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Littlecott HJ, Moore GF, Evans RE, Melendez-Torres GJ, McCann M, Reed H, Mann M, Dobbie F, Jennings S, Donaldson C, Hawkins J. Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: a systematic review and meta-ethnography of qualitative research. BMC Public Health 2023; 23:424. [PMID: 36869343 PMCID: PMC9983235 DOI: 10.1186/s12889-022-14727-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/25/2022] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND A relationship between smoking and interpersonal influences has been well established within the literature. There have been cultural shifts in denormalisation and a reduction in tobacco smoking in many countries. Hence there is a need to understand social influences on adolescents' smoking across smoking normalisation contexts. METHODS The search was conducted in July 2019 and updated in March 2022 within 11 databases and secondary sources. Search terms included schools, adolescents, smoking, peers, social norms and qualitative research. Screening was conducted by two researchers independently and in duplicate. Study quality was assessed using the eight-item Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-centre) tool for the appraisal of qualitative studies. Results were synthesised using a meta-narrative lens for meta-ethnography and compared across smoking normalisation contexts. RESULTS Forty one studies were included and five themes were developed, mapping onto the socio ecological model. The social processes by which adolescents take up smoking differed according to a mixture of school type, peer group structure and the smoking culture within the school, as well as the wider cultural context. Data available from smoking denormalised contexts, described changes in social interactions around smoking to cope with its stigmatisation. This was manifested through i) direct peer influence, whereby subtle techniques were employed, ii) group belonging whereby smoking was less likely to be seen as a key determinant of group membership and smoking was less commonly reported to be used as a social tool, and iii) popularity and identity construction, whereby smoking was perceived more negatively in a denormalised context, compared with a normalised context. CONCLUSIONS This meta-ethnography is the first study to demonstrate, drawing on international data, that peer processes in adolescent smoking may undergo changes as smoking norms within society change. Future research should focus on understanding differences across socioeconomic contexts, to inform the adaptation of interventions.
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Affiliation(s)
- H J Littlecott
- Pettenkofer School of Public Health (PSPH), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany. .,Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales, UK.
| | - G F Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales, UK
| | - R E Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - M McCann
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - H Reed
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales, UK
| | - M Mann
- Specialist Unit for Review Evidence, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park Campus, Cardiff, CF14 4YS, UK
| | - F Dobbie
- Usher Institute- University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - S Jennings
- Teaching and Learning for Health Professionals, Bristol Medical School, Faculty of Health Sciences, University of Bristol, 39-41 St Michael's Hill, Bristol, BS2 8EZ, UK
| | - C Donaldson
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales, UK
| | - J Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales, UK
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Pironon S, Cantwell-Jones A, Forest F, Ball J, Diazgranados M, Douglas R, Hawkins J, Howes MJR, Ulian T, Vaitla B, Collar D. Towards an action plan for characterizing food plant diversity. Nat Plants 2023; 9:34-35. [PMID: 36543935 DOI: 10.1038/s41477-022-01300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Affiliation(s)
- S Pironon
- Royal Botanic Gardens, Kew, Richmond, UK.
- UN Environment Programme World Conservation Monitoring Centre, Cambridge, UK.
| | - A Cantwell-Jones
- Science and Solutions for a Changing Planet DTP, Imperial College London, Ascot, UK
- Department of Life Sciences, Imperial College London, Ascot, UK
| | - F Forest
- Royal Botanic Gardens, Kew, Richmond, UK
| | - J Ball
- Royal Botanic Gardens, Kew, Richmond, UK
| | | | | | - J Hawkins
- School of Biological Sciences, University of Reading, Reading, UK
| | | | - T Ulian
- Royal Botanic Gardens, Kew, Richmond, UK
| | - B Vaitla
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - D Collar
- Department of Organismal and Environmental Biology, Christopher Newport University, Newport News, VA, USA
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Akamatsu H, Yang JH, Wakuda K, Hawkins J, Yanes R, Homann O, Tan M, Finger E, Borghaei H. 384P Prevalence of fibroblast growth factor receptor 2b (FGFR2b) protein overexpression in squamous non-small cell lung cancer (sqNSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.421] [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: 12/07/2022] Open
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Littlecott HJ, Moore GF, McCann M, Melendez-Torres GJ, Mercken L, Reed H, Mann M, Dobbie F, Hawkins J. Exploring the association between school-based peer networks and smoking according to socioeconomic status and tobacco control context: a systematic review. BMC Public Health 2022; 22:142. [PMID: 35057769 PMCID: PMC8772141 DOI: 10.1186/s12889-021-12333-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst prevalence of youth smoking in middle and high income countries has decreased, inequality has prevailed. The introduction of legislation regulating tobacco use in public spaces varies across countries, impacting the tobacco control context. Thus reviewing our knowledge of how social networks may influence smoking differently within different contexts is required to facilitate the development of context-specific interventions. METHODS The search, conducted on 31st May 2019, included the following smoking-related terms; schools, adolescents, peers and social networks. Inclusion and exclusion criteria were applied throughout the title and abstract screening and full text screening. Quality assessment and synthesis followed. Studies were narratively synthesised to identify changes according to legislative context. This synthesis was conducted separately for findings relating to three categories: socioeconomic status; social selection and influence; and network position. RESULTS Thirty studies were included. Differences in the relationship between network characteristics and smoking according to socioeconomic status were measured in five out of fifteen studies in Europe. Results varied across studies, with differences in network characteristics and their association with smoking varying both between schools of a differing and those of a similar socioeconomic composition. For studies conducted both before and after the introduction of comprehensive smoking legislation, the evidence for selection processes was more consistent than influence, which varied according to reciprocity. Findings showed that isolates were more likely to smoke and in-degree and out-degree centrality were related to smoking both before and after the introduction of legislation. The relationship between popularity and smoking was contingent on school level smoking prevalence in studies conducted before the introduction of legislation, but not after. CONCLUSIONS Overall, effects according to socioeconomic status were underreported in the included studies and no consistent evidence of change after the introduction of a comprehensive smoking ban was observed. Further network analyses are required using more recent data to obtain a comprehensive understanding of how network processes may influence smoking differently according to socioeconomic status, and how adaptation could be used to enhance intervention effectiveness. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42019137358 .
