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Aristophanous M, Hsu DG, Imber BS, Gui C, Daly J, Jancasz J, Huang C, Ballangrud A, Kuo L, Della Biancia C, Moran JM. Failure Mode and Effects Analysis Prior to the Introduction of AI Generated GTVs for Brain Metastases in the Clinical Workflow. Int J Radiat Oncol Biol Phys 2023; 117:S88. [PMID: 37784595 DOI: 10.1016/j.ijrobp.2023.06.413] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) AI autosegmentation of organs-at-risk (OARs) is common practice at many radiotherapy clinics. Despite the abundance of gross tumor volume (GTV) autosegmentation algorithms, adoption in clinical care has been slow due to the high risk associated with errors in GTV delineation. Here we present a failure mode and effects analysis (FMEA) to evaluate the risk associated with introducing AI derived GTVs in patients treated with stereotactic radiosurgery (SRS). MATERIALS/METHODS An AI GTV autosegmentation algorithm for brain metastases was developed in-house based on a V-Net 3D CNN. Registered CT and MR images and a contour of the brain are input into the software and all identified lesions are returned in a DICOM-RT structure set. Following algorithm evaluation, a workflow was developed to enable AI GTV autosegmentation to be introduced clinically for every SRS patient. The following steps were added to existing procedures: 1) workflow to send CT/MR and brain structure to external server, 2) autosegmentation run on the server, 3) AI GTV structures with a standard nomenclature added to existing OAR structure set, and 4) MD review, editing, and approval of AI GTVs. After successfully completing the physics evaluation testing of the new process, we formed a team of 10 faculty and staff including physicists, residents, physicians, and planners to perform the FMEA prior to clinical implementation. The team met to map the process, identify potential failure modes, and score their frequency of occurrence, severity, and detectability. A 3-point scale (1, 3, or 5) was used to simplify the scoring process. Occurrence was defined as rare, sometimes, or often; severity as low, medium, or high; and detectability as obvious, possible, or challenging. The risk probability numbers (RPNs) were calculated and the steps in the process with the highest RPNs were flagged for further discussion. RESULTS The FMEA team completed their process map and analysis primarily in 4 meetings. The process map began with acquisition of the patients CT simulation scan and ended with physician approval of final volumes for treatment planning. We identified 17 process steps and 72 possible failure modes, of which 26 were associated with the new workflow. Eighteen failure modes had an RPN greater than 30 (highest risk score in at least one category) and were flagged to assess mitigation strategies. Five were unique to the new AI GTV workflow and mitigation strategies will be designed prior to clinical use. Those involved risks related to inaccurate AI GTV contours, false positives, and an incomplete review stemming from over-reliance by team members on AI. CONCLUSION AI is increasingly being employed at every step of radiotherapy to automate and streamline processes. The FMEA analysis resulted in the identification of the riskiest parts of using AI GTV autosegmentation. This can be an effective tool in the development of checks to ensure that GTV autosegmentation methods can be safely introduced in support of patient care.
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Affiliation(s)
- M Aristophanous
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D G Hsu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - B S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Gui
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Daly
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Jancasz
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Huang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ballangrud
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Kuo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Della Biancia
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J M Moran
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
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McCarthy N, Daly J, Wall O, Wills T, Buckley C. 45 INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE IN FRAIL OLDER PERSONS’ CARE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.036] [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: 11/12/2022] Open
Abstract
Abstract
Background
Frail older adults present with complex care needs. Inter-Professional Education (IPE) is a means of creating a practice-ready workforce to improve patient safety and healthcare outcomes. A Steering Group was established comprised of acute and community clinicians, members of the Health Service Executive, service user, students and members of all Schools in the College of Medicine and Health in an Irish University (Medicine, Nursing and Midwifery, Pharmacy, Public Health, Clinical Therapies and Dentistry) to evaluate the effectiveness of IPE. A workshop dedicated to the management of frail older adults occurred for multidisciplinary healthcare students as part of a suite of three IPE workshops.
Methods
The validated ‘Interprofessional Collaborative Competencies Attainment Survey’ (ICCAS) evaluated student views of IPE pre- & post-workshop. This workshop involved a case-based study and facilitated discussion with involvement of frail older adult service users. One service user was in a rehabilitation unit post hospital admission, the other was living well at home. Their participation occurred using an online platform, supported by a consultant geriatrician in the rehabilitation unit and a relative for the home-based service user.
Results
Student scores on the six subscales of the ICCAS (communication, collaboration, roles and responsibilities, collaborative patient-centred approach, conflict management and team functioning) were compared. Scores in all categories achieved statistically significant increases after completion of the IPE workshop. The greatest positive change was observed in collaborative patient-centred approach with pre-workshop scores increasing from a mean of 2.61 to 4.25 (p<0.05).
Conclusion
This initiative explored the inclusion of a frail older adult workshop in the higher education setting. Older adults had an opportunity to share their lived experiences. Evaluation of this IPE initiative will inform future IPE activities to be incorporated into undergraduate education programmes. Similar IPE models can be replicated nationally to enable and enhance team-based working and integrated care.
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Affiliation(s)
- N McCarthy
- University College Cork Medical Education Unit, School of Medicine, , Cork, Ireland
| | - J Daly
- Health Service Executive Patient Safety, South Southwest Hospital Group, , Cork, Ireland
- Mercy University Hospital Department of Physiotherapy, , Cork, Ireland
| | - O Wall
- Primary Care Health Service Executive , Cork, Ireland
- University College Cork Occupational Therapy, , Cork, Ireland
| | - T Wills
- University College Cork School of Nursing and Midwifery, , Cork, Ireland
| | - C Buckley
- Office of the Nursing and Midwifery Services Director, Health Service Executive , Cork, Ireland
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Affiliation(s)
- E. Haggerty
- Massachusetts General Hospital, Boston, MA, USA
| | - J. Daly
- University of Colorado, Aurora, CO, USA
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Abstract
Over the last year, coronavirus disease 2019 (COVID-19) has accumulated over 37 million cases and over one million deaths worldwide (WHO, 2020). With no population immunity or vaccine at hand, all but fifteen countries issued 'stay at home' orders in a bid to contain the spread of the virus and limit the healthcare burden. 'Lockdown' included closure of dental practices. Both the virus itself and the various Government responses have had a profound impact on the work, home and social lives of the entire population and are likely to impact the oral health of many people. These oral health effects can be attributed to those caused directly by the virus and those caused indirectly through the subsequent societal response. Direct effects of COVID-19 on oral health include ageusia (an official symptom of COVID-19) and case reports of vesiculobullous lesions and necrotising periodontal disease (Patel and Woolley 2020). The ageusia associated with COVID-19 is transient and reports of other oral manifestations are based on low-grade and disputed evidence. The direct effects of COVID-19 are likely to be of modest consequence for population oral health.
