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Mehta SK, Suresh R, Brandt K, Diak DM, Smith SM, Zwart SR, Douglas G, Nelman-Gonzalez M, Clemett S, Brunstetter T, Crucian BE. Immune system dysregulation preceding a case of laboratory-confirmed zoster/dermatitis on board the International Space Station. J Allergy Clin Immunol Glob 2024; 3:100244. [PMID: 38577482 PMCID: PMC10992860 DOI: 10.1016/j.jacig.2024.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/07/2023] [Accepted: 01/27/2024] [Indexed: 04/06/2024]
Abstract
A case report detailing, for the first time, a case of laboratory-confirmed zoster in an astronaut on board the International Space Station is presented. The findings of reduced T-cell function, cytokine imbalance, and increased stress hormones which preceded the event are detailed. Relevance for deep space countermeasures is discussed.
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Affiliation(s)
| | - Rahul Suresh
- National Aeronautics and Space Administration, Houston, Tex
| | | | | | - Scott M. Smith
- National Aeronautics and Space Administration, Houston, Tex
| | | | - Grace Douglas
- National Aeronautics and Space Administration, Houston, Tex
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2
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Gehmlich K, Jiang A, Wadmore K, Hooper C, Douglas G, Ehler E, Broadway-Stringer S, Kalisch-Smith J, Sparrow D, Gautel M, Davies B, Watkins H. Crucial functions of alpha-actinin 2 in the embryonic heart. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust; British Heart Foundation
Background/Introduction
Alpha-actinin is an integral protein of the Z-discs in heart and skeletal muscle cells, with important structural and signalling functions. Missense variants in alpha-actinin can cause inherited conditions, e.g. myopathies and cardiomyopathies. The underlying disease mechanisms are still unknown.
Purpose
In order to study the disease mechanisms of an alpha-actinin missense variant, which is known to cause Hypertrophic Cardiomyopathy in human patients, a mouse model was generated.
Methods
Mice carrying the alpha-actinin missense variant were generated by CRISPR-Cas9 genome editing. The heterozygous adult mice carrying the alpha-actinin variant were characterised by echocardiography and quantitative PCR. Hearts of homozygous embryos were analysed at E15.5 by high-resolution episcopic microscopy (HREM).
Results
Mice carrying a single copy of the missense variant were viable and had normal appearance. Adult heterozygous mice showed no signs of cardiomyopathy on echocardiography. However, mature male mice displayed molecular signs of cardiomyopathy, such as induction of the fetal gene programme at transcript level.
The attempt to generate adult mice homozygous for the variant failed: 9 breeding pairs produced 18 litters with 83 weaned pups, but no homozygous offspring. Embryonic lethality was confirmed and E15.5 was the latest stage homozygous pups were reliably found to be viable. At this timepoint, genotype distribution was within the expected Mendelian ratios.
HREM of the hearts at this stage revealed increased right ventricular chamber size and decreased left atrial size, when compared to wildtype littermates. Membranous ventricular septal defects were observed in 3 out of 8 homozygous hearts. Further these embryos displayed aortic stenosis and dysplasic leaflets of the pulmonary valve.
Conclusions
Heterozygous adult mice only displayed sub-clinical signs of disease. In contrast, the missense variant is embryonic lethal in the homozygous setting and leads to a range of morphological abnormalities in E15.5 hearts. Future work will identify how altered functions of alpha-actinin cause these changes.
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Affiliation(s)
- K Gehmlich
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom of Great Britain & Northern Ireland
| | - A Jiang
- University of Oxford, Cardiovascular Medicine , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - K Wadmore
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom of Great Britain & Northern Ireland
| | - C Hooper
- University of Oxford, Cardiovascular Medicine , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - G Douglas
- University of Oxford, Cardiovascular Medicine , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - E Ehler
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - S Broadway-Stringer
- Institute of Cardiovascular Sciences , Birmingham , United Kingdom of Great Britain & Northern Ireland
| | - J Kalisch-Smith
- University of Oxford, Department of Physiology, Anatomy and Genetics , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - D Sparrow
- University of Oxford, Department of Physiology, Anatomy and Genetics , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - M Gautel
- King's College London , London , United Kingdom of Great Britain & Northern Ireland
| | - B Davies
- University of Oxford, Wellcome Centre for Human Genetics , Oxford , United Kingdom of Great Britain & Northern Ireland
| | - H Watkins
- University of Oxford, Cardiovascular Medicine , Oxford , United Kingdom of Great Britain & Northern Ireland
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3
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Robinson HK, Zaklyazminskaya E, Povolotskaya I, Surikova Y, Mallin L, Armstrong C, Mabin D, Benke PJ, Chrisant MR, McDonald M, Marboe CC, Agre KE, Deyle DR, McWalter K, Douglas G, Balashova MS, Kaimonov V, Shirokova N, Pomerantseva E, Turner CL, Ellard S. Biallelic variants in PPP1R13L cause paediatric dilated cardiomyopathy. Clin Genet 2020; 98:331-340. [PMID: 32666529 DOI: 10.1111/cge.13812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/27/2020] [Revised: 06/12/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022]
Abstract
Childhood dilated cardiomyopathy (DCM) is a leading cause of heart failure requiring cardiac transplantation and approximately 5% of cases result in sudden death. Knowledge of the underlying genetic cause can aid prognostication and clinical management and enables accurate recurrence risk counselling for the family. Here we used genomic sequencing to identify the causative genetic variant(s) in families with children affected by severe DCM. In an international collaborative effort facilitated by GeneMatcher, biallelic variants in PPP1R13L were identified in seven children with severe DCM from five unrelated families following exome or genome sequencing and inheritance-based variant filtering. PPP1R13L encodes inhibitor of apoptosis-stimulating protein of p53 protein (iASPP). In addition to roles in apoptosis, iASPP acts as a regulator of desmosomes and has been implicated in inflammatory pathways. DCM presented early (mean: 2 years 10 months; range: 3 months-9 years) and was progressive, resulting in death (n = 3) or transplant (n = 3), with one child currently awaiting transplant. Genomic sequencing technologies are valuable for the identification of novel and emerging candidate genes. Biallelic variants in PPP1R13L were previously reported in a single consanguineous family with paediatric DCM. The identification here of a further five families now provides sufficient evidence to support a robust gene-disease association between PPP1R13L and severe paediatric DCM. The PPP1R13L gene should be included in panel-based genetic testing for paediatric DCM.