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Affiliation(s)
- H J Littlecott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, Wales, UK.
| | - G F Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, Wales, UK
| | - M McCann
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - L Mercken
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - H Reed
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, Wales, UK
| | - M Mann
- Specialist Unit for Review Evidence, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park Campus, CF14 4YS, Cardiff, Wales, UK
| | - F Dobbie
- Usher Institute- University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - J Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, Wales, UK
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Sultan P, Ando K, Sultan E, Hawkins J, Blake L, Barwick F, Kawai M, Carvalho B. A systematic review of patient-reported outcome measures used to assess sleep in postpartum women using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Sleep 2021; 44:6278483. [PMID: 34013345 DOI: 10.1093/sleep/zsab128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/01/2021] [Revised: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES We performed a systematic review to identify the best patient-reported outcome measure (PROM) of postpartum sleep in women. METHODS We searched 4 databases for validated PROMs used to assess postpartum sleep. Studies were considered if they evaluated at least 1 psychometric measurement property of a PROM. An overall rating was assigned for each psychometric measurement property of each PROM based upon COSMIN criteria. A modified GRADE approach was used to assess the level of evidence and recommendations were then made for each PROM. RESULTS We identified 15 validation studies of 8 PROMs, in 9,070 postpartum women. An adequate number of sleep domains was assessed by 5 PROMs: Bergen Insomnia Scale (BIS), Pittsburgh Sleep Quality Index (PSQI), General Sleep Disturbance Scale (GSDS), Athens Insomnia Scale (AIS) and the Sleep Symptom Checklist (SSC). BIS and GSDS were the only PROMs to demonstrate adequate content validity and at least a low level of evidence of sufficient internal consistency, resulting in Class A recommendations. The BIS was the only PROM, which is easily accessible and free to use for non-commercial research, that achieved a Class A recommendation. CONCLUSION The BIS is the best currently available PROM of postpartum sleep. However, this PROM fails to assess several important domains such as sleep duration (and efficiency), chronotype, sleep-disordered breathing and medication usage. Future studies should focus on evaluating the psychometric measurement properties of BIS in the North American setting and in different cultural groups, or to develop a more specific PROM of postpartum sleep.
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Affiliation(s)
- P Sultan
- Associate Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - K Ando
- Assistant Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - E Sultan
- Clinical Instructor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - J Hawkins
- Medical Student. Stanford University School of Medicine, Stanford, CA, USA
| | - L Blake
- Associate Professor. UAMS Medical Library, UAMS, Little Rock, AR, USA SCIENC ES
| | - F Barwick
- Clinical Associate Professor, Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine
| | - M Kawai
- Clinical Associate Professor, Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine
| | - B Carvalho
- Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
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Littlecott HJ, Hawkins J, Mann M, Melendez-Torres GJ, Dobbie F, Moore G. Associations between school-based peer networks and smoking according to socioeconomic status and tobacco control context: protocol for a mixed method systematic review. Syst Rev 2019; 8:313. [PMID: 31810493 PMCID: PMC6896310 DOI: 10.1186/s13643-019-1225-z] [Citation(s) in RCA: 2] [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] [Received: 09/04/2019] [Accepted: 11/08/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Smoking remains a major public health concern. School-based social networks influence uptake of smoking among peers. During the past two decades, the UK macro-systemic context within which schools are nested and interact with has changed, with anti-smoking norms having become set at a more macro-systemic level. Whilst the overall prevalence of smoking in the UK has decreased, inequality has prevailed. It is plausible that the influence of school-based social networks on smoking uptake may vary according to socioeconomic status. Therefore, this study aims to understand how social influence on smoking among adolescents has changed in line with variance within and between contexts according to time and geography. METHODS The following databases will be searched: Medline, PsycINFO, Embase, Applied Social Sciences Index and Abstracts (ASSIA), British Education Index, Sociological abstracts, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC) and Scopus. Additional searches will include reference checking of key papers, citation tracking, word of mouth and grey literature searches. The search strategies will incorporate terms relating to smoking, adolescents, schools, peers, network analysis and qualitative research. Titles and abstracts and full texts will be independently screened and assessed for quality by at least two researchers. Included studies will be assessed for quality, and data will be extracted for synthesis, including participant characteristics, setting and tobacco control context, study design and methods, analysis and results and conclusions. Quantitative findings will be narratively synthesised, whilst a lines of argument synthesis combined with refutational analysis will be employed to synthesise qualitative data. Both sets of findings will be charted on a timeline to add context to network findings and obtain an enhanced understanding of changes over time. DISCUSSION This protocol is for a mixed methods synthesis of both social network findings, to investigate social structures and qualitative studies, to elicit contextual information. The review will synthesise changes in the context of social influence on adolescent smoking over time and geographically. As context is increasingly recognised as a key source of complexity, this enhanced understanding will help to inform future interventions targeting smoking through social influence. This will help to enhance their relevance to context, subsequent effectiveness and targeting of inequalities. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019137358.