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Geia L, Baird K, Bail K, Barclay L, Bennett J, Best O, Birks M, Blackley L, Blackman R, Bonner A, Bryant AO R, Buzzacott C, Campbell S, Catling C, Chamberlain C, Cox L, Cross W, Cruickshank M, Cummins A, Dahlen H, Daly J, Darbyshire P, Davidson P, Denney-Wilson E, De Souza R, Doyle K, Drummond A, Duff J, Duffield C, Dunning T, East L, Elliott D, Elmir R, Fergie OAM D, Ferguson C, Fernandez R, Flower AM D, Foureur M, Fowler C, Fry M, Gorman E, Grant J, Gray J, Halcomb E, Hart B, Hartz D, Hazelton M, Heaton L, Hickman L, Homer AO CSE, Hungerford C, Hutton A, Jackson AO D, Johnson A, Kelly MA, Kitson A, Knight S, Levett-Jones T, Lindsay D, Lovett R, Luck L, Molloy L, Manias E, Mannix J, Marriott AMR, Martin M, Massey D, McCloughen A, McGough S, McGrath L, Mills J, Mitchell BG, Mohamed J, Montayre J, Moroney T, Moyle W, Moxham L, Northam OAM H, Nowlan S, O'Brien AP, Ogunsiji O, Paterson C, Pennington K, Peters K, Phillips J, Power T, Procter N, Ramjan L, Ramsay N, Rasmussen B, Rihari-Thomas J, Rind B, Robinson M, Roche M, Sainsbury K, Salamonson Y, Sherwood J, Shields L, Sim J, Skinner I, Smallwood G, Smallwood R, Stewart L, Taylor S, Usher AM K, Virdun C, Wannell J, Ward R, West C, West R, Wilkes L, Williams R, Wilson R, Wynaden D, Wynne R. A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter. Contemp Nurse 2020; 56:297-308. [DOI: 10.1080/10376178.2020.1809107] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- L. Geia
- James Cook University, Townsville, QLD, Australia
| | - K. Baird
- University of Technology Sydney, Sydney, NSW, Australia
| | - K. Bail
- University of Canberra, Canberra, ACT, Australia
| | - L. Barclay
- University of Sydney, Sydney, NSW, Australia
| | - J. Bennett
- University of Newcastle, Callaghan, NSW, Australia
| | - O. Best
- University of Southern Queensland, Darling Heights, QLD, Australia
| | - M. Birks
- James Cook University, Townsville, QLD, Australia
| | - L. Blackley
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | - R. Blackman
- Gidgee Healing Mt Isa, Mount Isa, QLD, Australia
| | - A. Bonner
- Griffith University, Brisbane, QLD, Australia
| | - R. Bryant AO
- Rosemary Bryant Foundation, South Australia, Australia
| | - C. Buzzacott
- Rhodanthe Lipsett Indigenous Midwifery Charitable Fund, Caringbah, NSW, Australia
| | - S. Campbell
- Charles Darwin University, Darwin, NT, Australia
| | - C. Catling
- University of Technology Sydney, Sydney, NSW, Australia
| | | | - L. Cox
- Queensland University of Technology, Brisbane, QLD, Australia
| | - W. Cross
- Federation University, Ballarat, VIC, Australia
| | - M. Cruickshank
- University of Technology Sydney, Sydney, NSW, Australia
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - A. Cummins
- University of Technology Sydney, Sydney, NSW, Australia
| | - H. Dahlen
- Western Sydney University, Sydney, NSW, Australia
| | - J. Daly
- University of Sydney, Sydney, NSW, Australia
| | - P. Darbyshire
- Philip Darbyshire Consulting, Highbury, South Australia, Australia
| | - P. Davidson
- University of Technology Sydney, Sydney, NSW, Australia
- Western Sydney University, Sydney, NSW, Australia
- John Hopkins University, Baltimore, USA
| | | | | | - K. Doyle
- Western Sydney University, Sydney, NSW, Australia
| | - A. Drummond
- Queensland University of Technology, Brisbane, QLD, Australia
| | - J. Duff
- Queensland University of Technology, Brisbane, QLD, Australia
| | - C. Duffield
- University of Technology Sydney, Sydney, NSW, Australia
- Edith Cowan University, Perth, Western Australia, Australia
| | - T. Dunning
- Deakin University, Melbourne, VIC, Australia
| | - L. East
- University of New England, Armidale, NSW, Australia
| | - D. Elliott
- University of Technology Sydney, Sydney, NSW, Australia
| | - R. Elmir
- Western Sydney University, Sydney, NSW, Australia
| | - D. Fergie OAM
- Australian Catholic University, Fitzroy, VIC, Australia
| | - C. Ferguson
- Western Sydney University, Sydney, NSW, Australia
| | - R. Fernandez
- University of Wollongong, Keiraville, NSW, Australia
| | | | - M. Foureur
- University of Newcastle, Callaghan, NSW, Australia
| | - C. Fowler
- University of Technology Sydney, Sydney, NSW, Australia
| | - M. Fry
- University of Technology Sydney, Sydney, NSW, Australia
| | - E. Gorman
- New South Wales Health, Sydney, NSW, Australia
| | - J. Grant
- Charles Sturt University, Dubbo, NSW, Australia
| | - J. Gray
- University of Technology Sydney, Sydney, NSW, Australia
| | - E. Halcomb
- University of Wollongong, Keiraville, NSW, Australia
| | - B. Hart
- University of Notre Dame, Darlinghurst, NSW, Australia
| | - D. Hartz
- Charles Darwin University, Darwin, NT, Australia
| | - M. Hazelton
- University of Newcastle, Callaghan, NSW, Australia
| | - L. Heaton
- Western Sydney University, Sydney, NSW, Australia
| | - L. Hickman
- University of Technology Sydney, Sydney, NSW, Australia
- Contemporary Nurse Journal
| | | | | | - A. Hutton
- University of Newcastle, Callaghan, NSW, Australia
| | - D. Jackson AO
- University of Technology Sydney, Sydney, NSW, Australia
| | - A. Johnson
- University of Newcastle, Callaghan, NSW, Australia
| | - M. A. Kelly
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - A. Kitson
- Western Sydney University, Sydney, NSW, Australia
| | - S. Knight
- James Cook University, Townsville, QLD, Australia
| | | | - D. Lindsay
- James Cook University, Townsville, QLD, Australia
| | - R. Lovett
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - L. Luck
- Western Sydney University, Sydney, NSW, Australia
| | - L. Molloy
- University of Wollongong, Keiraville, NSW, Australia
| | - E. Manias
- Deakin University, Melbourne, VIC, Australia
| | - J. Mannix
- Western Sydney University, Sydney, NSW, Australia
| | | | - M. Martin
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - D. Massey
- Southern Cross University, Gold Coast Campus, QLD, Australia
| | | | - S. McGough
- Curtin University, Perth, Western Australia, Australia
| | - L. McGrath
- Aboriginal Medical Service Redfern, Sydney, NSW, Australia
| | - J. Mills
- La Trobe University, Melbourne, VIC, Australia
| | | | - J. Mohamed
- Lowitja Institute, Melbourne, VIC, Australia
| | - J. Montayre
- Western Sydney University, Sydney, NSW, Australia
| | - T. Moroney
- University of Wollongong, Keiraville, NSW, Australia
| | - W. Moyle
- Griffith University, Brisbane, QLD, Australia
| | - L. Moxham
- University of Wollongong, Keiraville, NSW, Australia
| | | | - S. Nowlan
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | | | - O. Ogunsiji
- Western Sydney University, Sydney, NSW, Australia
| | - C. Paterson
- University of Canberra, Canberra, ACT, Australia
| | - K. Pennington
- Flinders University, Adelaide, South Australia, Australia
| | - K. Peters
- Western Sydney University, Sydney, NSW, Australia
| | - J. Phillips
- University of Technology Sydney, Sydney, NSW, Australia
| | - T. Power
- University of Technology Sydney, Sydney, NSW, Australia
| | - N. Procter
- University of South Australia, Adelaide, South Australia, Australia
| | - L. Ramjan
- Western Sydney University, Sydney, NSW, Australia
| | - N. Ramsay
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | | | | | - B. Rind
- Aboriginal Health Unit Mt Druitt Hospital, Sydney, NSW, Australia
| | - M. Robinson
- Murdoch University, Perth, Western Australia, Australia
| | - M. Roche
- University of Technology Sydney, Sydney, NSW, Australia
| | - K. Sainsbury
- University of Canberra, Canberra, ACT, Australia
| | | | - J. Sherwood
- Charles Sturt University, Dubbo, NSW, Australia
| | - L. Shields
- University of Queensland, Brisbane, QLD, Australia
| | - J. Sim
- University of Wollongong, Keiraville, NSW, Australia
| | - I. Skinner
- James Cook University, Townsville, QLD, Australia
| | - G. Smallwood
- James Cook University, Townsville, QLD, Australia
| | - R. Smallwood
- University of Newcastle, Callaghan, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - L. Stewart
- James Cook University, Townsville, QLD, Australia
| | - S. Taylor
- Top End Health, Northern Territory, Darwin, NT, Australia
| | - K. Usher AM
- University of Technology Sydney, Sydney, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - C. Virdun
- University of Technology Sydney, Sydney, NSW, Australia
| | - J. Wannell
- Melbourne Poche Centre for Indigenous Health, Melbourne, VIC, Australia