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Affiliation(s)
- H K Robinson
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - E Zaklyazminskaya
- Medical Genetics Laboratory, Petrovsky National Research Centre of Surgery, Moscow, Russia.,NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - I Povolotskaya
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - Y Surikova
- Medical Genetics Laboratory, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - L Mallin
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - C Armstrong
- Paediatric Cardiac Service, Bristol Royal Hospital for Children, Bristol, UK
| | - D Mabin
- Paediatrics Service, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - P J Benke
- Clinical Genetics Dpt, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA.,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - M R Chrisant
- Clinical Genetics Dpt, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - M McDonald
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina, USA
| | - C C Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Centre, New York, New York, USA
| | - K E Agre
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - D R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - K McWalter
- Clinical Genomics, GeneDx Inc, Gaithersburg, Maryland, USA
| | - G Douglas
- Clinical Genomics, GeneDx Inc, Gaithersburg, Maryland, USA
| | - M S Balashova
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia.,Chair of Genetics, I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V Kaimonov
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - N Shirokova
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - E Pomerantseva
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - C L Turner
- Peninsula Clinical Genetics Service, Department of Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Ellard
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical and Clinical Science, College of Medicine and Health, Exeter, UK
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4
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Crucian BE, Makedonas G, Sams CF, Pierson DL, Simpson R, Stowe RP, Smith SM, Zwart SR, Krieger SS, Rooney B, Douglas G, Downs M, Nelman-Gonzalez M, Williams TJ, Mehta S. Countermeasures-based Improvements in Stress, Immune System Dysregulation and Latent Herpesvirus Reactivation onboard the International Space Station - Relevance for Deep Space Missions and Terrestrial Medicine. Neurosci Biobehav Rev 2020; 115:68-76. [PMID: 32464118 DOI: 10.1016/j.neubiorev.2020.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 02/11/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
The International Space Station (ISS) has continued to evolve from an operational perspective and multiple studies have monitored both stress and the immune system of ISS astronauts. Alterations were ascribed to a potentially synergistic array of factors, including microgravity, radiation, psychological stress, and circadian misalignment. Comparing similar data across 12 years of ISS construction and operations, we report that immunity, stress, and the reactivation of latent herpesviruses have all improved in ISS astronauts. Major physiological improvements seem to have initiated approximately 2012, a period coinciding with improvements onboard ISS including cargo delivery and resupply frequency, personal communication, exercise equipment and protocols, food quality and variety, nutritional supplementation, and schedule management. We conclude that spaceflight associated immune dysregulation has been positively influenced by operational improvements and biomedical countermeasures onboard ISS. Although an operational challenge, agencies should therefore incorporate, within vehicle design limitations, these dietary, operational, and stress-relieving countermeasures into deep space mission planning. Specific countermeasures that have benefited astronauts could serve as a therapy augment for terrestrial acquired immunodeficiency patients.
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Affiliation(s)
| | | | | | | | - Richard Simpson
- Department of Nutritional Sciences, Department of Pediatrics, Department of Immunobiology, The University of Arizona, Tucson, Arizona, United States
| | | | - Scott M Smith
- NASA Johnson Space Center, Houston, Texas, United States
| | - Sara R Zwart
- University of Texas Medical Branch, Galveston, Texas, United States
| | | | | | - Grace Douglas
- NASA Johnson Space Center, Houston, Texas, United States
| | - Meghan Downs
- NASA Johnson Space Center, Houston, Texas, United States
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5
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Zimmermann J, Remus T, Lemercier G, Barker D, Obrecht D, Gambino G, Douglas G. Anti-tumor cell activity and in vitro profile of the next generation CXCR4 antagonist Balixafortide. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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6
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Patel J, Chuaiphichai S, Douglas G, Channon KM. P342A new role for RGS-1 in vascular function and blood pressure regulation. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.255] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Patel
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - S Chuaiphichai
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - G Douglas
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
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7
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Chuaiphichai S, Rashbrook VS, Hale AB, Trelfa L, Mcneill E, Lygate CA, Channon KM, Douglas G. P350Deficiency in endothelial cell tetrahydrobiopterin increases resistance vascular remodelling, blood pressure, and susceptibility to aortic abdominal aneurysm in response to angiotensin II. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Chuaiphichai
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - V S Rashbrook
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - A B Hale
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - L Trelfa
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - E Mcneill
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - G Douglas
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
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8
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Stadnyk AW, Douglas G, Comeau A, Jain U, Schwaeble W, Stover C, Bieko R, Langille M. A154 PROPERDIN DEFICIENCY DOES NOT IMPACT THE MOUSE RESPONSE TO DSS-INDUCED COLITIS DESPITE DIFFERENCES IN COLONIC MICROBIOME. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.155] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A W Stadnyk
- Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - G Douglas
- Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - A Comeau
- Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - U Jain
- Microbiology and immunology, Dalhousie University, Halifax, NS, Canada
| | - W Schwaeble
- University of Leicester, Leicester, United Kingdom
| | - C Stover
- University of Leicester, Leicester, United Kingdom
| | - R Bieko
- Microbiology and immunology, Dalhousie University, Halifax, NS, Canada
| | - M Langille
- Pediatrics, Dalhousie University, Halifax, NS, Canada
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9
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Gladstone M, McLinden M, Douglas G, Jolley E, Schmidt E, Chimoyo J, Magombo H, Lynch P. 'Maybe I will give some help…. maybe not to help the eyes but different help': an analysis of care and support of children with visual impairment in community settings in Malawi. Child Care Health Dev 2017; 43:608-620. [PMID: 28393382 PMCID: PMC5485081 DOI: 10.1111/cch.12462] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Visual impairment in children is common in low and middle-income settings. Whilst visual impairment (VI) can impact on the development of children, many reach full potential with appropriate early intervention programmes. Although there is increased emphasis on early child development globally, it is not yet clear how to provide specific programmes for children with VI in low and middle-income settings. This study aims to identify facilitators and barriers to the provision of a developmental stimulation programme for children with VI in rural and urban Malawi. METHODS We undertook 6 focus groups, 10 home observations and 20 in-depth interviews with carers of children with VI under 6 years in urban and rural Southern Malawi. We utilised topic guides relating to care, play, communication and feeding. Qualitative data were subject to thematic analysis that included placing themes within Bronfenbrenner's ecological framework. We established authenticity of themes through feedback from participants. RESULTS We identified themes within Bronfenbrenner's framework at five levels: (1) blindness acting as a barrier to stimulation and communication, health and complex needs all affecting the individual child; (2) understanding of VI, ability to be responsive at the microsystem level of the carer; (3) support from other carers at microsystem level within a mesosystem; (4) support from other professionals (knowledge of, identification and management of children with VI, responsibilities and gender roles, environmental safety and prejudice, stigma and child protection all at the level of the exosystem. DISCUSSION This study has revealed the requirements needed in order to produce meaningful and appropriate programmes to support nutrition, care and early stimulation for children with VI in this and similar African settings. This includes supporting carers to understand their child's developmental needs, how to better communicate with, feed and stimulate their child; offering advice sensitive to carers' responsibilities and professional training to better support carers and challenge community stigma.