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Affiliation(s)
- H. J. Littlecott
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - J. Hawkins
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - M. Mann
- Specialist Unit for Review Evidence (SURE), Cardiff University, Level 5, Neuadd Meirionnydd, Cardiff, CF10 3AT UK
| | - G. J. Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - F. Dobbie
- Usher Institute, University of Edinburgh, Doorway 1, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - G. Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), 1-3 Museum Place, Cardiff, CF10 3BD UK
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Bartelink NHM, van Assema P, Jansen MWJ, Savelberg HHCM, Moore GF, Hawkins J, Kremers SPJ. Process evaluation of the healthy primary School of the Future: the key learning points. BMC Public Health 2019; 19:698. [PMID: 31170941 PMCID: PMC6554901 DOI: 10.1186/s12889-019-6947-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background While schools have potential to contribute to children’s health and healthy behaviour, embedding health promotion within complex school systems is challenging. The ‘Healthy Primary School of the Future’ (HPSF) is an initiative that aims to integrate health and well-being into school systems. Central to HPSF are two top-down changes that are hypothesized as being positively disruptive to the Dutch school system: daily free healthy lunches and structured physical activity sessions. These changes are expected to create momentum for bottom-up processes leading to additional health-promoting changes. Using a programme theory, this paper explores the processes through which HPSF and the school context adapt to one another. The aim is to generate and share knowledge and experiences on how to implement changes in the complex school system to integrate school health promotion. Methods The current study involved a mixed methods process evaluation with a contextual action-oriented research approach. The processes of change were investigated in four Dutch primary schools during the development year (2014–2015) and the first two years of implementation (2015–2017) of HPSF. The schools (each with 15–26 teachers and 233–389 children) were in low socio-economic status areas. Measurements included interviews, questionnaires, observations, and analysis of minutes of meetings. Results Top-down advice, combined with bottom-up involvement and external practical support were key facilitators in embedding HPSF within the schools’ contexts. Sufficient coordination and communication at the school level, team cohesion, and feedback loops enhanced implementation of the changes. Implementation of the healthy lunch appeared to be disruptive and create momentum for additional health-promoting changes. Conclusions Initiating highly visible positive disruptions to improve school health can act as a catalyst for wider school health promotion efforts. Conditions to create a positive disruption are enough time, and sufficient bottom-up involvement, external support, team cohesion and coordination. The focus should be on each specific school, as each school has their own starting point and process of change. Trial registration The study was retrospectively registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616). Electronic supplementary material The online version of this article (10.1186/s12889-019-6947-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N H M Bartelink
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. .,Public Health Services, Academic Collaborative Centre for Public Health Limburg, P.O. Box 33, 6400, AA, Heerlen, The Netherlands.
| | - P van Assema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - M W J Jansen
- Public Health Services, Academic Collaborative Centre for Public Health Limburg, P.O. Box 33, 6400, AA, Heerlen, The Netherlands.,Department of Health Services Research, CAPHRI, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - H H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - G F Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales
| | - J Hawkins
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales
| | - S P J Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Cole E, Gulser M, Stimpson K, Bentzley B, Hawkins J, Xiao X, Schatzberg A, Sudheimer K, Williams N. Stanford accelerated intelligent neuromodulation therapy for treatment-resistant depression (SAINT-TRD). Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.299] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bentzley B, Cole E, Gulser M, Stimpson K, Hawkins J, Xiao X, Schatzberg A, Sudheimer K, Williams N. Accelerated intermittent theta-burst stimulation suppresses suicidal ideation in patients with treatment-resistant depression. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Morgan K, Hawkins J, Hallingberg B, Roberts C, Murphy S, Moore G. Energy drink use and health complaints: findings from the 2013/14 HBSC study in Wales. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | - G Moore
- Cardiff University, Cardiff, UK
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Hawkins J, Morrison M, Hawkins M, Byrne E, Kitchen S, Jennings I, Makris M, Preston F, Metcalfe P, Gray E. Establishment of the 1st International Genetic Reference Panel for Factor V Leiden, human gDNA. Thromb Haemost 2017. [DOI: 10.1160/th05-11-0767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryForty-one laboratories participated in an international collaborative study to assess the suitability of a panel of three genomic DNA samples as the 1st International Genetic Reference Panel for the Factor V Leiden (FVL) variant.The code numbers of the materials were 03/254 (FV wild type), 03/260 (FVL homozygote) and 03/248 (FVL heterozygote).The participants evaluated the panel against their in-house controls which were known patient samples and commercial controls. In total, 859 genotype tests were carried out on the panel, with an error rate of 0.7%.The errors were not related to specific samples of the panel or to any specific techniques.The findings of this study have indicated that this panel is suitable to be used as a reference material for genotyping of factor V Leiden. It was therefore recommended that the three genomic DNA samples be established as the 1st International Genetic Reference Panel for Factor V Leiden, Human gDNA, 04/224. This recommendation was approved by the Scientific and Standardization Committee (SSC) of the ISTH (International Society on Thrombosis and Haemostasis) in June 2004 and the Expert Committee on Biological Standardization (ECBS) of theWorld Health Organization (WHO) in November 2004.
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Riveros-Perez E, Hermesch A, Barbour L, Hawkins J. Aplastic anemia in two consecutive pregnancies: obstetric and anesthetic management. Int J Obstet Anesth 2017; 33:71-75. [PMID: 29108725 DOI: 10.1016/j.ijoa.2017.08.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
Aplastic anemia is a serious condition occasionally coexisting with pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management are particularly challenging, and treatment requires knowledge of pathophysiologic mechanisms in order to provide safe care to this group of patients. We describe the successful obstetric management and labor analgesia of a patient with a diagnosis of aplastic anemia in two consecutive pregnancies.