| | - R. Ward
- University of Southern Queensland, Darling Heights, QLD, Australia
| | - C. West
- James Cook University, Townsville, QLD, Australia
| | - R. West
- Griffith University, Brisbane, QLD, Australia
| | - L. Wilkes
- Western Sydney University, Sydney, NSW, Australia
| | - R. Williams
- Charles Darwin University, Darwin, NT, Australia
| | - R. Wilson
- University of Newcastle, Callaghan, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - D. Wynaden
- Curtin University, Perth, Western Australia, Australia
| | - R. Wynne
- Western Sydney University, Sydney, NSW, Australia
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Swain F, Daly J, Baidya S, Wilson B, Morrison J, Liew Y‐W, Powley T, Jivan Y, Bryant S, Allen A, Crampton N. Acute haemolytic reaction secondary to an ABO minor mismatched platelet transfusion from a group A blood donor. Transfus Med 2019; 29:133-135. [DOI: 10.1111/tme.12591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/18/2019] [Accepted: 02/12/2019] [Indexed: 12/23/2022]
Affiliation(s)
- F. Swain
- Princess Alexandra Hospital Brisbane Queensland Australia
| | - J. Daly
- Australian Red Cross Blood Service Brisbane Queensland Australia
| | - S. Baidya
- Australian Red Cross Blood Service Brisbane Queensland Australia
| | - B. Wilson
- Australian Red Cross Blood Service Brisbane Queensland Australia
| | - J. Morrison
- Australian Red Cross Blood Service Brisbane Queensland Australia
| | - Y. ‐W. Liew
- Australian Red Cross Blood Service Brisbane Queensland Australia
| | - T. Powley
- Australian Red Cross Blood Service Brisbane Queensland Australia
| | - Y. Jivan
- QML Pathology Brisbane Queensland Australia
| | - S. Bryant
- Australian Red Cross Blood Service Brisbane Queensland Australia
| | - A. Allen
- Australian Red Cross Blood Service Brisbane Queensland Australia
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Al-naqeeb J, Danner S, Fagnan L, Ramsey K, Michaels L, Mitchell J, Branca K, Morris C, Nease D, Zittleman L, Levy B, Daly J, Hahn D, Dolor R, Hanifin J, Tofte S, Zuckerman K, Hansis K, Gundersen M, Dillon K, Block J, Karr F, Dunbrasky S, Lapidus J, Siebe K, Simpson E. 195 The burden of childhood atopic dermatitis in U.S. primary care settings. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.210] [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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Meyers L, Nelson RK, Nolte F, Donovan V, Bard JD, Storch G, Spitzer S, Salimnia H, Leber A, Lindsey K, Stellrecht K, Selvarangan R, Daly J, Fey PD, Gesteland P, Faucett A, Malin B, Ginocchio C, Poritz M. Implementation of an Instantaneous Pathogen Specific Surveillance System. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1066] [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: 11/12/2022] Open
Affiliation(s)
- Lindsay Meyers
- Data Science, Post Market Surveillance, BioFire Diagnostics, Salt Lake City, UT
| | | | | | | | - Jennifer Dien Bard
- Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | | | | | | | - Amy Leber
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | | | | | | | - J Daly
- Primary Children's Medical Center, Salt Lake City, UT
| | - Paul D. Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | - Mark Poritz
- Chemistry Research, BioFire Defense, Murray, UT
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Sanderson SK, Ampofo K, Stockmann CR, Pavia A, Mason E, Daly J, Blaschke AJ, Rosen P, Korgenski EK, Byington CL. Changing Etiology of Parapneumonic Empyema Through the Pneumococcal Conjugate Vaccine Era in Utah, 2004-2014. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1316] [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: 11/13/2022] Open
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Stockmann C, Rogatcheva M, Harrel B, Vaughn M, Crisp R, Poritz M, Thatcher S, Korgenski EK, Barney T, Daly J, Pavia AT. How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? Insights using multiplex PCR-based detection. Clin Microbiol Infect 2014; 21:179.e9-15. [PMID: 25599941 DOI: 10.1016/j.cmi.2014.07.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 03/29/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/22/2022]
Abstract
The objective of this study was to compare the aetiologic yield of standard-of-care microbiologic testing ordered by physicians with that of a multiplex PCR platform. Stool specimens obtained from children and young adults with gastrointestinal illness were evaluated by standard laboratory methods and a developmental version of the FilmArray Gastrointestinal (GI) Diagnostic System (FilmArray GI Panel), a rapid multiplex PCR platform that detects 23 bacterial, viral and protozoal agents. Results were classified according to the microbiologic tests requested by the treating physician. A median of three (range 1-10) microbiologic tests were performed by the clinical laboratory during 378 unique diarrhoeal episodes. A potential aetiologic agent was identified in 46% of stool specimens by standard laboratory methods and in 65% of specimens tested using the FilmArray GI Panel (p < 0.001). For those patients who only had Clostridium difficile testing requested, an alternative pathogen was identified in 29% of cases with the FilmArray GI Panel. Notably, 11 (12%) cases of norovirus were identified among children who only had testing for Clostridium difficile ordered. Among those who had C. difficile testing ordered in combination with other tests, an additional pathogen was identified in 57% of stool specimens with the FilmArray GI Panel. For patients who had no C. difficile testing performed, the FilmArray GI Panel identified a pathogen in 63% of cases, including C. difficile in 8%. Physician-specified laboratory testing may miss important diarrhoeal pathogens. Additionally, standard laboratory testing is likely to underestimate co-infections with multiple infectious diarrhoeagenic agents.
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Affiliation(s)
- C Stockmann
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
| | - M Rogatcheva
- BioFire Diagnostics Inc., Salt Lake City, UT, USA
| | - B Harrel
- BioFire Diagnostics Inc., Salt Lake City, UT, USA
| | - M Vaughn
- BioFire Diagnostics Inc., Salt Lake City, UT, USA
| | - R Crisp
- BioFire Diagnostics Inc., Salt Lake City, UT, USA
| | - M Poritz
- BioFire Diagnostics Inc., Salt Lake City, UT, USA
| | - S Thatcher
- BioFire Diagnostics Inc., Salt Lake City, UT, USA
| | - E K Korgenski
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
| | - T Barney
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
| | - J Daly
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - A T Pavia
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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O'Boyle CP, Perkins W, Varma S, Daly J, Perks AGP. To mislead or not to mislead?: letter of response to article: Kokkinos C, Sorkin T, Powell B. To Mohs or not to Mohs. J Plast Reconstr Aesthetic Surg (2014) 67: 23-26. J Plast Reconstr Aesthet Surg 2014; 67:1157-8. [PMID: 24721125 DOI: 10.1016/j.bjps.2014.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/08/2014] [Indexed: 11/25/2022]
Affiliation(s)
- C P O'Boyle
- Department of Plastic & Reconstructive Surgery, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK. ciaran.o'
| | - W Perkins
- Department of Dermatology, Nottingham Treatment Centre, Circle Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2FT, UK
| | - S Varma
- Department of Dermatology, Nottingham Treatment Centre, Circle Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2FT, UK
| | - J Daly
- Department of Plastic & Reconstructive Surgery, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - A G P Perks
- Department of Plastic & Reconstructive Surgery, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
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Tarlinton R, Daly J, Dunham S, Kydd J. Schmallenberg virus: Could wildlife reservoirs threaten domestic livestock? Vet J 2013; 198:309-10. [DOI: 10.1016/j.tvjl.2013.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
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Hewson ID, Daly J, Hallett KB, Liberali SA, Scott CLM, Spaile G, Widmer R, Winters J. Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders. Aust Dent J 2011; 56:221-6. [PMID: 21623817 DOI: 10.1111/j.1834-7819.2011.01328.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.