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Affiliation(s)
- M. Gladstone
- Department of Women and Children's Health, Institute of Translational MedicineUniversity of Liverpool, Alder Hey NHS Children's Foundation TrustLiverpoolUK
| | - M. McLinden
- Visual Impairment Centre for Teaching and Research (VICTAR), School of EducationUniversity of BirminghamBirminghamUK
| | - G. Douglas
- Visual Impairment Centre for Teaching and Research (VICTAR), School of EducationUniversity of BirminghamBirminghamUK
| | - E. Jolley
- Department of Strategic Programme DevelopmentEvidence and Research (SPIDER)SightsaversWest SussexUK
| | - E. Schmidt
- Department of Strategic Programme DevelopmentEvidence and Research (SPIDER)SightsaversWest SussexUK
| | - J. Chimoyo
- Montfort Special Needs Education CollegeLimbeMalawi
| | - H. Magombo
- Montfort Special Needs Education CollegeLimbeMalawi
| | - P. Lynch
- Visual Impairment Centre for Teaching and Research (VICTAR), School of EducationUniversity of BirminghamBirminghamUK
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10
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Abstract
Introduction We wished to obtain a snapshot of current service provision and how this could best be developed approximately one year on from the introduction of the National Institute for Clinical Excellence (NICE) guidelines for the management of chronic obstructive pulmonary disease (COPD) and the inclusion of COPD care in the New GMS Contract Quality and Outcomes Framework (QOF). Methodology A questionnaire-based survey sent to every general practice (n = 84) in Grampian. Results Responses were received from 75 of 84 practices (89%). Questionnaires were returned by both general practitioners (GPs) and practice nurses in 45 practices (54%). All responding practices reported that they had COPD registers. 60/75 (80%) of practices reported having a dedicated COPD clinic; 70/75 (93%) had a spirometer. Areas identified for service development were: quality assuring training in COPD care and spirometry; expanding pulmonary rehabilitation provision (86%), delivering this service locally (54%) and in primary care (75%); standardising referral, assessment and communication about provision of home oxygen; training in pulse oximetry (71%). Conclusion This data has important implications for the validity of the quality indicators (QOF) under the new GMS contract. Our respondents identified areas where the new GMS contract QOF could be improved, as well as providing useful suggestions for service development. Respondents recognised that not all clinical services can be effectively delivered by general practice with data supporting the development of intermediate care services for people with COPD.
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Affiliation(s)
- J Cleland
- Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, University of Aberdeen, AB25 2AY.
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11
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Hulme C, Robinson PG, Saloniki EC, Vinall-Collier K, Baxter PD, Douglas G, Gibson B, Godson JH, Meads D, Pavitt SH. Shaping dental contract reform: a clinical and cost-effective analysis of incentive-driven commissioning for improved oral health in primary dental care. BMJ Open 2016; 6:e013549. [PMID: 27609858 PMCID: PMC5020665 DOI: 10.1136/bmjopen-2016-013549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and cost-effectiveness of a new blended dental contract incentivising improved oral health compared with a traditional dental contract based on units of dental activity (UDAs). DESIGN Non-randomised controlled study. SETTING Six UK primary care dental practices, three working under a new blended dental contract; three matched practices under a traditional contract. PARTICIPANTS 550 new adult patients. INTERVENTIONS A new blended/incentive-driven primary care dentistry contract and service delivery model versus the traditional contract based on UDAs. MAIN OUTCOME MEASURES Primary outcome was as follows: percentage of sites with gingival bleeding on probing. Secondary outcomes were as follows: extracted and filled teeth (%), caries (International Caries Detection and Assessment System (ICDAS)), oral health-related quality of life (Oral Health Impact Profile-14 (OHIP-14)). Incremental cost-effective ratios used OHIP-14 and quality adjusted life years (QALYs) derived from the EQ-5D-3L. RESULTS At 24 months, 291/550 (53%) patients returned for final assessment; those lost to follow-up attended 6.46 appointments on average (SD 4.80). The primary outcome favoured patients in the blended contract group. Extractions and fillings were more frequent in this group. Blended contracts were financially attractive for the dental provider but carried a higher cost for the service commissioner. Differences in generic health-related quality of life were negligible. Positive changes over time in oral health-related quality of life in both groups were statistically significant. CONCLUSIONS This is the first UK study to assess the clinical and cost-effectiveness of a blended contract in primary care dentistry. Although the primary outcome favoured the blended contract, the results are limited because 47% patients did not attend at 24 months. This is consistent with 39% of adults not being regular attenders and 27% only visiting their dentist when they have a problem. Promotion of appropriate attendance, especially among those with high need, necessitates being factored into recruitment strategies of future studies.
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Affiliation(s)
- C Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - P G Robinson
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - E C Saloniki
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - P D Baxter
- Division of Epidemiology & Biostatistics, Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - G Douglas
- School of Dentistry, University of Leeds, Leeds, UK
| | - B Gibson
- Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - J H Godson
- School of Dentistry, University of Leeds, Leeds, UK
| | - D Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - S H Pavitt
- Director of the Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
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12
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Affiliation(s)
| | | | - E P Davison
- Newcastle University Hospitals, University of Newcastle upon Tyne
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13
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Kerr A, Tam L, Cioroch M, Hale A, Douglas G, Channon K, Wade-Martins R. A novel combinatorial non-viral vector to treat familial hypercholesterolaemia (FH). Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Teng Z, Douglas G, Brown A, Sutcliffe M, Gillard J. Impact of fibre orientation in fibrous cap on the mechanical loading in human coronary atherosclerotic plaques. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Corcoran C, Douglas G, Pavey S, Fielding A, McLinden M, McCall S. Network 1000: the changing needs and circumstances of visually-impaired people: project overview. British Journal of Visual Impairment 2016. [DOI: 10.1177/0264619604050045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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
This article outlines the progress of a newly-commissioned three year study known as Network 1000. It is a three-year project funded through the Community Fund and is being carried out by the University of Birmingham on behalf of Vision 2020. The project’s aim is to create a panel survey of 1000 visually-impaired people to be interviewed regularly over the three-year period, and hopefully beyond, enabling their changing needs and circumstances to be monitored over time. The findings will be used to influence policy-makers and service-providers, and will also be disseminated to a wider audience of people with an interest in visual impairment. Building on the longitudinal nature of the project enables the project team to develop a methodology that is both democratic and inclusive. The underlying research philosophy is one of inclusion and participation and in this respect the people this research affects the most - those who are visually impaired - are involved in all stages of the research process. People with a visual impairment have played a key role in generating the data and the themes that will drive the construction of the main survey instrument. The article is divided into five sections that describe the progress of the project to date: first, it briefly outlines the background to the project; second, it describes the underlying philosophy behind the democratic approach to inclusion and participant involvement; third, it presents preliminary results from generative interviews; fourth, it discusses how the team will recruit participants to the project with particular reference to the two-stage sample design that has been adopted; and finally, it describes how this two-stage approach will be operationalized. The article concludes by outlining the next phase of the project and with a short reflection on the research process to date.