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Affiliation(s)
- E Riveros-Perez
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, United States.
| | - A Hermesch
- Maternal Fetal Medicine, University of Colorado School of Medicine, United States
| | - L Barbour
- Medicine and Obstetrics and Gynecology, University of Colorado School of Medicine, United States
| | - J Hawkins
- Department of Anesthesiology, Director of Obstetric Anesthesia, University of Colorado School of Medicine, United States
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McConnon L, Godwin J, Hawkins J, Bond A, Fletcher A. Use of the school setting during the summer holidays: formative process evaluation of ‘Food and Fun’. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.441] [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: 11/13/2022] Open
Affiliation(s)
| | | | | | - A Bond
- Cardiff University, Cardiff, UK
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Hawkins J. Using activity monitors to support physical activity changes: experiences from exercise referral schemes in Wales. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.058] [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: 11/13/2022] Open
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Joshi LT, Welsch A, Hawkins J, Baillie L. The effect of hospital biocide sodium dichloroisocyanurate on the viability and properties of Clostridium difficile spores. Lett Appl Microbiol 2017. [PMID: 28639362 DOI: 10.1111/lam.12768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Clostridium difficile is the primary cause of healthcare-associated diarrhoea globally and produces spores which are resistant to commonly used biocides and are able persist on contaminated surfaces for months. This study examined the effect of sublethal concentrations of the biocide sodium dichloroisocyanurate (NaDCC) on the viability of spores produced by 21 clinical isolates of C. difficile representing a range of PCR ribotypes. Spores exposed to 500 ppm NaDCC for 10 min exhibited between a 4-6 log10 reduction in viability which was independent of spore PCR ribotype. The effect of sublethal concentrations of biocide on the surface properties of exosporium positive and negative clinical isolates was determined using a spore adhesion to hydrocarbon (SATH) assay. These isolates differed markedly in their responses suggesting that exposure to biocide can have a profound effect on hydrophobicity and thus the ability of spores to adhere to surfaces. This raises the intriguing possibility that sublethal exposure to NaDCC could inadvertently promote the spread of the pathogen in healthcare facilities. SIGNIFICANCE AND IMPACT OF THE STUDY This study is the first to report on changes in Clostridium difficile spore surface property after exposure to sublethal levels of the commonly used biocide sodium dichloroisocyanurate. The implications of these changes to the spore surface include increased adherence of the spores to inorganic surfaces which can directly contribute to persistence and spread of spores within the hospital environment.
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Affiliation(s)
- L T Joshi
- Peninsula Schools of Medicine and Dentistry, Portland Square, Plymouth University, Plymouth, UK
| | - A Welsch
- Peninsula Schools of Medicine and Dentistry, Portland Square, Plymouth University, Plymouth, UK
| | - J Hawkins
- Peninsula Schools of Medicine and Dentistry, Portland Square, Plymouth University, Plymouth, UK
| | - L Baillie
- Peninsula Schools of Medicine and Dentistry, Portland Square, Plymouth University, Plymouth, UK
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Torabinejad M, Moazzami SM, Moaddel H, Hawkins J, Gustefson C, Faras H, Wright K, Shabahang S. Effect of MTA particle size on periapical healing. Int Endod J 2017; 50 Suppl 2:e3-e8. [PMID: 27977855 DOI: 10.1111/iej.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/08/2016] [Indexed: 12/01/2022]
Abstract
AIM To examine the effect of reduction in MTA particle size on dento-alveolar and osseous healing in dogs. METHODOLOGY Root canals of 24 mandibular premolars in four 2-year-old beagles were prepared and filled with gutta-percha and sealer. Two to four weeks later, during periapical surgery, the root-end cavity preparations in these teeth were filled with either grey ProRoot MTA or modified (reduced particle sizes with faster setting time) MTA. The animals were sacrificed 4 months later. Degrees of inflammation, type of inflammatory cells, fibrous connective tissue adjacent to the root-end filling materials, cementum formation over the resected roots and root-end filling materials and bone healing were examined. Data were analysed using the McNemar test. RESULTS No significant differences in healing of periapical tissues were found when comparing ProRoot MTA to a modified MTA containing reduced particle sizes. CONCLUSION Reducing the particle sizes of MTA did not impact its biological properties.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
| | - S M Moazzami
- Department of Endodontics, Mashad University, Mashad, Iran
| | - H Moaddel
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
| | - J Hawkins
- Private Practice, Kennewick, WA, USA
| | | | - H Faras
- Department of Endodontics, Kuwait University, Kuwait City, Kuwait
| | - K Wright
- Department of Anatomy, Loma Linda University, Loma Linda, CA, USA
| | - S Shabahang
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
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Alhamlan FS, Majumder MS, Brownstein JS, Hawkins J, Al-Abdely HM, Alzahrani A, Obaid DA, Al-Ahdal MN, BinSaeed A. Case characteristics among Middle East respiratory syndrome coronavirus outbreak and non-outbreak cases in Saudi Arabia from 2012 to 2015. BMJ Open 2017; 7:e011865. [PMID: 28082362 PMCID: PMC5253590 DOI: 10.1136/bmjopen-2016-011865] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES As of 1 November 2015, the Saudi Ministry of Health had reported 1273 cases of Middle East respiratory syndrome (MERS); among these cases, which included 9 outbreaks at several hospitals, 717 (56%) patients recovered, 14 (1%) remain hospitalised and 543 (43%) died. This study aimed to determine the epidemiological, demographic and clinical characteristics that distinguished cases of MERS contracted during outbreaks from those contracted sporadically (ie, non-outbreak) between 2012 and 2015 in Saudi Arabia. DESIGN Data from the Saudi Ministry of Health of confirmed outbreak and non-outbreak cases of MERS coronavirus (CoV) infections from September 2012 through October 2015 were abstracted and analysed. Univariate and descriptive statistical analyses were conducted, and the time between disease onset and confirmation, onset and notification and onset and death were examined. RESULTS A total of 1250 patients (aged 0-109 years; mean, 50.825 years) were reported infected with MERS-CoV. Approximately two-thirds of all MERS cases were diagnosed in men for outbreak and non-outbreak cases. Healthcare workers comprised 22% of all MERS cases for outbreak and non-outbreak cases. Nosocomial infections comprised one-third of all Saudi MERS cases; however, nosocomial infections occurred more frequently in outbreak than non-outbreak cases (p<0.001). Patients contracting MERS during an outbreak were significantly more likely to die of MERS (p<0.001). CONCLUSIONS To date, nosocomial infections have fuelled MERS outbreaks. Given that the Kingdom of Saudi Arabia is a worldwide religious travel destination, localised outbreaks may have massive global implications and effective outbreak preventive measures are needed.