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Affiliation(s)
- I D Hewson
- Dental Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
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15
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Daly J. The public health implications of technology and its assessment. Community Health Stud 2010; 14:219-22. [PMID: 2253456 DOI: 10.1111/j.1753-6405.1990.tb00620.x] [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: 12/31/2022]
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16
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Ellis C, Babenko P, Goldiez B, Daly J, Martin GA. Dynamic terrain for multiuser real-time environments. IEEE Comput Graph Appl 2010; 30:80-84. [PMID: 24807096 DOI: 10.1109/mcg.2010.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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17
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Komesaroff PA, Kafanelis B, Black C, Cable V, Sudhir K, Daly J. Experiences at menopause of women in a non-English-speaking community: a qualitative study. Climacteric 2009. [DOI: 10.1080/cmt.5.1.78.86] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Baguelin M, Newton JR, Demiris N, Daly J, Mumford JA, Wood JLN. Control of equine influenza: scenario testing using a realistic metapopulation model of spread. J R Soc Interface 2009; 7:67-79. [PMID: 19364721 DOI: 10.1098/rsif.2009.0030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present a metapopulation model of the spread of equine influenza among thoroughbred horses parametrized with data from a 2003 outbreak in Newmarket, UK. The number of horses initially susceptible is derived from a threshold theorem and a published statistical model. Two simulated likelihood-based methods are used to find the within- and between-yard transmissions using both exponential and empirical latent and infectious periods. We demonstrate that the 2003 outbreak was largely locally driven and use the parametrized model to address important questions of control. The chance of a large epidemic is shown to be largely dependent on the size of the index yard. The impact of poor responders to vaccination is estimated under different scenarios. A small proportion of poor responders strongly influences the efficiency of vaccine policies, which increases risk further when the vaccine and infecting strains differ following antigenic drift. Finally, the use of vaccinating in the face of an outbreak is evaluated at a global and individual management group level. The benefits for an individual horse trainer are found to be substantial, although this is influenced by the behaviour of other trainers.
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Affiliation(s)
- M Baguelin
- Animal Health Trust, Lanwades Park, Kentford, Newmarket CB8 7UU, UK.
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19
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Hadley S, Huckabee C, Pappas PG, Daly J, Rabkin J, Kauffman CA, Merion RM, Karchmer AW. Outcomes of antifungal prophylaxis in high-risk liver transplant recipients. Transpl Infect Dis 2008; 11:40-8. [PMID: 19144094 DOI: 10.1111/j.1399-3062.2008.00361.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Antifungal prophylaxis for liver transplant recipients (LTRs) is common among patients considered at high risk of infection, but optimal prophylaxis duration and drug has not been defined. This study aimed to assess the effects of 14 days of antifungal therapy prophylaxis in reducing proven invasive fungal infections (IFI) in high-risk subjects. Eligible subjects who met 2 or more risk criteria were randomized 1:1 to the treatment arms (liposomal amphotericin B or fluconazole) and were followed for 100 days post transplantation for evidence of IFI. The study was designed to enroll 300 subjects, but was closed early for insufficient enrollment. A total of 71 subjects were enrolled and randomized. Two-thirds of subjects completed 14 days of study therapy. Ten subjects developed proven or probable IFI with Candida species (9 subjects) and Cryptococcus neoformans (1 subject); rates were similar in the 2 treatment arms. Eleven subjects died, but no death was attributed to study drug or IFI. In summary, high-risk LTRs tolerated antifungal prophylaxis well, and rates of IFI were lower than previously reported in untreated high-risk LTRs.
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Affiliation(s)
- S Hadley
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
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20
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Abstract
BACKGROUND Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. AIM The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. KEY ISSUES Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. CONCLUSIONS Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.
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Affiliation(s)
- P M Davidson
- School of Nursing, Family and Community Health, University of Western Sydney and Sydney West Area Health Service, Sydney.
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21
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Dear A, Daly J, Brennan SO, Tuckfield A, George PM. An intronic mutation within FGB (IVS1+2076 a-->g) is associated with afibrinogenemia and recurrent transient ischemic attacks. J Thromb Haemost 2006; 4:471-2. [PMID: 16420582 DOI: 10.1111/j.1538-7836.2006.01722.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Crouch CF, Daly J, Henley W, Hannant D, Wilkins J, Francis MJ. The use of a systemic prime/mucosal boost strategy with an equine influenza ISCOM vaccine to induce protective immunity in horses. Vet Immunol Immunopathol 2005; 108:345-55. [PMID: 16098611 DOI: 10.1016/j.vetimm.2005.06.009] [Citation(s) in RCA: 31] [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: 11/26/2004] [Revised: 04/21/2005] [Accepted: 06/16/2005] [Indexed: 11/30/2022]
Abstract
In horses, natural infection confers long lasting protective immunity characterised by mucosal IgA and humoral IgGa and IgGb responses. In order to investigate the potential of locally administered vaccine to induce a protective IgA response, responses generated by vaccination with an immunostimulating complex (ISCOM)-based vaccine for equine influenza (EQUIP F) containing A/eq/Newmarket/77 (H7N7), A/eq/Borlänge/91 (H3N8) and A/eq/Kentucky/98 (H3N8) using a systemic prime/mucosal boost strategy were studied. Seven ponies in the vaccine group received EQUIP F vaccine intranasally 6 weeks after an initial intramuscular immunisation. Following intranasal boosting a transient increase in virus-specific IgA was detected in nasal wash secretions. Aerosol challenge with the A/eq/Newmarket/1/93 reference strain 4 weeks after the intranasal booster resulted in clinical signs of infection and viral shedding in seven of seven influenza-naive control animals whereas the seven vaccinated ponies had statistically significantly reduced clinical signs and duration of virus excretion. Furthermore, following this challenge, significantly enhanced levels of virus-specific IgA were detected in the nasal washes from vaccinated ponies compared with the unvaccinated control animals. These data indicate that the intranasal administration of EQUIP F vaccine primes the mucosal system for an enhanced IgA response following exposure to live influenza virus.
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Affiliation(s)
- C F Crouch
- Schering-Plough Animal Health, Breakspear Road South, Harefield, Uxbridge, Middlesex UB9 6LS, UK.
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Grassmann O, Held D, Daly J, Hennig M. Quantification of (pseudo)polymorphic mixtures using full pattern analysis of X-ray powder diffraction data. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305085624] [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: 11/11/2022] Open
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24
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Crouch CF, Daly J, Hannant D, Wilkins J, Francis MJ. Immune responses and protective efficacy in ponies immunised with an equine influenza ISCOM vaccine containing an 'American lineage' H3N8 virus. Vaccine 2005; 23:418-25. [PMID: 15530689 DOI: 10.1016/j.vaccine.2004.01.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 07/02/2003] [Accepted: 01/26/2004] [Indexed: 11/28/2022]
Abstract
Protective responses generated by vaccination with an immuno-stimulating complex (ISCOM)-based vaccine for equine influenza (EQUIP F), containing a new 'American lineage' H3N8 virus, were studied. Seven ponies in the vaccine group received two intramuscular injections of EQUIP F given 6 weeks apart. Aerosol challenge with an A/eq/Newmarket/1/93 reference strain 4 weeks after booster vaccination resulted in clinical signs of infection and viral shedding in 7 influenza-naive control animals whereas the vaccinated ponies were significantly protected from both clinical signs and virus excretion. Influenza virus-specific IgG responses in serum following immunisation with the ISCOM vaccine were predominantly of the IgGa and IgGb sub-isotypes, a pattern similar to that generated by equine influenza virus infection. However, in contrast to the response following infection, virus-specific antibody responses in nasal washes following immunisation were characterised by the presence of IgG but not IgA.These results demonstrated that an ISCOM-based vaccine containing A/eq/Kentucky/98 provides strong protective immunity against challenge with an 'American lineage' H3N8 reference virus.
