, De Camilli PV, Dean C, DeFries RS, Deisenhofer J, Delmer DP, DeLong EF, DeRosier DJ, Diener TO, Dirzo R, Dixon JE, Donoghue MJ, Doolittle RF, Dunne T, Ehrlich PR, Eisenstadt SN, Eisner T, Emanuel KA, Englander SW, Ernst WG, Falkowski PG, Feher G, Ferejohn JA, Fersht A, Fischer EH, Fischer R, Flannery KV, Frank J, Frey PA, Fridovich I, Frieden C, Futuyma DJ, Gardner WR, Garrett CJR, Gilbert W, Goldberg RB, Goodenough WH, Goodman CS, Goodman M, Greengard P, Hake S, Hammel G, Hanson S, Harrison SC, Hart SR, Hartl DL, Haselkorn R, Hawkes K, Hayes JM, Hille B, Hökfelt T, House JS, Hout M, Hunten DM, Izquierdo IA, Jagendorf AT, Janzen DH, Jeanloz R, Jencks CS, Jury WA, Kaback HR, Kailath T, Kay P, Kay SA, Kennedy D, Kerr A, Kessler RC, Khush GS, Kieffer SW, Kirch PV, Kirk K, Kivelson MG, Klinman JP, Klug A, Knopoff L, Kornberg H, Kutzbach JE, Lagarias JC, Lambeck K, Landy A, Langmuir CH, Larkins BA, Le Pichon XT, Lenski RE, Leopold EB, Levin SA, Levitt M, Likens GE, Lippincott-Schwartz J, Lorand L, Lovejoy CO, Lynch M, Mabogunje AL, Malone TF, Manabe S, Marcus J, Massey DS, McWilliams JC, Medina E, Melosh HJ, Meltzer DJ, Michener CD, Miles EL, Mooney HA, Moore PB, Morel FMM, Mosley-Thompson ES, Moss B, Munk WH, Myers N, Nair GB, Nathans J, Nester EW, Nicoll RA, Novick RP, O'Connell JF, Olsen PE, Opdyke ND, Oster GF, Ostrom E, Pace NR, Paine RT, Palmiter RD, Pedlosky J, Petsko GA, Pettengill GH, Philander SG, Piperno DR, Pollard TD, Price PB, Reichard PA, Reskin BF, Ricklefs RE, Rivest RL, Roberts JD, Romney AK, Rossmann MG, Russell DW, Rutter WJ, Sabloff JA, Sagdeev RZ, Sahlins MD, Salmond A, Sanes JR, Schekman R, Schellnhuber J, Schindler DW, Schmitt J, Schneider SH, Schramm VL, Sederoff RR, Shatz CJ, Sherman F, Sidman RL, Sieh K, Simons EL, Singer BH, Singer MF, Skyrms B, Sleep NH, Smith BD, Snyder SH, Sokal RR, Spencer CS, Steitz TA, Strier KB, Südhof TC, Taylor SS, Terborgh J, Thomas DH, Thompson LG, Tjian RT, Turner MG, Uyeda S, Valentine JW, Valentine JS, Van Etten JL, van Holde KE, Vaughan M, Verba S, von Hippel PH, Wake DB, Walker A, Walker JE, Watson EB, Watson PJ, Weigel D, Wessler SR, West-Eberhard MJ, White TD, Wilson WJ, Wolfenden RV, Wood JA, Woodwell GM, Wright HE, Wu C, Wunsch C, Zoback ML. Climate change and the integrity of science. Science 2010; 328:689-90. [PMID: 20448167 DOI: 10.1126/science.328.5979.689] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Choudhury R, Barreto G, Ganeshaguru K, Cirak S, Scoto M, Muntoni F, Guglieri M, Straub V, Bell G, Speed C, Bourke J, Bushby K, Quinlivan R, Jones R, Hunt A. P07 Translation related clinical trials in duchenne muscular dystrophy (DMD) in the UK. Neuromuscul Disord 2010. [DOI: 10.1016/s0960-8966(10)70022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bell G, Janossy K. Cuffed or uncuffed tubes during anaesthesia in infants and small children. Br J Anaesth 2010; 104:387-8; author reply 388. [PMID: 20150348 DOI: 10.1093/bja/aeq010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
The purpose of this experiment was to find out how a population becomes adapted to extremely stressful conditions as its environment deteriorates. We created a deteriorating environment for experimental selection lines of yeast by a stepwise increase in the concentration of salt in the growth medium. After each step, we tested the ability of the lines to grow at a high concentration of salt near the lethal limit for the ancestral strain. We found that mutations enhancing growth in this highly stressful environment began to spread at intermediate salt concentrations. The degree of enhancement was related to effective population size by a power law with a small exponent. The effect size of these mutations also increased with the population size in a similar fashion. From these results, we interpret adaptation to lethal stress as an indirect response to selection for resistance to previous lower levels of stress in a deteriorating environment. This suggests that the pattern of genetic correlation between successively higher levels of stress is an important factor in facilitating evolutionary rescue.