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Affiliation(s)
- C. Corcoran
- VICTAR, School of Education, University of Birmingham, Birmingham B15 2TT, UK,
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16
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Dubey S, Agrawal A, Chauhan L, Mukherjee S, Douglas G. Combined trabeculotomy-trabeculectomy with antimetabolite and releasable suture: outcome with primary congenital glaucoma in a north Indian population. Nepal J Ophthalmol 2015; 7:16-25. [PMID: 26695601 DOI: 10.3126/nepjoph.v7i1.13161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the surgical outcomes of combined trabeculotomy- trabeculectomy with mitomycin-C and releasable suture in children with primary congenital glaucoma (PCG) in a North Indian population. DESIGN Retrospective, interventional, consecutive, non-comparative case series. MATERIALS AND METHODS The medical records of 137 eyes of 77 patients who underwent combined trabeculotomy- trabeculectomy with 0.2 mg/ml mitomycin C (MMC) either bilaterally (49 patients) or unilaterally (28 patients) between January 2004 and March 2012 were reviewed retrospectively. The main outcome measures were postoperative intraocular pressures, corneal clarity and diameter, duration of follow-up, success rate and complications. RESULTS The mean preoperative intraocular pressure reduced from 34 ± 7 mm Hg (range 15- 54 mm Hg) to 17 ± 7 mm Hg (range 5 - 32 mm Hg) with a mean reduction of 44 % (P less than 0.001). The mean follow-up period was 24.4 ± 10.3 months (range 6 - 48 months). Complete success defined as intraocular pressure less than 21 mm Hg without any medication and clinically stable glaucoma at last follow-up was achieved in 113 eyes (83 %) while a 'qualified success' of intraocular pressure less than 21 mm Hg with one medication was achieved in ten eyes (7 %). The Kaplan-Meier survival analysis revealed success rates (at 'n' months) of 90 % (6), 85 % (12), 82 % (24), 80 % (36) and 77 % (48). There were no significant intraoperative or postoperative complications. CONCLUSION Primary combined trabeculotomy-trabeculectomy with mitomycin-C and releasable suture offers a viable surgical option in Northern Indian infants with primary congenital glaucoma. The use of 0.2 mg/ml mitomycin C for 2 minutes improves the overall success while the releasable suture decreases the risk of postoperative complications especially associated with the use of antimetabolites.
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Affiliation(s)
- S Dubey
- Dr Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj New Delhi 110002, India
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Patel J, McNeill E, Douglas G, Hale A, De Bono J, Lee R, Iqbal A, Regan-Komito D, Stylianou E, Greaves D, Channon K. Rgs-1 regulates leukocyte trafficking in atherosclerosis and aortic aneurysm formation through altered chemokine signalling. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chuaiphichai S, Mcneill E, Douglas G, Crabtree MJ, Bendall JK, Hale AB, Alp NJ, Channon KM. 303A cell-Autonomous role for endothelial GTP cyclohydrolase 1 and tetrahydrobiopterin in blood pressure regulation. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu089.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patel J, Mcneill E, Douglas G, Hale A, De Bono J, Greaves DR, Channon KM. P623RGS-1 modulates leukocyte trafficking in atherosclerosis and aortic aneurysm formation through chemokine receptor desensitisation. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Patel J, McNeill E, Douglas G, de Bono J, Greaves D, Channon K. A new role for the regulator of g-protein signalling-1 in inflammatory cell function in angiotensin II-induced aortic aneurysm formation. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2013.11.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pelletier M, Paddock V, Leblanc H, Forgie R, Archer B, Ferguson D, Douglas G, Yip A, Hassan A. The Effect of Transcatheter Aortic Valve Implantation (TAVI) on Cognitive Function. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.360] [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: 10/26/2022] Open
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Douglas G, Adeney J, Johnston K, Wendling L, Coleman S. Major element, trace element, nutrient, and radionuclide mobility in a mining by-product-amended soil. J Environ Qual 2012; 41:1818-1834. [PMID: 23128739 DOI: 10.2134/jeq2012.0139] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study investigates the use of a mineral processing by-product, neutralized used acid (NUA), primarily composed of gypsum and Fe-oxyhydroxide, as a soil amendment. A 1489-d turf farm field trial assessed nutrient, trace element, and radionuclide mobility of a soil amended with ∼5% by mass to a depth of 15 cm of NUA. Average PO-P fluxes collected as subsoil leachates were 0.7 and 26.6 kg ha yr for NUA-amended and control sites, respectively, equating to a 97% reduction in PO-P loss after 434 kg P ha was applied. Total nitrogen fluxes in NUA-amended soil leachates were similarly reduced by 82%. Incorporation of NUA conferred major changes in leachate geochemistry with a diverse suite of trace elements depleted within NUA-amended leachates. Gypsum dissolution from NUA resulted in an increase from under- to oversaturation of the soil leachates for a range of Fe- and Ca-minerals including calcite and ferrihydrite, many of which have a well-documented ability to assimilate PO-P and trace elements. Isotopic analysis indicated little Pb addition from NUA. Both Sr and Nd isotope results revealed that NUA and added fertilizer became an important source of Ca to leachate and turf biomass. The NUA-amended soils retained a range of U-Th series radionuclides, with little evidence of transfer to soil leachate or turf biomass. Calculated radioactivity dose rates indicate only a small increment due to NUA amendment. With increased nutrient, trace element, and solute retention, and increased productivity, a range of potential agronomic benefits may be conferred by NUA amendment of soils, in addition to the potential to limit offsite nutrient loss and eutrophication.
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Affiliation(s)
- G Douglas
- CSIRO Land and Water, WA, Australia.
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Fan L, Douglas G, Bendall J, McNeill E, Channon K. C Endothelial specific Nox2 over-expression increases susceptibility to angiotensin II induced aortic dissection. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877a.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Keir SD, Spina D, Douglas G, Herd C, Page CP. Airway responsiveness in an allergic rabbit model. J Pharmacol Toxicol Methods 2011; 64:187-95. [PMID: 21854860 DOI: 10.1016/j.vascn.2011.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 08/02/2011] [Accepted: 08/03/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Animal models of allergy and bronchial hyperresponsiveness (BHR) are useful in researching pulmonary diseases and evaluating drug effects on the airways. Neonatally immunised rabbits exhibit several features of asthma as adults, including early and late airway responses following antigen challenge, oedema and inflammatory cell infiltration into the lung, BHR to inhaled histamine and methacholine (compared with naïve rabbits) and exacerbations of BHR following antigen challenge. Therefore this model can be used to investigate the underlying mechanisms of BHR and for the preclinical evaluation of new drugs for the treatment of asthma. AIM To describe the characteristics of airway responses in a rabbit model of allergic inflammation and to evaluate the relationship between skin test reactivity to antigen, airway inflammation and BHR. METHODS New Zealand White rabbits were neonatally immunised against Alternaria tenius. At 3 months of age, airway responsiveness was measured to aerosolised histamine, methacholine or allergen. Bronchoalveolar lavage (BAL) was performed and cell counts recorded. Direct skin tests were performed to assess skin reactivity to allergen and passive cutaneous anaphylaxis (PCA) tests were performed to determine titres of circulating IgE. RESULTS In a population of allergic rabbits, allergen challenge induced a significant bronchoconstriction, airway inflammation and BHR. Skin test responsiveness to allergen did not correlate with various indices of pulmonary mechanics e.g. baseline sensitivity to methacholine and histamine, or allergen-induced BHR. In contrast, skin test responsiveness did predict airway inflammation as assessed by measurements of eosinophil recruitment to the lung. CONCLUSION The allergic rabbit is a useful model to further our understanding of allergic diseases. Recording lung function using a minimally invasive procedure allows repeated measurements to be made in rabbits longitudinally, and each animal may thus be used as its own control. Our observations do not support the use of skin responsiveness to allergen as a predictor of airway sensitivity as we observed no correlation between skin sensitivity and airway responsiveness to inhaled histamine, methacholine or allergen. However, skin reactivity did predict airway inflammation as assessed by measurements of eosinophil recruitment to the lung. Our results also further highlight the likely dissociation between airway inflammation and BHR.