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Affiliation(s)
- C F Crouch
- Schering-Plough Animal Health, Breakspear Road South, Harefield, Uxbridge, Middlesex, UB9 6LS, UK.
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25
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Edlund Toulemonde C, Daly J, Sindle T, Guigal PM, Audonnet JC, Minke JM. Efficacy of a recombinant equine influenza vaccine against challenge with an American lineage H3N8 influenza virus responsible for the 2003 outbreak in the United Kingdom. Vet Rec 2005; 156:367-71. [PMID: 15816180 DOI: 10.1136/vr.156.12.367] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [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
Fifteen influenza-naive Welsh mountain ponies were randomly assigned to three groups of five. A single dose of a recombinant ALVAC vaccine was administered intramuscularly to five of the ponies, two doses, administered five weeks apart, were administered to five, and the other five served as unvaccinated, challenge controls. Two weeks after the completion of the vaccination programme, the ponies were all challenged by exposure to an aerosol of influenza virus A/eq/Newmarket/5/03. Their clinical signs were scored daily for 14 days according to a standardised scoring protocol, and nasal swabs were taken daily for 10 days to monitor the excretion of virus. The challenge produced severe clinical signs of influenza (fever, coughing, nasal discharge and dyspnoea) in all five control ponies, but the vaccinated ponies developed only mild disease, consisting of a serous nasal discharge lasting for only one day. The excretion of virus was almost completely suppressed in the vaccinated ponies, but the control ponies shed the virus for up to seven days after the challenge.
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Abstract
AIMS To describe the validation and reliability of a new pain tool (the Alder Hey Triage Pain Score, AHTPS) for children at triage in the accident and emergency (A&E) setting. METHODS A new behavioural observational pain tool was developed because of dissatisfaction with available tools and a lack of confidence in self-assessment scores at triage. The study was conducted in a large paediatric A&E department; 575 children (aged 0-16 years) were included. Inter-rater reliability and various aspects of validity were assessed. In addition this tool was compared to the Wong-Baker self-assessment tool. The children were concurrently scored by a research nurse and triage nurses to assess inter-rater reliability. Construct validity was assessed by comparing the research nurse's triage score with the research nurse reassessment score after intervention and/or analgesia. Known group construct validity was assessed by comparing the research nurse's score at triage with the level of pain of the condition as judged by the discharge diagnosis. Predictive validity was assessed by comparing the research nurse's AHTPS with the level of analgesia needed by each patient. The AHTPS was also compared to a self-assessment score. RESULTS A high level of inter-rater reliability, kappa statistic 0.84 (95% CI 0.80 to 0.88), was shown. Construct validity was well demonstrated; known group construct validity and predictive validity were also demonstrated to a varying degree. CONCLUSIONS Results support the use of this observational pain scoring tool in the triage of children in A&E.
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Affiliation(s)
- B Stewart
- Royal Liverpool Children's Hospital NHS Trust, Alder Hey, Liverpool, UK.
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27
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Davidson P, Rees DM, Brighton TA, Enis J, McCrohon J, Elliott D, Cockburn J, Paull G, Daly J. Non-valvular atrial fibrillation and stroke: Implications for nursing practice and therapeutics. Aust Crit Care 2004; 17:65-73. [PMID: 15218819 DOI: 10.1016/s1036-7314(04)80005-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/30/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance and is increasing in prevalence due to the ageing of the population, and rates of chronic heart failure. Haemodynamic compromise and thromboembolic events are responsible for significant morbidity and mortality in Australian communities. Non-valvular AF is a significant predictor for both a higher incidence of stroke and increased mortality. Stroke affects approximately 40,000 Australians every year and is Australia's third largest killer after cancer and heart disease. The burden of illness associated with AF, the potential to decrease the risk of stroke and other embolic events by thromboprophylaxis and the implications of this strategy for nursing care and patient education, determine AF as a critical element of nursing practice and research. A review of the literature was undertaken of the CINAHL, Medline, EMBASE and Cochrane Databases from 1966 until September 2002 focussing on management of atrial fibrillation to prevent thrombotic events. This review article presents key elements of this literature review and the implications for nursing practice.
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28
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Schmidt BG, Daly J, Witter CT. 542 RAPID IDENTIFICATION OF BACTERIAL MENINGITIS SPECIES BY HIGH RESOLUTION MELTING OF POLYMERASE CHAIN REACTION AMPLIFIED 16S RIBOSOMAL RIBONUCLEIC ACID GENE. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-542] [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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29
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Carroll KC, Adamson K, Korgenski K, Croft A, Hankemeier R, Daly J, Park CH. Comparison of a Commercial Reversed Passive Latex Agglutination Assay to an Enzyme Immunoassay for the Detection of Shiga Toxin-Producing Escherichia coli. Eur J Clin Microbiol Infect Dis 2003; 22:689-92. [PMID: 14574618 DOI: 10.1007/s10096-003-1053-9] [Citation(s) in RCA: 18] [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] [Indexed: 11/25/2022]
Abstract
A multicenter study was performed to compare the performance of a prototypic reversed passive latex agglutination assay (VTEC Screen "Seiken"; Denka-Seiken, Japan) with the Premier EHEC Enzyme Immunoassay (Meridian Diagnostics, USA) for the detection of Shiga toxin in 554 diarrheal stool samples. Standard culture on sorbitol MacConkey agar and the use of latex agglutination reagents were included to identify the Escherichia coli O157, O26 and O111 serotypes. There was 99% agreement between the VTEC screen and enzyme immunoassay (kappa=0.823). Seventeen samples were positive for toxin by one or both assays. One toxin-positive sample using the enzyme immunoassay and four positive samples using the VTEC Screen could not be confirmed. Serotypes identified included: O157:H7 (n=8), O26 (n=2), O111 (n=1) and O45:H2 (n=1). The VTEC screen is easy to perform and comparable to the Meridian EHEC test for detection of Shiga toxin in clinical samples.
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Affiliation(s)
- K C Carroll
- Department of Pathology, ARUP Laboratories, Inc./ University of Utah, 500 Chipeta Way, Salt Lake City, UT 84108, USA.
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30
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31
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Abstract
A stochastic model of equine influenza (EI) is constructed to assess the risk of an outbreak in a Thoroughbred population at a typical flat race training yard. The model is parameterised using data from equine challenge experiments conducted by the Animal Health Trust (relating to the latent and infectious period of animals) and also published data on previous epidemics (to estimate the transmission rate for equine influenza). Using 89 ponies, an empirical relationship between pre-challenge antibody and the probability of becoming infectious is established using logistic regression. Changes in antibody level over time are quantified using published and unpublished studies comprising 618 ponies and horses. A plausible Thoroughbred population is examined over the course of a year and the model is used to assess the risk of an outbreak of EI in the yard under the current minimum vaccination policy in the UK. The model is adapted to consider an alternative vaccination programme where the frequency of vaccination in older horses (2-year-olds and upwards) is increased. Model results show that this practical alternative would offer a significant increase in protection. Spread of infection between yards is also considered to ascertain the risk of secondary outbreaks.
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Affiliation(s)
- A W Park
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK.
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32
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Kennedy GA, Morton J, Western R, Butler J, Daly J, Durrant S. Impact of stem cell donation modality on normal donor quality of life: a prospective randomized study. Bone Marrow Transplant 2003; 31:1033-5. [PMID: 12774056 DOI: 10.1038/sj.bmt.1704053] [Citation(s) in RCA: 33] [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] [Indexed: 11/09/2022]
Abstract
As part of a previously reported trial comparing granulocyte-colony stimulating factor (G-CSF) stimulated bone marrow and peripheral blood stem cells (PBSCs) in allogeneic stem cell transplantation, we included a questionnaire to compare donor morbidity and long-term complications between the two donation procedures. Bone marrow donation was associated with significantly more donors experiencing localized pain at the donation site compared to PBSC collection. However, this was not associated with any increased delay in returning to normal activity. Although a minority of bone marrow donors suffered chronic pain at the donation site, no serious long-term side effects relating to G-CSF stimulated stem cell donation were identified.