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Affiliation(s)
- F S Alhamlan
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - M S Majumder
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - J Hawkins
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - H M Al-Abdely
- Public Health Deputy, Ministry of Health, Riyadh, Saudi Arabia
| | - A Alzahrani
- Public Health Deputy, Ministry of Health, Riyadh, Saudi Arabia
| | - D A Obaid
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M N Al-Ahdal
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A BinSaeed
- Public Health Deputy, Ministry of Health, Riyadh, Saudi Arabia
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Nsoesie E, Hawkins J, Tuli G, Kluberg S, Brownstein J. The Use of Social Media and Business Reviews for Foodborne Illness Surveillance. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Benson RA, Hawkins J, Pherwani AD. Novel technique for tunnelling paediatric cuffed venous catheters. Ann R Coll Surg Engl 2016; 98:522. [PMID: 27241602 DOI: 10.1308/rcsann.2016.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R A Benson
- University Hospitals of North Midlands NHS Trust , UK
| | - J Hawkins
- University Hospitals of North Midlands NHS Trust , UK
| | - A D Pherwani
- University Hospitals of North Midlands NHS Trust , UK
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Richardson S, Kacmar R, Hawkins J, Eltzschig HK, Kleck C, Burger E, Hodges J. Use of continuous fetal heart rate monitoring during discectomy at 24weeks of gestation. Int J Obstet Anesth 2015; 25:95-6. [PMID: 26597410 DOI: 10.1016/j.ijoa.2015.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/19/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
Affiliation(s)
- S Richardson
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - R Kacmar
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - J Hawkins
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - H K Eltzschig
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - C Kleck
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - E Burger
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - J Hodges
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
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Beynon R, Hawkins J, Laing R, Higgins N, Whiting P, Jameson C, Sterne JAC, Vergara P, Hollingworth W. The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model. Health Technol Assess 2014; 17:1-88, v-vi. [PMID: 23673151 DOI: 10.3310/hta17190] [Citation(s) in RCA: 26] [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: 12/13/2022] Open
Abstract
BACKGROUND Diagnostic selective nerve root block (SNRB) involves injection of local anaesthetic, sometimes in conjunction with corticosteroids, around spinal nerves. It is used to identify symptomatic nerve roots in patients with probable radicular pain that is not fully concordant with imaging findings. OBJECTIVES (1) Determine the diagnostic accuracy of SNRB in patients with low back and radiating pain in a lower limb; (2) evaluate whether or not accuracy varies by patient subgroups; (3) review injection-related adverse events; and (4) evaluate the cost-effectiveness of SNRB. DATA SOURCES MEDLINE, EMBASE, Science Citation Index, Bioscience Information Service (BIOSIS), Latin American and Caribbean Health Sciences Literature (LILACS) and grey literature databases were searched from inception to August 2011. Reference lists of included studies were screened. METHODS A systematic review (SR) of studies that assessed the accuracy of SNRB or adverse events in patients with low back pain and symptoms in a lower limb for the diagnosis of lumbar radiculopathy. Study quality was assessed using the quality assessment of diagnostic accuracy studies (QUADAS)-2 checklist. We used random-effects meta-analysis to pool diagnostic accuracy data. Decision tree and Markov models were developed, combining SR results with information on the costs and outcomes of surgical and non-surgical care. Uncertainty was assessed using probabilistic and deterministic sensitivity analyses. RESULTS Five studies assessed diagnostic accuracy: three diagnostic cohort and two within-patient case-control studies. All were judged to be at high risk of bias and had high concerns regarding applicability. In individual studies, sensitivity ranged from 57% [95% confidence interval (CI) 43% to 70%] to 100% (95% CI 76% to 100%) and specificity from 9.5% (95% CI 1% to 30%) to 86% (95% CI 76% to 93%). The most reliable estimate was judged to come from two cohort studies that used post-surgery outcome as the reference standard; summary sensitivity and specificity were 93% (95% CI 86% to 97%) and 26% (95% CI 5% to 68%), respectively. No study provided sufficient detail to judge whether or not accuracy varied by patient subgroup. Seven studies assessed adverse events. There were no major or permanent complications; minor complications were reported in 0-6% of patients. The addition of SNRB to the diagnostic work-up was not cost-effective with an incremental cost per quality-adjusted life-year of £1,576,007. Sensitivity analyses confirmed that SNRB was unlikely to be a cost-effective