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Affiliation(s)
- S D Keir
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, 5th Floor Franklin Wilkins Building, Waterloo Campus, London, SE1 9NH, UK
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Douglas G, Douglas K, Henry F. George Keith Douglas. West J Med 2011. [DOI: 10.1136/bmj.d4405] [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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Fan L, Douglas G, Bendall J, Channon K. Targeted endothelial Nox2 over-expression potentiates angiotensin ii induced aortic dissection in mice. Atherosclerosis 2010. [DOI: 10.1016/j.atherosclerosis.2010.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Douglas G. William Richard Easy. West J Med 2010. [DOI: 10.1136/bmj.c4520] [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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Barker B, Macfarlane J, Lim WS, Douglas G, Macfarlane J. Local guidelines for management of adult community acquired pneumonia: a survey of UK hospitals. Thorax 2009; 64:181. [DOI: 10.1136/thx.2007.095216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Duthie S, Black C, Douglas G, Jackson AD, Webster D. Tuberculosis outbreak associated with a mosque: challenges of large scale contact tracing. Euro Surveill 2008. [DOI: 10.2807/ese.13.51.19069-en] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this report, we describe the investigation and management of an outbreak of TB associated with a mosque in Scotland, and consider the implications of large-scale TB contact tracing. In 2005, an Algerian man living in the north-east of Scotland was found to be sputum smear-positive for TB. Initial investigation identified three (18.8%) close contacts with active disease. Due to the high rate of transmission, contact tracing was extended to casual contacts of the index case at a mosque. No sub-group at highest risk of exposure could be defined at the mosque. Screening of mosque attendees identified two cases (0.53%), with a further two identified by review of existing cases and enhanced surveillance. Two additional cases were linked to the outbreak by genetic profile. Response to the screening exercise was initially poor, but after modification of the communication strategy, 438 people were offered screening with 86% attending. The investigation and management of a TB outbreak is challenging and requires a complex message about risk to be communicated. In a mosque setting, there were additional complexities that, to the best of our knowledge, have not been reported previously. It was crucial, in designing the communication strategy, to identify key individuals within the community to assist with tailoring the message to address risk perception and to help to deliver the message. Despite this, approximately 50% of those considered to have the highest exposure (adult males regularly attending Friday lunchtime prayer meetings) did not come forward for screening. The screening of casual contacts in this setting was complex and time-consuming with a low detection rate.
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Affiliation(s)
- S Duthie
- Health Protection, NHS Grampian, Aberdeen, United Kingdom
| | - C Black
- University of Aberdeen, Aberdeen, United Kingdom
- Health Protection, NHS Grampian, Aberdeen, United Kingdom
| | - G Douglas
- Health Protection, NHS Grampian, Aberdeen, United Kingdom
| | - A D Jackson
- Health Protection Scotland, Glasgow, United Kingdom
| | - D Webster
- Health Protection, NHS Grampian, Aberdeen, United Kingdom
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Duthie S, Black C, Douglas G, Jackson AD, Webster D. Tuberculosis outbreak associated with a mosque: challenges of large scale contact tracing. Euro Surveill 2008; 13:19069. [PMID: 19094914] [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: 05/27/2023] Open
Abstract
In this report, we describe the investigation and management of an outbreak of TB associated with a mosque in Scotland, and consider the implications of large-scale TB contact tracing. The screening of casual contacts in this setting was complex and time-consuming with a low detection rate.
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Affiliation(s)
- S Duthie
- Health Protection, NHS Grampian, Aberdeen, United Kingdom
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Douglas G, Caitcheon G, Palmer M. Sediment source identification and residence times in the Maroochy River estuary, southeast Queensland, Australia. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s00254-008-1336-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rodushkin I, Bergman T, Douglas G, Engström E, Sörlin D, Baxter DC. Authentication of Kalix (N.E. Sweden) vendace caviar using inductively coupled plasma-based analytical techniques: Evaluation of different approaches. Anal Chim Acta 2007; 583:310-8. [PMID: 17386561 DOI: 10.1016/j.aca.2006.10.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 10/19/2006] [Accepted: 10/26/2006] [Indexed: 10/23/2022]
Abstract
Different analytical approaches for origin differentiation between vendace and whitefish caviars from brackish- and freshwaters were tested using inductively coupled plasma double focusing sector field mass spectrometry (ICP-SFMS) and multi-collector inductively coupled plasma mass spectrometry (MC-ICP-MS). These approaches involve identifying differences in elemental concentrations or sample-specific isotopic composition (Sr and Os) variations. Concentrations of 72 elements were determined by ICP-SFMS following microwave-assisted digestion in vendace and whitefish caviar samples from Sweden (from both brackish and freshwater), Finland and USA, as well as in unprocessed vendace roe and salt used in caviar production. This data set allows identification of elements whose contents in caviar can be affected by salt addition as well as by contamination during production and packaging. Long-term method reproducibility was assessed for all analytes based on replicate caviar preparations/analyses and variations in element concentrations in caviar from different harvests were evaluated. The greatest utility for differentiation was demonstrated for elements with varying concentrations between brackish and freshwaters (e.g. As, Br, Sr). Elemental ratios, specifically Sr/Ca, Sr/Mg and Sr/Ba, are especially useful for authentication of vendace caviar processed from brackish water roe, due to the significant differences between caviar from different sources, limited between-harvest variations and relatively high concentrations in samples, allowing precise determination by modern analytical instrumentation. Variations in the 87Sr/86Sr ratio for vendace caviar from different harvests (on the order of 0.05-0.1%) is at least 10-fold less than differences between caviar processed from brackish and freshwater roe. Hence, Sr isotope ratio measurements (either by ICP-SFMS or by MC-ICP-MS) have great potential for origin differentiation. On the contrary, it was impossible to differentiate between Swedish caviar processed from brackish water roe and Finnish freshwater caviar based solely on 187Os/188Os ratios.
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Affiliation(s)
- I Rodushkin
- Division of Applied Geology, Luleå University of Technology, S-971 87 Luleå, Sweden.