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Affiliation(s)
- G A Kennedy
- Department of Haematology, Royal Brisbane Hospital, Brisbane, Australia
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33
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Ryan BM, Lefort F, McManus R, Daly J, Keeling PWN, Weir DG, Kelleher D. A prospective study of circulating mutant KRAS2 in the serum of patients with colorectal neoplasia: strong prognostic indicator in postoperative follow up. Gut 2003; 52:101-8. [PMID: 12477769 PMCID: PMC1773535 DOI: 10.1136/gut.52.1.101] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Mutant tumour derived DNA has been detected in the sera of colorectal cancer patients. We investigated if mutant serum KRAS2 was detectable preoperatively in a large group of patients with colorectal neoplasia. A prospective study of 94 patients who underwent putative curative resection for colorectal carcinoma (CRC) was performed to ascertain if serum mutant KRAS2 could be used postoperatively as a disease marker. METHODS Preoperative sera from 78 patients were analysed (group A). Sera from 94 patients were obtained three monthly for up to three years during the postoperative period (group B). Codon 12 and 13 KRAS2 mutations were analysed in matched tumour and serum samples. RESULTS In the preoperative group (group A), KRAS2 mutation was found in 41/78 (53%) tumours and in 32/78 (41%) preoperative sera. Of 41 tumour KRAS2 mutation positive cases, 31/41 (76%) had an identical serum mutation detectable. In group B, the postoperative follow up group, 60/94 cases were primary tumour KRAS2 mutation positive. Of these 60, 16/60 (27%) became persistently serum mutant KRAS2 positive postoperatively. Ten of 16 (63%) of these developed a recurrence compared with only 1/44 (2%) patients who remained serum mutant negative (odds ratio 71.7 (95% confidence interval 7.7-663.9; p=0.0000). None of 34 tumour mutation negative cases became serum mutant KRAS2 positive postoperatively, despite recurrence in 9/34 patients. The relative hazard of disease recurrence in postoperative serum mutant KRAS2 positive patients was 6.37 (2.26-18.0; p=0.000). CONCLUSIONS Serum mutant KRAS2 can be detected preoperatively in all stages of colorectal neoplasia. Postoperatively, serum mutant KRAS2 is a strong predictor of disease recurrence, stronger even than Dukes' stage of disease, and thus shows potential for use in clinical practice as a marker of preclinical disease recurrence.
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Affiliation(s)
- B M Ryan
- Department of Clinical Medicine, St James's Hospital, Dublin, Ireland.
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Daly J, Durant RC, Friess SL, Holland GF, Kny H, Witkop B. Labilization of Ester Bonds in Aminocyclitol Derivatives. II. Polyacetates of Deoxystreptamine1. J Am Chem Soc 2002. [DOI: 10.1021/ja01507a033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Komesaroff PA, Kafanelis B, Black C, Cable V, Sudhir K, Daly J. Experiences at menopause of women in a non-English-speaking community: a qualitative study. Climacteric 2002; 5:78-86. [PMID: 11974562] [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: 02/24/2023]
Abstract
CONTEXT It is important that clinicians appreciate the link between physiological disturbances and cultural meanings. The community surrounding the Baker Medical Research Institute in Melbourne, Australia includes a substantial number of women from a Greek-speaking background who attend the Menopause Clinic. OBJECTIVE To demonstrate how qualitative methodologies can assist with the development of clinical services by employing them to elucidate the role of cultural variables in the ways in which Greek women view menopause, aging, illness and medicine. DESIGN This was a qualitative study employing in-depth interviews on five separate occasions over 2 years, analyzed with thematic and ethnographic content analysis. PATIENTS Subjects were 40 Greek-speaking women attending the Clinic, aged 45-60 years. RESULTS There is an intricate association between experiences of the menopause and family relationships, problems raised by immigration and the cultural dislocation caused by it, beliefs and theories of the body, religion, and traditional approaches to healing and medicine. Many women had experienced unfavorable or unsatisfactory encounters with medicine in the past, reflecting lack of understanding of the women's experiences and failures of communication about clinical assessments and recommended treatments. Traditional therapies were often used without advising doctors. CONCLUSIONS The study emphasizes the potential utility of qualitative research methods for improving clinical practice by elaborating the specific requirements of particular groups, and thereby allowing doctors to deliver services that are more acceptable to patients from both a cultural and an ethical point of view, and also more effective. The process established for the evolution of our clinic may serve as a model for other clinics seeking to direct themselves to the needs of particular social groups or communities.
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Affiliation(s)
- P A Komesaroff
- Baker Medical Research Institute, PO Box 6492, St. Kilda Central, Melbourne 8008, Australia
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Abstract
Nursing is facing a crisis nationally and internationall, with Australia, the United States, New Zealand, Canada, the United Kingdom and Western Europe experiencing critical shortages of nurses. Problems with recruitment, retention and an ageing workforce means that attempts to ensure a viable nursing workforce must be placed at the top of the professional agenda. Strategies currently used to manage the crisis, such as overseas recruitment, are not sustainable and are ethically dubious. The demographic timebomb is ticking and up to half the current nursing workforce will reach retirement age by 2020. It is vital that there are adequate numbers of skilled and qualified nurses to take their places. Nursing and nurses are facing unprecedented challenges and pressures in the workplace. Job satisfaction is threatened as nurses are pressured to do more with less, Nursing productivity has increased phenomenally over the past ten years in response to increased demands and decreasing numbers of staff. The nursing workplace has disturbingly high levels of occupational violence, and many nurses operate within a culture of blame and scapegoating. There is evidence that organizational change is imposed upon nurses with little or no consultation and the literature reveals that this has a direct and negative effect on job satisfaction and on retention of nurses. This paper explores some of the critical issues that nursing must confront to be successful in establishing and maintaining a vigorous, dynamic and viable workforce.
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Affiliation(s)
- D Jackson
- School of Nursing, Family and Community Health College of Social and Health Sciences, University of Western Sydney, Parramatta
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37
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Daly J, Lumley J. Public health responses to global challenges. Aust N Z J Public Health 2001; 25:387-8. [PMID: 11688614 DOI: 10.1111/j.1467-842x.2001.tb00644.x] [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: 12/15/2022] Open
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38
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Abstract
The growing burden of heart failure (HF) challenges health practitioners to implement and evaluate models of care to facilitate optimal health related outcomes. Australia supports a publicly funded universal health insurance system with a strong emphasis on primary care provided by general practitioners. The burden of chronic HF, and a social and political framework favoring community-based, noninstitutionalized care, represents an ideal environment in which home-based HF programs can be implemented successfully. Cardiovascular nurses are well positioned to champion and mentor implementation of evidence-based, patient-centered programs in Australian communities. This paper describes the facilitators and barriers to implementation of best practice models in the Australian context. These include the challenge of providing care in a diverse, multicultural society and the need for clinical governance structures to ensure equal access to the most effective models of care.
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Affiliation(s)
- P Davidson
- School of Nursing, Family and Community Health, University of Western Sydney, Australia.