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Affiliation(s)
- P Samani
- Department of Biology, McGill University, Montreal, QC, Canada
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Imran M, Livesley P, Bell G, Pai P, Anijeet H. A Case Report of Successful Management of Aerococcus urinae Peritonitis in a Patient on Peritoneal Dialysis. Perit Dial Int 2009; 30:661-2. [DOI: 10.3747/pdi.2010.00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M. Imran
- Royal Liverpool University Hospital NHS Trust Liverpool, United Kingdom
| | - P. Livesley
- Royal Liverpool University Hospital NHS Trust Liverpool, United Kingdom
| | - G. Bell
- Royal Liverpool University Hospital NHS Trust Liverpool, United Kingdom
| | - P. Pai
- Royal Liverpool University Hospital NHS Trust Liverpool, United Kingdom
| | - H. Anijeet
- Royal Liverpool University Hospital NHS Trust Liverpool, United Kingdom
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Abstract
The traditional view is that evolution proceeds very slowly, over immense periods of time, driven by weak selection acting on innumerable genes of small effect. Recent studies of rapid evolution, in the laboratory and in the field, have given a radically different picture. Although beneficial mutations tend to be small in effect when they first appear, those that survive to spread and become fixed are usually among the minority with large effect. Hence, although hundreds of loci of small effect may contribute to variation in character state, adaptation is predominantly caused by alleles of large effect. This leads to the hope that the particular mutations responsible for adaptation to altered conditions of life can be identified and characterized. This has been achieved in some cases and may soon become routine. Furthermore, it raises the possibility that adaptive change can be predicted from a knowledge of genetics and ecology. Experimental evolution suggests that any given selection line that is adapting to changed conditions will follow one of a few themes (broadly speaking, loci), each of which may have many variations (mutations within the locus producing similar phenotypes). Hence, evolutionary change can be predicted only within limits, even in principle. Nevertheless, recent attempts to predict how very simple genomes change have been surprisingly successful, and we may be close to a new predictive understanding of the genetic basis of adaptation.
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Affiliation(s)
- G Bell
- Department of Biology, McGill University, Montréal, Québec, Canada H3A 181.
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Middleton N, Jelen P, Bell G. Whole blood and mononuclear cell glutathione response to dietary whey protein supplementation in sedentary and trained male human subjects. Int J Food Sci Nutr 2009; 55:131-41. [PMID: 14985185 DOI: 10.1080/096374080410001666504] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sedentary male subjects (n=9) on a controlled diet were fed two doses (0.8 or 1.6 g/kg body mass) of a whey protein isolate (WPI), in addition to an isocaloric placebo; blood samples were drawn over a 4-h period and glutathione concentration determined. There was no effect of the supplementation at either level over the 4-h sampling period. The effects of a WPI supplemented diet on glutathione concentrations in whole blood as well as peripheral mononuclear cell populations were also investigated over a 6-week period in male subjects (n=18) involved in arduous aerobic training; blood was collected prior to and following a 40 km simulated cycling trial. The aerobic training period resulted in significantly lower glutathione concentrations in whole blood, an effect that was mitigated by WPI supplementation. A significant increase in mononuclear cell glutathione was also observed in subjects receiving the WPI supplement following the 40 km simulated cycling trial.