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Jean W, Fisher V, Grubb L, Douglas G, Ostrosky-Zeichner L. Infection Control as the Real Bug Patrol: “Gnats” in the Burn Unit. Am J Infect Control 2006. [DOI: 10.1016/j.ajic.2006.05.129] [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: 10/24/2022]
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Tam CW, Husmann K, Clark NC, Clark JE, Lazar Z, Ittner LM, Götz J, Douglas G, Grant AD, Sugden D, Poston L, Poston R, McFadzean I, Marber MS, Fischer JA, Born W, Brain SD. Enhanced Vascular Responses to Adrenomedullin in Mice Overexpressing Receptor-Activity–Modifying Protein 2. Circ Res 2006; 98:262-70. [PMID: 16373602 DOI: 10.1161/01.res.0000200737.63865.58] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [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: 11/16/2022]
Abstract
Adrenomedullin (AM) levels are elevated in cardiovascular disease, but little is known of the role of specific receptor components. AM acts via the calcitonin receptor-like receptor (CLR) interacting with a receptor-activity–modifying protein (RAMP). The AM
1
receptor is composed of CLR and RAMP2, and the calcitonin gene–related peptide (CGRP) receptor of CLR and RAMP1, as determined by molecular and cell-based analysis. This study examines the relevance of RAMP2 in vivo. Transgenic (TG) mice that overexpress RAMP2 in smooth muscle were generated. The role of RAMP2 in the regulation of blood pressure and in vascular function was investigated. Basal blood pressure, acute angiotensin II–raised blood pressure, and cardiovascular properties were similar in wild-type (WT) and TG mice. However, the hypotensive effect of IV AM, unlike CGRP, was enhanced in TG mice (
P
<0.05), whereas a negative inotropic action was excluded by left-ventricular pressure–volume analysis. In aorta relaxation studies, TG vessels responded in a more sensitive manner to AM (EC
50
, 8.0±1.5 nmol/L) than WT (EC
50
, 17.9±3.6 nmol/L). These responses were attenuated by the AM receptor antagonist, AM
22-52
, such that residual responses were identical in all mice. Remaining relaxations were further inhibited by CGRP receptor antagonists, although neither affected AM responses when given alone. Mesenteric and cutaneous resistance vessels were also more sensitive to AM in TG than WT mice. Thus RAMP2 plays a key role in the sensitivity and potency of AM-induced hypotensive responses via the AM
1
receptor, providing evidence that this receptor is a selective target for novel therapeutic approaches.
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Affiliation(s)
- C W Tam
- Cardiovascular Division, King's College London, United Kingdom
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Abstract
Dietary soy intake in man is proposed to provide cardiovascular protection, but it is not established whether this property is attributable to the soy protein per se or to associated dietary isoflavones. This investigation aimed to establish whether the dietary isoflavones in soy protein affect cardiovascular function. Ten days prior to mating, male and female Wistar rats were habituated to either a soy based isoflavone rich diet (plasma concentration 1.87 micromol l(-1) isoflavones) or the same diet after isoflavone elution (plasma isoflavone not detectable). Offspring were weaned onto and maintained on the same diet as their dam and sire for 6 months. Blood pressure, and constrictor and dilator responses in the aorta and mesenteric resistance arteries were assessed at 3 and 6 months of age. There was no effect of isoflavone removal from the diet on blood pressure, heart rate, aortic function or mesenteric artery contractile function, at either 3 or 6 months of age. Resistance mesenteric arteries from 6-month-old female rats fed the isoflavone rich diet demonstrated a modest increase in arterial distensibility compared with those fed the depleted diet, and mesenteric arteries from male and female rats fed the isoflavone rich diet showed increased sensitivity to acetylcholine. In summary, the isoflavone content of soy protein has no influence on blood pressure in healthy rats fed a diet based on soy protein, but influences small artery function.
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Affiliation(s)
- G Douglas
- Division of Reproductive Health, Endocrinology and Development, Medical School of Guy's, King's and St Thomas' Hospital, King's College LondonLondon, UK
| | - J A Armitage
- Division of Reproductive Health, Endocrinology and Development, Medical School of Guy's, King's and St Thomas' Hospital, King's College LondonLondon, UK
| | - P D Taylor
- Division of Reproductive Health, Endocrinology and Development, Medical School of Guy's, King's and St Thomas' Hospital, King's College LondonLondon, UK
| | - J R Lawson
- Special Diets ServicesPO Box 705, Witham, Essex, UK
| | - G E Mann
- Cardiovascular Division, King's College London, New Hunts HouseGuy's Campus, London, UK
| | - L Poston
- Division of Reproductive Health, Endocrinology and Development, Medical School of Guy's, King's and St Thomas' Hospital, King's College LondonLondon, UK
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Khan IY, Dekou V, Douglas G, Jensen R, Hanson MA, Poston L, Taylor PD. A high-fat diet during rat pregnancy or suckling induces cardiovascular dysfunction in adult offspring. Am J Physiol Regul Integr Comp Physiol 2004; 288:R127-33. [PMID: 15308487 DOI: 10.1152/ajpregu.00354.2004] [Citation(s) in RCA: 257] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Epidemiological and animal studies suggest that diet-induced epigenetic modifications in early life can contribute to development of the metabolic syndrome in adulthood. We previously reported features of the metabolic syndrome in adult offspring of rats fed a diet rich in animal fat during pregnancy and suckling. We now report a study to compare the relative effects of high-fat feeding during 1) pregnancy and 2) the suckling period in the development of these disorders. As observed previously, 6-mo-old female offspring of fat-fed dams suckled by the same fat-fed dams (OHF) demonstrated raised blood pressure, despite being fed a balanced diet from weaning. Female offspring of fat-fed dams "cross fostered" to dams consuming a control diet during suckling (OHF/C) demonstrated raised blood pressure compared with controls (OC) [systolic blood pressure (SBP; mmHg) means +/- SE: OHF/C, 132.5 +/- 3.0, n = 6 vs. OC, 119.0 +/- 3.8, n = 7, P < 0.05]. Female offspring of controls cross fostered to dams consuming the fat diet (OC/HF) were also hypertensive [SBP (mmHg) 131.0 +/- 2.5 mmHg, n = 6 vs. OC, P < 0.05]. Endothelium-dependent relaxation (EDR) of male and female OHF and OHF/C mesenteric small arteries was similar and blunted compared with OC (P < 0.001). OC/HF arteries showed profoundly impaired EDR (OC/HF vs. OHF, P < 0.001). OHF/C and OC/HF demonstrated hyperinsulinemia and increased adiposity. Features of the metabolic syndrome in adult offspring of fat-fed rats can be acquired both antenatally and during suckling. However, exposure during pregnancy confers adaptive protection against endothelial dysfunction induced by maternal fat feeding during suckling.