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Tayer WG, Nicassio PM, Weisman MH, Schuman C, Daly J. Disease status predicts fatigue in systemic lupus erythematosus. J Rheumatol 2001; 28:1999-2007. [PMID: 11550966] [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: 02/21/2023]
Abstract
OBJECTIVE To investigate the relative contributions of disease status, helplessness, and depression to fatigue in patients with systemic lupus erythematosus (SLE) in a path-analytic framework. METHODS The disease status of 81 patients with SLE was evaluated by a clinical rheumatologist using the Systemic Lupus Activity Measure. Patients completed self-report measures of psychosocial data, depression, helplessness, and fatigue at 2 assessment periods, 3 months apart. SLE diagnoses were confirmed with patients' physicians. RESULTS The model proposed that SLE disease status would predict fatigue directly, and indirectly, through helplessness and depression. At Time 1, disease status, helplessness, and depression were significantly correlated with each other and with fatigue, with helplessness and depression partially mediating the relationship between disease status and fatigue. Longitudinal analyses showed that disease status at Time 1 predicted fatigue, regardless of helplessness and depression operating as mediators at either Time 1 or Time 2. CONCLUSION The cross sectional findings revealed direct and indirect relationships between disease status and fatigue, with helplessness and depression as mediating variables. However, disease status was the only predictor of fatigue over time. Disease status also predicted Time 2 helplessness, which, in turn, was associated with Time 2 depression. Fatigue amelioration may be an important result of successful management of the underlying SLE process.
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Affiliation(s)
- W G Tayer
- California School of Professional Psychology, San Diego, at Alliant University, 92121-3725, USA
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Abstract
Quality use of medicines (QUM) as a discrete concept is gaining increasing importance in Australia and is supported by a policy platform which has federal government and health professional support. The QUM movement is also supported by a strong consumer base and this lobby group has been responsible for endorsement as a major health initiative. However, the importance of QUM to achievement of optimal patient outcomes has not achieved sufficient recognition in the critical care literature. Implicit in the discussion of QUM is the rational, ethical, safe and effective use of drugs within a best practice framework. Successful implementation of QUM requires appropriate infrastructure and the commitment and cooperation of medical, nursing and pharmacy staff. Support, education and training provide the prerequisites of knowledge, skills and awareness for quality use of medicines for all groups. An emphasis upon evidence based practice and the prevalence of polypharmacy in contemporary health care systems requires examination of factors that are barriers to best practice. QUM in critical care areas requires appropriately skilled staff who are competent to manage patients with a wide range of selected drugs, often in highly stressful situations. In many situations in critical care, the role of the critical care nurse is one of patient advocate. It is important to note that the delivery of critical care is not limited to a discrete setting and is inclusive of management at the trauma scene, assessment and delivery of care in the emergency department, through to intensive, coronary care and high dependency units. This paper presents a discussion of the concept of QUM and its relevance in the critical care context. Key theoretical, policy and research considerations for establishment of QUM in critical care are reviewed and discussed. This paper seeks to describe key issues in QUM and endorse the need for a research agenda in critical care.
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Affiliation(s)
- P Davidson
- School of Nursing, Family & Community Health, College of Social & Health Sciences, University of Western Sydney, Cardiology Department, St George Hospital, Sydney, NSW
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Abstract
Licensees of all licensed premises in the Hunter Region of New South Wales, Australia, were offered free services to encourage adoption of health promotion initiatives relating to responsible service of alcohol, environmental tobacco smoke, healthy food choices, breast and cervical cancer prevention, and the prevention of HIV/AIDS. A total of 239 premises participated in the follow-up survey. Increases in prevalence ranged between 11% and 59% for alcohol-related initiatives. The prevalence of smoke-free areas and healthy food choices increased from 32% to 65% and 42% to 96%, respectively, and the provision of cancer prevention information increased from 3% to 59%. Licensed premises represent a particularly challenging sector for health promotion practitioners to work in. The results of this study suggest that the adoption of health promotion initiatives by licensed premises can be increased. A considerable opportunity therefore exists for health promotion practitioners to become more actively involved in facilitating the adoption of such initiatives in this setting.
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Affiliation(s)
- J Wiggers
- Faculty of Medicine and Health Sciences, University of Newcastle, NSW, Australia.
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Daly J, Lumley J. The joys and trials of Journal editorship. Aust N Z J Public Health 2001; 25:107-8. [PMID: 11357902 DOI: 10.1111/j.1753-6405.2001.tb01828.x] [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: 12/01/2022] Open
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Abstract
Clinical judgement, the keystone of medical expertise, is a hot topic. By contrast, patient judgement, also of central importance in health care, receives little attention. Patients have the last say concerning whether or not they seek medical treatment for symptoms, follow a doctor's advice or accept reassurance. Delay in seeking help for serious symptoms, non-compliance with treatment advice and failure of doctors to reassure many of the 'worried well' have long been recognized as serious problems. We argue that what is common to these important problems is patient judgement. Surveys yielding information about the average influence of a large number of individual variables do not do justice to the complex interaction of influences that can influence the judgements of an individual person under particular social circumstances. This is what explains the wide variety of patient reactions. From the medical standpoint, such unpredictable patient behaviour seems irrational. The patient perspective on the meaning of their actions is a hiatus in our knowledge, which is hampering the planning of effective interventions. Too few studies have sought the perspective of patients by asking them why they acted as they did. Thus, the wide spectrum of patient response in these situations in relation to personality, life experience and social context cannot be studied without interpretive field studies that include interview of patients with qualitative interpretation.
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Affiliation(s)
- I G McDonald
- Centre for the Study of Clinical Practice, St Vincent's Hospital, Victoria Parade, Fitzroy, Australia.
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44
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Daly J, Lahiri DK, Justus DE, Kotwal GJ. Detection of the membrane-retained carboxy-terminal tail containing polypeptides of the amyloid precursor protein in tissue from Alzheimer's disease brain. Life Sci 2001; 63:2121-31. [PMID: 9839536 DOI: 10.1016/s0024-3205(99)80009-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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] [Indexed: 11/21/2022]
Abstract
A major hallmark of Alzheimer's disease (AD) is the presence of extracellular amyloid plaques consisting primarily of amyloid beta peptide (A beta) which is derived from a larger beta-amyloid precursor protein (APP). APP is processed via secretory and endosomal/lysosomal pathways by a group of proteases called secretases. During the processing of APP, the carboxy-terminal tail fragment has been suggested to remain within the cell. To investigate the fate of this fragment, we generated an antibody specific for a nine amino acid residue, the sequence of which was derived from the carboxy-terminal putative cytoplasmic tail of APP. Computer analysis of the entire APP gene, searching for regions of greatest antigenicity, surface probability, hydrophilicity, and presence of beta turns, indicated that the cytoplasmic tail region is an immunodominant region of APP. The peptide coupled to keyhole limpet hemocyanin protein, produced a very high titer antibody (1:1 x 10(6)). To evaluate the specificity of the antibody, immunoprecipitation of in vitro transcribed and translated DNA encoding the carboxy-terminal amino acids of APP in wheat germ extract was carried out. A single immunoprecipitated band of the correct size was seen by SDS-PAGE. The antibody was also able to specifically detect the accumulation of the stable C-terminal tail containing fragments of APP in neurites of the amygdala and hippocampus regions of the human brain tissue from AD subjects, but did not react with age-matched control normal brain tissue. The localization of the C-terminal tail of APP within the brain tissue of AD patients underscores the likely importance of the C-terminus in the pathogenesis of AD.
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Affiliation(s)
- J Daly
- Department of Microbiology and Immunology, University of Louisville School of Medicine, KY 40292, USA
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45
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Baratta EJ, Easterly DG, Bell SA, Cheng CS, Daly J, Fuhrmann GC, Kapish JB, Kingan KL, Larsen IL, Schlenker JM, Sheibley RH, Silverstone M, Uyesugi GS. Determination of Iodine-131 at Low Levels in Milk: Collaborative Study. J AOAC Int 2001. [DOI: 10.1093/jaoac/84.2.507] [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]
Abstract
Abstract
The official method for the determination of iodine-131 in milk has a lower limit of detection (LLD) of 10 pCi/L (0.37 Bq/L). The Nuclear Regulatory Commission had recommended that a method claiming to have an LLD of <0.3 pCi/L (<1.1E-02 Bq/L) be used. That method, which is capable of measuring iodine-131 below the level of detection of the Official Method, was collaboratively studied. The method uses a palladium iodide precipitate to concentrate the iodine-131 and measures (counts) its 364 keV gamma energy in coincidence with the beta decay or with a low-background beta-counting system. The study was performed by using 3 concentrations of iodine- 131 in milk: 2.6, 5.0, and 8.0 pCi/L (9.62E-02, 1.85E-01, and 2.96E-01 Bq/L, respectively). Eleven laboratories agreed to participate in the study. Eight laboratories submitted data for the study. The averages of the results were 2.68, 5.30, and 8.12 pCi/L (9.92E-02, 1.96E-01, and 3.00E-01 Bq/L, respectively), respectively. The intra- and interlaboratory variations were acceptable. The method was adopted First Action by AOAC INTERNATIONAL.