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Affiliation(s)
- N Middleton
- Faculty of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
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Griggs R, Herr B, Eagle M, McColl E, Bell G, Tawil R, Pandya S, McDermott M, Bushby K. T.P.5.03 Equipoise concerning corticosteroid use in boys with Duchenne muscular dystrophy: persistent wide variations in practice. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Audit of unplanned hospital admission provides information to guide quality improvement measures and is a crude indicator of quality of care in ambulatory surgery. Our objectives were to re-audit factors relating to this outcome. Previous audit conducted in this unit revealed an unplanned admission rate of 3.7%. Data were collected between April 2000-March 2004. Of 13 592 day surgery patients, 238 (1.8%) unplanned admissions occurred. The admission rate displayed a falling trend and represented a significant improvement over the previous audit (p < 0.001). Unplanned admissions were most commonly caused by nausea/vomiting 23.5% (n = 56), postoperative bleeding 13.9% (n = 34), and unexpected extent/difficulty of procedure 11.8% (n = 28). Of all admissions, 18.5% (n = 44) were following orchidopexy, 16.4% (n = 39) following circumcision, and 12.6% (n = 30) following dental extraction. This audit shows that the unplanned admission rate is low and falling, and compares favourably with other units. Measures have been implemented targeting patients at high risk of admission.
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Affiliation(s)
- D A Blacoe
- West of Scotland School of Anaesthesia, Anaesthetic Department, Gartnavel General Hospital, Glasgow, G12 OYN, UK.
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Perkins MC, Bell G, Briggs D, Davies MC, Friedman A, Hart CA, Roberts CJ, Rutten FJM. The application of ToF-SIMS to the analysis of herbicide formulation penetration into and through leaf cuticles. Colloids Surf B Biointerfaces 2008; 67:1-13. [PMID: 18775653 DOI: 10.1016/j.colsurfb.2008.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 04/06/2008] [Accepted: 04/29/2008] [Indexed: 11/19/2022]
Abstract
Understanding the movement of the active ingredient in relation to the other formulation components following application is crucial to an overall understanding of herbicide performance. We describe the novel use of time-of-flight secondary ion mass spectrometry (ToF-SIMS) as a tool for following the movement of herbicide formulation components into and across plant cuticles. This technique provides new insights since it provides both high (sub-micron) spatial resolution combined with the chemical specificity associated with organic mass spectrometry. The components studied include the oligomeric ethoxylate surfactants Synperonic A7 and A20 and active ingredient Sulfosate (trimesium glyphosate). The movement of these molecules, both separately and when combined in a simple formulation, into the surface of Prunus laurocerasus leaves and across the isolated plant cuticle was investigated and clear differences in penetration/diffusion behaviour were identified. ToF-SIMS was uniquely able to (simultaneously) spatially resolve all the species involved, including the anion and cation components of the active ingredient. Also, using spectral reconstructions from the imaging raw data streams, the behaviour of individual oligomers within the surfactant distributions, could be assessed. The observations are discussed with reference to the action of surfactants identified in parallel micro-structural studies and the current understanding of herbicide uptake.