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Affiliation(s)
- I Y Khan
- Maternal and Fetal Research Unit, Division of Reproductive Health, Endocrinology and Development,King's College, London, UK
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Mudu P, Migliore G, Alderisio M, Morosini P, Douglas G, Navone R, Montanari G, Di Bonito L, Vitali A, Moretti D, Giovagnoli MR, Fulciniti F, Branca M, Vitale A. Papnet-assisted cytological diagnosis intensifies the already marked variability among cytological laboratories. EUR J GYNAECOL ONCOL 2002; 23:211-5. [PMID: 12094957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE The main objective was to assess the sensitivity, specificity and reliability of PAPNET-assisted diagnosis in comparison with conventional screening. SETTING Seven Italian and one English University or Research Institutes, and a random sample of an other 20 Italian Laboratories of the Italian National Health Service (INHS) provided the cervical smears. METHODS During the training phase every center examined in rotation four sets of slides for a total of 300 representative slides. Afterwards, 900 "positive" slides were added to the 3,100 slides which were collected consecutively without any selection or exclusion. The eight main centers were divided into four couples and each couple of centers examined 775 slides with the PAPNET system, "blindly" to the original diagnosis. An expert cytopathologist (M.A.) of the National Institute of Health (NIH) reassessed 40% of the slides with an original negative diagnosis to evaluate the false negative rate. Two expert NIH cytopathologists (M.A., G.M.) re-examined all slides where a disagreement had been observed between the original and one or both of the study diagnoses. The main analyses concerned the following three main categories: WNL and unsatisfactory for evaluation; ASCUS, AGUS and LSIL; HSIL and carcinoma. A special algorithm was devised to define the reference diagnosis for sensitivity and specificity assessment. RESULTS Laboratories, even belonging to the same couple, classified as "no review" a very different proportion of slides ranging from 35% to 74%. The index of kappa agreement between the members of couples examining the same sets of slides was low or very low, ranging from 0.30 to 0.03. The sensitivity of the review classification was particularly low in some laboratories. Surprisingly, only a small correlation was observed between the sensitivity of the review classification and the proportion of slides classified as "review". The "tentative" diagnosis on PAPNET tiles of the "review" slides was almost as reliable as the microscopic diagnosis. In the overall performance, there were many significant differences among the eight laboratories. The best laboratory had a sensitivity of 95% and a specificity of 96%. At least three laboratories displayed unacceptably low sensitivity and one a very low specificity. CONCLUSION Altogether these results seem to confirm that there are wide differences among cytological laboratories per se, and that these differences are intensified by the use of an instrument like PAPNET. The huge variation in performance may be explained by differences in basic skills and by different training, but it is difficult to understand exactly what could have been done to reduce it.
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Cadwgan A, Laing R, Molyneaux P, Robson D, Beadsworth M, Mackenzie A, Douglas G. An outbreak of hepatitis A in injection drug users. J Infect 2002. [DOI: 10.1016/s0163-4453(02)90292-6] [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: 12/01/2022]
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Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, Douglas G, Muers M, Smith D, White J. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess 2002; 5:1-149. [PMID: 11701099 DOI: 10.3310/hta5260] [Citation(s) in RCA: 176] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are common diseases of the airways and lungs that have a major impact on the health of the population. The mainstay of treatment is by inhalation of medication to the site of the disease process. This can be achieved by a number of different device types, which have wide variations in costs to the health service. A number of different inhalation devices are available. The pressurised metered-dose inhaler (pMDI) is the most commonly used and cheapest device, which may also be used in conjunction with a spacer device. Newer chlorofluorocarbons (CFC)-free inhaler devices using hydrofluoroalkanes (HFAs) have also been developed. The drug is dissolved or suspended in the propellant under pressure. When activated, a valve system releases a metered volume of drug and propellant. Other devices include breath-actuated pMDIs (BA-pMDI), such as Autohaler and Easi-Breathe. They incorporate a mechanism activated during inhalation that triggers the metered-dose inhaler. Dry powder inhalers (DPI), such as Turbohaler, Diskhaler, Accuhaler and Rotahaler, are activated by inspiration by the patient. The powdered drug is dispersed into particles by the inspiration. With nebulisers oxygen, compressed air, or ultrasonic power is used to break up solutions or suspensions of medication into droplets for inhalation. The aerosol is administered by mask or by a mouthpiece. There has been no previous systematic review of the evidence of clinical effectiveness and cost-effectiveness of these different inhaler devices. OBJECTIVES To review systematically the clinical effectiveness and cost-effectiveness of inhaler devices in asthma and COPD. METHODS The different aspects of inhaler devices were separated into the most clinically relevant comparisons. Methods involved systematic searching of electronic databases and bibliographies for randomised controlled trials (RCTs) and systematic reviews. Pharmaceutical companies and experts in the field were contacted for further information. Trials that met the inclusion criteria were appraised and data extraction was under-taken by one reviewer and checked by a second reviewer, with any discrepancies being resolved through agreement. RESULTS--IN VITRO CHARACTERISTICS VERSUS IN VIVO TESTING AND CLINICAL RESPONSE: There is evidence that when comparative testing is performed on inhaler devices using the same methods, there is some correlation between particle size measurements and clinical response. However, the measurements are dependent upon the methods used, and a single measure of a device in isolation is of limited value. Also, there is little data on comparing devices of different types. There is currently insufficient data to verify the ability of in vitro assessments to predict inhaler performance in vivo. RESULTS--EFFECTIVENESS OF METERED-DOSE INHALERS FOR THE DELIVERY OF CORTICOSTEROIDS IN ASTHMA: The review of three trials in children and 21 trials in adults demonstrated no evidence to suggest clinical benefits of any other inhaler device over a pMDI in corticosteroid delivery. RESULTS--EFFECTIVENESS OF METERED-DOSE INHALERS FOR THE DELIVERY OF BETA-AGONISTS IN STABLE ASTHMA: In children, 11 studies were reviewed, of which seven compared the Turbohaler with the pMDI. One study found a significant treatment difference in peak expiratory flow rate, although there were differences in the patients' baseline characteristics. In adults, a review of 70 studies found no demonstrable difference in the clinical bronchodilator effect of short-acting b2-agonists delivered by the standard pMDI compared with that produced by any other DPI, HFA-pMDI or the Autohaler device. The finding that HFA-pMDIs may reduce treatment failure and oral steroid requirement in beta-agonist delivery needs further confirmatory research in adequately randomised clinical trials. RESULTS--EFFECTIVENESS OF NEBULISERS VERSUS METERED-DOSE INHALERS FOR THE DELIVERY OF BRONCHODILATORS IN STABLE ASTHMA: In children, three included trials compared different devices with a nebuliser and demonstrated no evidence of clinical superiority of nebulisers over inhaler devices in bronchodilator delivery. A total of 23 studies in adults found no equivalence for the main pulmonary outcomes and no evidence of difference in other outcomes. RESULTS--EFFECTIVENESS OF METERED-DOSE INHALERS FOR THE DELIVERY OF BETA-AGONISTS IN COPD: Only two studies were included in this review. No evidence of clinical difference was found in beta-agonist delivery. RESULTS--EFFECTIVENESS OF NEBULISERS VERSUS METERED-DOSE INHALERS FOR THE DELIVERY OF BRONCHODILATORS IN COPD: Evidence from 14 trials demonstrated equivalence for the main outcomes of pulmonary function. For other outcomes there was no evidence of treatment difference in bronchodilator delivery. RESULTS--PATIENTS' ABILITY TO USE METERED-DOSE INHALERS: Differences among studies and the heterogeneity of the results make it difficult to draw conclusions about inhaler technique differences between device types. The review of technique after teaching the correct technique suggests that there is no difference in patients' ability to use DPI or pMDIs. RESULTS--ECONOMIC ANALYSIS: The total number of NHS prescriptions for inhaler therapy for asthma in 1998 was over 31 million, with a net ingredient cost in excess of 392 million GB pounds. This economic assessment uses decision analysis to estimate the relative cost-effectiveness of inhaler devices for the delivery of bronchodilator and corticosteroid inhaled therapy. Overall, there were no differences in patient outcomes among the devices. On the assumption that the devices were clinically equivalent, pMDIs were the most cost-effective devices for asthma treatment. CONCLUSIONS This systematic review examined the evidence from clinical trials evaluating the clinical effectiveness of different inhaler devices in the delivery of inhaled corticosteroids and beta2-bronchodilators for patients with asthma and COPD. The evidence from the published clinical literature demonstrates no difference in clinical effectiveness between nebulisers and alternative inhaler devices compared to standard pMDI with or without a spacer device. The cost-effectiveness evidence therefore favours pMDIs (or the cheapest inhaler device) as first-line treatment in all patients with stable asthma unless other specific reasons are identified. Patients can use pMDIs as effectively as other inhaler devices as long as the correct inhalation technique is taught. CONCLUSIONS--RECOMMENDATIONS FOR RESEARCH: Further clinical trials are required to demonstrate any differences in the clinical effectiveness and cost-effectiveness of inhaler devices and nebulisers compared with pMDIs. These should be of sufficient statistical power and methodological rigour to demonstrate any clinical benefit. Trials should be undertaken in community settings to ensure the generalisability of results. Outcome measures should be more patient-centred and report adverse effects more completely. Reporting of data from trials should be improved.