method for diagnosis and planning surgical therapy. LIMITATIONS We identified very few studies; all were at high risk of bias. The conduct and interpretation of SNRBs varied and there was no gold standard for diagnosis. Limited information about the impact of SNRB on subsequent care and the long-term costs and benefits of surgery increased uncertainty about cost-effectiveness. CONCLUSIONS There were few studies that estimated the diagnostic accuracy of SNRB in patients with radiculopathy and all were limited by the difficulty of making a reference standard diagnosis. Summary estimates suggest that specificity is low, but results are based on a small number of studies at a high risk of bias. Based on current weak evidence, it is unlikely that SNRB is a cost-effective method for identifying the symptomatic nerve root prior to lumbar spine surgery. Future research should focus on randomised controlled trials to evaluate whether or not SNRB improves patient outcomes at acceptable cost. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- R Beynon
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Cheng Q, Park KH, Macdougall JD, Zindler A, Lugmair GW, Staudigel H, Hawkins J, Lonsdale P. Isotopic Evidence for a Hotspot Origin of the Louisville Seamount Chain. Seamounts, Islands, and Atolls 2013. [DOI: 10.1029/gm043p0283] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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White C, Hawkins J, Pone E, Al-Qahtani A, Mai T, Zan H, Casali P. AID dysregulation in lupus-prone MRL/ Faslpr/lpr mice promotes interchromosomal c-Myc/IgH loci translocations, increased class switch DNA recombination and production of anti-dsDNA IgG autoantibodies: modulation by HoxC4 (148.25). The Journal of Immunology 2011. [DOI: 10.4049/jimmunol.186.supp.148.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Activation-induced cytidine deaminase (AID) initiates immunoglobulin (Ig) gene somatic hypermutation (SHM) and class switch DNA recombination (CSR), which are critical in the generation of pathogenic autoantibodies. In these studies, we addressed the regulation of AID by HoxC4 in lupus. We found that SLE patients and lupus-prone MRL/Faslpr/lpr mice displayed increased expression of HoxC4, which directly activates the promoter of the AID gene, and increased expression of AID. Dysregulation of these proteins was associated with increased CSR in B cells of MRL/Faslpr/lpr mice. In the HoxC4-/- MRL/Faslpr/lpr mice we generated, HoxC4-deficiency resulted in reduced AID expression, impaired CSR and decreased serum anti-dsDNA IgG, particularly IgG2a production, in association with a reduction in IgG deposition in kidney glomeruli. Consistent with our previous findings that upregulated AID expression is associated with extensive DNA lesions, we found a high frequency of c-Myc to IgH translocations in MRL/Faslpr/lpr mice. The frequency of c-Myc to IgH translocations was significantly reduced in autoimmune MRL/Faslpr/lpr mice deficient in HoxC4. Our findings showed that HoxC4 is upregulated in lupus B cells, and this plays a major role in dysregulating AID expression, increasing CSR and autoantibody production, and promoting c-Myc to IgH translocations.
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Affiliation(s)
| | - J. Hawkins
- 1University of California, Irvine, Irvine, CA
| | - Egest Pone
- 1University of California, Irvine, Irvine, CA
| | | | - Thach Mai
- 1University of California, Irvine, Irvine, CA
| | - Hong Zan
- 1University of California, Irvine, Irvine, CA
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Spiess FN, Macdonald KC, Atwater T, Ballard R, Carranza A, Cordoba D, Cox C, Garcia VM, Francheteau J, Guerrero J, Hawkins J, Haymon R, Hessler R, Juteau T, Kastner M, Larson R, Luyendyk B, Macdougall JD, Miller S, Normark W, Orcutt J, Rangin C. East pacific rise: hot springs and geophysical experiments. Science 2010; 207:1421-33. [PMID: 17779602 DOI: 10.1126/science.207.4438.1421] [Citation(s) in RCA: 574] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Hydrothermal vents jetting out water at 380 degrees +/- 30 degrees C have been discovered on the axis of the East Pacific Rise. The hottest waters issue from mineralized chimneys and are blackened by sulfide precipitates. These hydrothermal springs are the sites of actively forming massive sulfide mineral deposits. Cooler springs are clear to milky and support exotic benthic communities of giant tube worms, clams, and crabs similar to those found at the Galápagos spreading center. Four prototype geophysical experiments were successfully conducted in and near the vent area: seismic refraction measurements with both source (thumper) and receivers on the sea floor, on-bottom gravity measurements, in situ magnetic gradiometer measurements from the submersible Alvin over a sea-floor magnetic reversal boundary, and an active electrical sounding experiment. These high-resolution determinations of crustal properties along the spreading center were made to gain knowledge of the source of new oceanic crust and marine magnetic anomalies, the nature of the axial magma chamber, and the depth of hydrothermal circulation.