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Affiliation(s)
- M C Perkins
- Laboratory of Biophysics and Surface Analysis, School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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Abstract
The trophic relationships of an ecological community were represented by digital individuals consuming resources or prey within a simulated ecosystem and producing offspring that may differ from their parents. When individuals meet, a few simple rules are used to decide the outcome of their interaction. Trophically complex systems persist for long periods of time even in finite communities, provided that the strength of predator-prey interaction is sufficient to repay the cost of maintenance. The topology of the food web and important system-level attributes such as overall productivity follow from the rules of engagement: that is, the macroscopic properties of the ecosystem follow from the microscopic attributes of individuals, without the need to invoke the emergence of novel processes at the level of the whole system. Evolutionarily stable webs exist only when the pool of available species is small. If the pool is large, or speciation is allowed, species composition changes continually, while overall community properties are maintained. Ecologically separate and topologically different source webs based on the same pool of resources usually coexist for long periods of time, through negative frequency-dependent selection at the level of the source web as a whole. Thus, the evolved food web of species-rich communities is a highly dynamic structure with continual species turnover. It both imposes selection on each species and itself responds to selection, but selection does not necessarily maximize stability, productivity or any other community property.
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Affiliation(s)
- G Bell
- Redpath Museum and Biology Department, McGill University, Montreal, Quebec, Canada.
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Abstract
AIM To identify potential problems in the quality of care when oral surgery is provided in the primary health care setting. METHOD Retrospective analysis of referral patterns, waiting times, treatment with clinical and histological diagnosis, including complications of 600 patients referred to a practice-based oral surgical referral service. RESULTS Fifty-three patients were not treated. Seventy-nine percent of patients were treated within four weeks of referral. The most common procedure performed was surgical removal of impacted third molar teeth. The most frequently observed complications were dry socket (n = 31/703), pain and inflammation associated with resorbable sutures (n = 11/453), and post-operative infection (n = 9/547). One patient with post-operative infection required care in the acute hospital setting. CONCLUSION Acknowledging the small sample, it was safe and effective to diagnose and treat a broad spectrum of patients and oral surgical problems in the primary health care setting.
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Affiliation(s)
- G Bell
- Oakdale Cottage, Hawksdale, Dalston, Carlisle, Cumbria, UK.
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Al-Aloul M, Jackson M, Bell G, Ledson M, Walshaw M. Comparison of methods of assessment of renal function in cystic fibrosis (CF) patients. J Cyst Fibros 2006; 6:41-7. [PMID: 16807143 DOI: 10.1016/j.jcf.2006.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 04/21/2006] [Accepted: 05/08/2006] [Indexed: 11/21/2022]
Abstract
Renal failure is increasingly being recognised in CF patients, usually as a consequence of long-term nephrotoxic therapy. There is a need for a simple method of assessment of renal function in this patient group. We compared measured creatinine clearance from validated timed urine collections (the generally accepted practical test of glomerular filtration) with 10 formulae used to estimate creatinine clearance in a group of 74 CF adult patients and 29 matched normal controls. Compared to direct measurement, formulae gave a range of values (95% CI for mean bias -13 to +27.9 ml/min). Even those with the best correlation (r=0.7) gave wide error ranges (limits of agreement: -42.3 to 45.9 ml/min). The most commonly used formulae (Cockroft-Gault [CGF] and abbreviated Modification of Diet in Renal Disease [aMDRD]) were not superior to most other formulae tested. Both CGF and aMDRD-derived estimates compared less favourably in CF patients than controls (mean bias: 9.7 vs 3.4 ml/min (p<0.05) and 4.9 vs 1.4 (p<0.05) respectively; 78% vs 95% (p<0.01) and 77% vs 97% (p<0.01) of estimates within 33% of measurement respectively). In particular, both CGF and aMDRD grossly overestimated renal function (mean bias 18.3 and 15.8 ml/min respectively, p<0.001) in CF patients with reduced creatinine clearance (<80 ml/min). CGF, aMDRD and other formulae cannot be used to reliably assess renal function in CF patients, since they will fail to detect those with renal impairment. Some form of carefully supervised direct measurement is still required.
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Affiliation(s)
- M Al-Aloul
- Adult Cystic Fibrosis Unit, The Cardiothoracic Centre, Thomas Drive, Royal Liverpool University Teaching Hospital, L14 3PE, UK
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