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Affiliation(s)
- D Brocklebank
- Department of Epidemiology and Public Health, Bradford Hospitals NHS Trust, UK
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Anderson V, Carneiro M, Bulterys M, Douglas G, Polliotti B, Slikker W. Perinatal infections: HIV and co-infections in the placenta and therapeutic interventions-a workshop report. Placenta 2001; 22 Suppl A:S34-7. [PMID: 11312626 DOI: 10.1053/plac.2001.0641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- V Anderson
- Department of Pathology, SUNY-HSC at Brooklyn, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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West J, Douglas G, Houghton S, Lawrence V, Whiting K, Glasgow K. Time perception in boys with attention-deficit/hyperactivity disorder according to time duration, distraction and mode of presentation. Child Neuropsychol 2000; 6:241-50. [PMID: 11992188 DOI: 10.1076/chin.6.4.241.3140] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In a recent theoretical model of attention-deficit/hyperactivity disorder (ADHD), Barkley (1997a) predicted that ADHD children experience impairments in their psychological sense of time. This was demonstrated in a series of experiments by Barkley, Koplowicz, Anderson, and McMurray (1997). The present study sought to investigate the effects of ADHD subtype, stimulus duration, mode of presentation (visual versus auditory) and distractors on the performance of a simple time reproduction task. Data were obtained from 44 ADHD children (14 predominantly inattentive and 30 combined type) and 44 age-matched Controls using the Time Perception Application version 1.0 (Barkley, University of Massachusetts Medical Center, 1998). Results revealed that the ADHD children made significantly larger errors on Visual time reproduction tasks than the Controls, regardless of ADHD subtype or the presence of distractors. Furthermore, ADHD children were more likely to overestimate the shorter time intervals (0.5 and 2 s) and underestimate the longer time intervals (3, 4 and 6 s) relative to Controls. No group differences were observed on the auditory time reproduction task, with both ADHD and Control groups consistently underestimating the durations to be reproduced. The results of this study provide further support for the prediction that children with ADHD have an impaired sense of time.
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Affiliation(s)
- J West
- University of Western Australia, Nedlands, 6009, Australia.
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Houghton S, Douglas G, West J, Whiting K, Wall M, Langsford S, Powell L, Carroll A. Differential patterns of executive function in children with attention-deficit hyperactivity disorder according to gender and subtype. J Child Neurol 1999; 14:801-5. [PMID: 10614567 DOI: 10.1177/088307389901401206] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present investigation examined differential patterns in executive functions of children with attention-deficit hyperactivity disorder (ADHD; no diagnosed comorbid disorders) according to subtype and gender, and identified instrumentation sensitive to executive function in children aged 6 to 12 years with ADHD. Data were obtained from 94 children diagnosed with ADHD (predominantly inattentive, n = 32, ADHD combined, n = 62), and from 28 controls. Participants with ADHD, who were unmedicated at the time of testing, were administered five tests of executive function (the Wisconsin Card Sorting Test, the Stroop Color-Word Test, the Matching Familiar Figures Test, the Trail Making Test, and the Tower of London). A two-way multivariate analysis of covariance with age as the covariate and subtype and gender as the independent variables was conducted on all of the tests administered. While children with ADHD predominantly inattentive and those with ADHD combined differed from controls, it was only the latter subtype that differed significantly in perseveration and response inhibition. The absence of diagnosed comorbidity in the children with ADHD at the time of test administration demonstrates that the impairments in executive function are clearly located in ADHD, particularly in the ADHD combined subtype, thus providing support for Barkley's proposed unifying theory of ADHD.
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Affiliation(s)
- S Houghton
- Graduate School of Education, University of Western Australia, Perth, Australia.
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Gadd CS, Friedman CP, Douglas G, Miller DJ. Information resources assessment of a healthcare integrated delivery system. Proc AMIA Symp 1999:525-9. [PMID: 10566414 PMCID: PMC2232856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations.
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Affiliation(s)
- C S Gadd
- Department of Medicine, University of Pittsburgh, PA, USA
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Abstract
Data pertaining to prevalence and frequency of drug use were obtained from 1,394 Western Australian metropolitan high school students using a self-report questionnaire. Alcohol, marijuana, tobacco, hallucinogens, and amphetamines were reported as the most prevalent substances, with over 50% of "current drug users" using alcohol and marijuana on a frequent basis (i.e., weekly to more than once per day). Significant interactions existed between Gender and prevalence of tobacco and hallucinogens; and School Year Level and prevalence of tobacco, alcohol, hallucinogens and amphetamines. In terms of the frequency of use, significant interactions were found between Gender and marijuana; and between School Year Level and tobacco. Approximately 40% of substance-using participants used one single substance, 40% used two or three substances, and 20% used four or more substances. The results suggest there is a need for educators to have a greater understanding of the patterns of substance use in order for them to more aptly shape drug education programs.
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Affiliation(s)
- P Odgers
- Graduate School of Education, University of Western Australia, Nedlands
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Affiliation(s)
- C Bodner
- Department of Medicine and Therapeutics, University of Aberdeen
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Abstract
Data pertaining to self-reported substance use, reputation enhancement, self-concept and coping strategies were obtained from 1,204 Western Australian metropolitan state high school adolescents using the High School Student Activity Questionnaire. Previous research has identified low self-concept levels and inadequate coping strategies as being major contributors to adolescent substance use. The findings of the present research offer some support for this. A 4 x 2 x 3 MANOVA revealed, however, that reputation enhancement differentiated between current substance users, ex-users and non-users to a greater extent than either self-concept levels or coping strategies. Differences between male and female students, however, were identified more through self-concept and coping variables than by reputation enhancement variables. No interaction effect and no main effect for year group were present. The implications for drug education are discussed.
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Affiliation(s)
- P Odgers
- Graduate School of Education, University of Western Australia, Perth, Australia
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Ross S, Godden D, Friend J, Legge J, Douglas G. Incidence and prognosis of asthma to age 33. Asthma or wheezy bronchitis in childhood is independent risk factor for wheezing symptoms in adulthood. BMJ 1996; 313:815. [PMID: 8842086 PMCID: PMC2352209 DOI: 10.1136/bmj.313.7060.815a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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