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Affiliation(s)
- Edmong J Baratta
- U.S. Food and Drug Administration, 109 Holton Street, Winchester, MA 01890-1152
| | - David G Easterly
- U.S. Environmental Protection Agency, P.O. Box 93478, Las Vegas, NV 89193-3478
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Jogerst G, Daly J, Zimmerman MB. Physician use of and attitudes regarding the minimum data set. J Am Med Dir Assoc 2001; 2:4-9. [PMID: 12812598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To determine physician use of the Minimum Data Set (MDS), part of the Resident Assessment Instrument (RAI). DESIGN A population-based survey. SETTING The United States. PARTICIPANTS A total of 2223 physicians listing geriatrics as their primary specialty, 1921 of whom are internists and 302 family physicians. MEASUREMENTS A 34-item questionnaire asking nine physician-specific demographic questions; nursing home caseload; percent time spent reviewing MDS and care plan; how the information on the MDS was used. Physicians were also asked to describe their attitudes about the MDS. RESULTS Among the 472 physicians who completed the survey and cared for nursing home patients, 357 were internists and 107 were family physicians. Ninety-one percent of the physicians were board certified, 76% had certificate of added qualifications in geriatrics,65% oversaw 20 nursing home patients. Only 11% of physicians reported reviewing the entire MDS, and 21% part of the MDS for all of their patients. Nineteen percent of physicians did not review the care plan for any of their patients. Fifty-six percent of 461 comments made by physicians regarding the MDS were negative or derogatory. CONCLUSIONS Many practicing geriatricians are not using MDS to facilitate medical decisions. If this physician population is not using the MDS, there is a need to improve the information transfer from the MDS form to the busy clinician.
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Affiliation(s)
- G Jogerst
- Department of Family Medicine, The University of Iowa, Iowa City 52242, USA
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47
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Daly J, Lumley J. Journal transition points to a bright future for its contribution to public health. Aust N Z J Public Health 2000; 24:563-4. [PMID: 11215001 DOI: 10.1111/j.1467-842x.2000.tb00517.x] [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: 11/27/2022] Open
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Jackson D, Daly J, Davidson P, Elliott D, Cameron-Traub E, Wade V, Chin C, Salamonson Y. Women recovering from first-time myocardial infarction (MI): a feminist qualitative study. J Adv Nurs 2000; 32:1403-11. [PMID: 11136408 DOI: 10.1046/j.1365-2648.2000.01622.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [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: 11/20/2022]
Abstract
Although myocardial infarction (MI) is a leading cause of death and disablement for women internationally, little is known about women's recovery. This paper describes an exploratory descriptive study that was informed by feminist principles, and which aimed to explore the recovery experiences of a group of women survivors of first-time MI in the initial period following discharge from hospital. A total of 10 female survivors were interviewed using an open-ended semi-structured interview schedule administered at 7, 14 and 21 days post-hospital discharge. Findings revealed that recovery was experienced as a complex process, initially characterized by fear and uncertainty. Over the duration of the study these feelings were replaced with a more positive outlook, a return of energy, and a sense of confidence in the future. Participants identified an unmet need for reliable information which persisted over the duration of the study. The findings of this study have implications for nursing practice and research. Chief among these is the issue of effective provision of information to women following an acute MI. The importance of providing relevant information to be understood and retained by people experiencing crisis cannot be overstated. Equally important are the provision of opportunities for patients to have regular contact with health professionals to question and seek clarifying information. These findings should now be tested on larger populations.
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Affiliation(s)
- D Jackson
- Division of Nursing, Faculty of Health, UWS Macarthur, Campbelltown, Australia.
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Hindiyeh M, Jense S, Hohmann S, Benett H, Edwards C, Aldeen W, Croft A, Daly J, Mottice S, Carroll KC. Rapid detection of Campylobacter jejuni in stool specimens by an enzyme immunoassay and surveillance for Campylobacter upsaliensis in the greater Salt Lake City area. J Clin Microbiol 2000; 38:3076-9. [PMID: 10921981 PMCID: PMC87189 DOI: 10.1128/jcm.38.8.3076-3079.2000] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [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: 03/02/2000] [Accepted: 05/08/2000] [Indexed: 11/20/2022] Open
Abstract
The Alexon-Trend, Inc. (Ramsey, Minn.), ProSpecT Campylobacter microplate assay was compared with culture on a Campy-CVA plate (Remel, Lenexa, Kans.) and blood-free campylobacter agar with cefoperazone (20 microg/ml), amphotericin B (10 microg/ml), and teicoplanin (4 microg/ml) (CAT medium; Oxoid Limited, Hampshire, England) with 631 patient stool samples. The CAT medium was used to isolate Campylobacter upsaliensis. The enzyme immunoassay (EIA) had a sensitivity and a specificity of 89 and 99%, respectively, and the positive and negative predictive values were 80 and 99%, respectively. Even though we extensively looked for C. upsaliensis in stool samples from patients from the greater Salt Lake City area, we did not isolate this species during the study period. The overall excellent specificity of the EIA allows rapid detection and treatment of positive patients; however, a negative result should be confirmed by culture when clinical suspicion is high.
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Affiliation(s)
- M Hindiyeh
- ARUP Laboratories Inc., Salt Lake City, Utah, USA
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50
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Johnson PA, Conway MA, Daly J, Nicolson C, Robertson J, Mills KH. Plasmid DNA encoding influenza virus haemagglutinin induces Th1 cells and protection against respiratory infection despite its limited ability to generate antibody responses. J Gen Virol 2000; 81:1737-45. [PMID: 10859379 DOI: 10.1099/0022-1317-81-7-1737] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [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: 11/18/2022] Open
Abstract
Direct intramuscular injection of plasmid DNA can generate immune responses against encoded antigens. However, the relative ability of DNA vaccines to induce cellular and humoral immunity after a single or booster immunization and the persistence of this response have not been fully elucidated. In this study, induction and maintenance of antibody and T cell subtypes with different doses of naked DNA encoding the haemagglutinin (HA) gene of influenza virus were examined and compared to the immune responses and protection induced by respiratory tract infection and immunization with a killed virus vaccine. Like natural infection, immunization with HA DNA induced potent Th1 responses. Spleen cells from mice immunized once with HA DNA in the dose range 10 ng to 100 microgram secreted significant levels of IFN-gamma, but low or undetectable IL-5, in response to influenza virus in vitro. Furthermore, CD4(+) HA-specific Th1 clones were generated from spleens of immunized mice. Although T cell responses waned 12 weeks after a single immunization, antigen-specific Th1 cells persisted in the spleen for at least 6 months after two booster immunizations. In contrast, influenza virus-specific ELISA IgG titres were low after a single immunization and required two booster immunizations to reach significant levels. Furthermore, haemagglutination inhibition (HI) antibodies were weak or undetectable after two immunizations. Nevertheless, two doses of HA DNA conferred almost complete protection against respiratory challenge with live virus. Thus, despite the limited ability to induce antibodies, DNA vaccines confer protective immunity against influenza virus infection, which appears to be mediated by Th1 cells.
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Affiliation(s)
- P A Johnson
- Infection and Immunity Group, Department of Biology, National University of Ireland, Maynooth, Co. Kildare, Ireland
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