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Rodgers M, Hodges R, Hawkins J, Hollingworth W, Duffy S, McKibbin M, Mansfield M, Harbord R, Sterne J, Glasziou P, Whiting P, Westwood M. Colour vision testing for diabetic retinopathy: a systematic review of diagnostic accuracy and economic evaluation. Health Technol Assess 2010; 13:1-160. [PMID: 20003824 DOI: 10.3310/hta13600] [Citation(s) in RCA: 13] [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: 11/22/2022] Open
Abstract
OBJECTIVE To determine the diagnostic performance and cost-effectiveness of colour vision testing (CVT) to identify and monitor the progression of diabetic retinopathy (DR). DATA SOURCES Major electronic databases including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews were searched from inception to September 2008. REVIEW METHODS A systematic review of the evidence was carried out according to standard methods. An online survey of National Screening Programme for Diabetic Retinopathy (NSPDR) clinical leads and programme managers assessed the diagnostic tools used routinely by local centres and their views on future research priorities. A decision tree and Markov model was developed to estimate the incremental costs and effects of adding CVT to the current NSPDR. RESULTS In total, 25 studies on CVT met the inclusion criteria for the review, including 18 presenting 2 x 2 diagnostic accuracy data. The quality of studies and reporting was generally poor. Automated or computerised CVTs reported variable sensitivities (63-97%) and specificities (71-95%). One study reported good diagnostic accuracy estimates for computerised CVT plus retinal photography for detection of sight-threatening DR, but it included few cases of retinopathy in total. Results for pseudoisochromatic plates, anomaloscopes and colour arrangement tests were largely inadequate for DR screening, with Youden indices (sensitivity + specificity - 100%) close to zero. No studies were located that addressed patient preferences relating to CVT for DR. Retinal photography is universally employed as the primary method for retinal screening by centres responding to the online survey; none used CVT. The review of the economic evaluation literature found no previous studies describing the cost and effects of any type of CVT. Our economic evaluation suggested that adding CVT to the current national screening programme could be cost-effective if it adequately increases sensitivity and is relatively inexpensive. The deterministic base-case analysis indicated that the cost per quality-adjusted life-year gained may be 6364 pounds and 12,432 pounds for type 1 and type 2 diabetes respectively. However, probabilistic sensitivity analysis highlighted the substantial probability that CVT is not diagnostically accurate enough to be either an effective or a cost-effective addition to current screening methods. The results of the economic model should be treated with caution as the model is based on only one small study. CONCLUSIONS There is insufficient evidence to support the use of CVT alone, or in combination with retinal photography, as a method for screening for retinopathy in patients with diabetes. Better quality diagnostic accuracy studies directly comparing the incremental value of CVT in addition to retinal photography are needed before drawing conclusions on cost-effectiveness. The most frequently cited preference for future research was the use of optical coherence tomography for the detection of clinically significant macular oedema.
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Affiliation(s)
- M Rodgers
- Centre for Reviews and Dissemination, University of York, UK
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Shapiro M, Duca KA, Lee K, Delgado-Eckert E, Hawkins J, Jarrah AS, Laubenbacher R, Polys NF, Hadinoto V, Thorley-Lawson DA. A virtual look at Epstein-Barr virus infection: simulation mechanism. J Theor Biol 2008; 252:633-48. [PMID: 18371986 DOI: 10.1016/j.jtbi.2008.01.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 01/09/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
Epstein-Barr virus (EBV) is an important human pathogen that establishes a life-long persistent infection and for which no precise animal model exists. In this paper, we describe in detail an agent-based model and computer simulation of EBV infection. Agents representing EBV and sets of B and T lymphocytes move and interact on a three-dimensional grid approximating Waldeyer's ring, together with abstract compartments for lymph and blood. The simulation allows us to explore the development and resolution of virtual infections in a manner not possible in actual human experiments. Specifically, we identify parameters capable of inducing clearance, persistent infection, or death.
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Affiliation(s)
- M Shapiro
- Department of Pathology, Jaharis Building, Tufts University School of Medicine, 150 Harrison Ave., Boston, MA 02111, USA
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Hawkins J, Wells J. How infrastructure procurement can enhance social development. Proceedings of the Institution of Civil Engineers - Management, Procurement and Law 2007. [DOI: 10.1680/mpal.2007.160.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper reports the findings of a study by Engineers Against Poverty and the Institution of Civil Engineers into the factors in infrastructure procurement that are currently inhibiting the achievement of social development objectives. The paper explores the impact/performance of the asset and the service it delivers (the product), and the opportunities during the project's construction and operation (the process). The study adopted a very broad definition of ‘procurement’ to embrace all stages from project identification to the final monitoring, enforcement and evaluation. Methods included reviews of procurement documentation and practice in four case-study countries (India, Indonesia, Kenya and Nigeria), round-table discussions and in-depth interviews with stakeholders. This yielded a long list of inhibiting factors but also some encouraging efforts at reform. The paper concludes that procurement procedures and contract agreement have the potential to promote social objectives. However, the objectives should be clearly identified in the project design; the budget and procurement strategy have to be appropriate; and implementation must be monitored and enforced.
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Affiliation(s)
- J. Hawkins
- Institution of Civil Engineers London, UK
| | - J. Wells
- Engineers Against Poverty London, UK
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Li J, Hawkins J. A system for evaluating inpatient care cost-efficiency in a hospital. Stud Health Technol Inform 2002; 84:1171-4. [PMID: 11604914] [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
The cost-efficiency evaluation is one important aspect in the health care organization performance assessment. This paper introduces the ratio of exact cost to Relative Intensity Weights, cost per case weight, as one indicator. A statistical approach for cost-efficiency analyses is presented in this paper. The analyses would be done at the population level and patient level. The linkage between population and individual patients provides the capability to review the distributions of several cost-efficiency measures and to do further studies, including factor adjustment. A well established health care data warehouse is to accomplish a timely and evaluation of the cost-efficiency in hospital.
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Affiliation(s)
- J Li
- Health Care Improvement Unit, St. Michael's Hospital, University of Toronto, Toronto, Ontario, M5B 1W8, Canada.
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Geanellos R, Fry A, Pearce H, Williams J, Hawkins J, Manning E, Cowell K. 'The experience of community mental health case management provided from an acute in-patient psychiatric unit'. Int J Psychiatr Nurs Res 2001; 7:815-32. [PMID: 11915388] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In Australia, case management is the cornerstone of mental health service delivery for seriously ill clients living in the community. In this study, case management was provided from an acute, inpatient psychiatric unit; a model thought to be unique. Findings from this qualitative study explicated the experience of case management from client and case manager (CM) perspectives. They note the nature, purpose, processes and outcomes of case management within that context. Findings were positive, suggesting clients and CM's develop a therapeutic alliance through which interventions are implemented and which result in clients experiencing personal (re) integration and enhanced well-being. These findings are discussed and they suggest an alternative model of service delivery well regarded by both clients and CM's.
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Affiliation(s)
- R Geanellos
- University of Western Sydney, School of Nursing, Family & Community Health Building, ER-Parramatta Campus, Locked Bag 1797, Penrith South DC 1797, NSW, Australia.
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Hawkins J. Addressing the shortage of radiologists. Radiol Manage 2001; 23:26-8. [PMID: 11499079] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
In a survey of 254 hospital radiology departments conducted last year, Dallas-based U.S. Radiology Partners (USRP), a radiology management firm, found that 45 percent of hospitals are understaffed in radiology. Fifty-six percent of hospital radiology department heads surveyed by USRP indicated that staffing shortages were diminishing the quality of care their departments are able to provide. Moreover, staffing shortages are occurring at a time when radiology volume generally is increasing. There are various underlying reasons why the supply of radiologists and other physicians is insufficient to meet demand in many areas, including institutional misdiagnosis, graduate medical education, patient preferences, the economy, restrictions on international medical graduates, practice patterns, patient and physician demographics and new technology. Given current physician supply and demand trends, a strategic radiology staffing plan is needed. Such a plan would include the following elements: retention, candidate parameters, contracts and incentives, sourcing, screening, interviewing, responsiveness and decisiveness.
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Affiliation(s)
- J Hawkins
- Hawkins & Associates, Dallas, Texas, USA.
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Abstract
Itk is a Tec family tyrosine kinase found in T cells that is activated upon ligation of the T cell receptor (TCR/CD3), CD2, or CD28. Itk contains five domains in addition to the catalytic domain: pleckstrin homology, Tec homology which contains a proline-rich region, Src homology 3, and Src homology 2. To provide a basis for understanding the contribution of these various domains to catalysis, recombinant Itk was purified and its substrate specificity determined by steady-state kinetic methods. Measurements of the rates of phosphorylation of various protein substrates, including Src associated in mitosis 68K protein (SAM68), CD28, linker for activation of T cells, and CD3 zeta, at a fixed concentration indicated that SAM68 was phosphorylated most rapidly. Wild-type Itk and three Itk mutants were characterized by comparing their activity (k(cat)) using the SAM68 substrate. A deletion mutant removing the pleckstrin homology domain and part of the Tec homology domain (Itk(Delta152)) had approximately 10-fold less activity than wild type, a mutant with an altered proline-rich domain (P158A,P159A) had a more dramatic 100-fold loss of activity, and the catalytic domain alone was essentially inactive. Itk(Delta152) had K(m) values for ATP and SAM68 nearly identical to those of the wild-type enzyme, while Itk(P158A,P159A) had approximately 3-fold higher K(m) values for each substrate. SAM68 phosphorylation by the wild-type and mutant enzymes in the presence of several tyrosine kinase inhibitors were compared using a homogeneous time-resolved fluorescence assay. Both the Itk(Delta152) deletion mutant and the Itk(P158A,P159A) mutant had IC(50) values similar to those of the wild-type enzyme for staurosporine, PP1, and damnacanthal. These comparisons, taken together with the similar K(m) values for ATP and SAM68 substrate between the wild-type and the mutant enzymes, indicate that the amino acids in the N-terminal 152 residues and proline-rich domains enhance catalysis by affecting turnover rate rather than substrate binding.
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Affiliation(s)
- J Hawkins
- Department of High Throughput Screening and Automation, Merck Research Laboratories, Rahway, New Jersey 07065, USA
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Haggerty LA, Kelly U, Hawkins J, Pearce C, Kearney MH. Pregnant women's perceptions of abuse. J Obstet Gynecol Neonatal Nurs 2001; 30:283-90. [PMID: 11383951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE To determine whether pregnant women's perceptions of abuse severity and danger, and their ability to control the abuse, are significantly correlated with the acts of abuse they experience, and to find out whether relationships exist among women's appraisals of abuse severity, danger, and their perceived ability to stop the abuse. DESIGN A correlational design was used to compare the abusive acts experienced by the women and their perceptions of that abuse. SETTING Nine prenatal clinics in urban areas of the northeastern United States. PARTICIPANTS Sixty-one ethnically diverse, pregnant abused women were interviewed. MAIN OUTCOME MEASURE Pearson's product-moment correlations were used to examine relationships between abusive experiences and women's perceptions of abuse. RESULTS Women's perceptions of abuse severity were modestly correlated with threatened (r = .25) and actual violence (r = .36). Perceptions of abuse severity and danger were correlated (r = .41). CONCLUSIONS Women's beliefs about abuse severity, danger, and their ability to control abuse cannot be fully comprehended by exploring the discrete acts they experience. Further research is needed to identify additional factors that influence those beliefs.
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Affiliation(s)
- L A Haggerty
- Boston College, School of Nursing, Chestnut Hill, MA, USA.
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Abstract
The undisputed optimum treatment for venous leg ulcers is compression therapy, where an external appliance (multilayer, short-stretch bandaging and compression hosiery) promotes venous return through graduated compression of the tissues and capillaries. However, this is not always acceptable to the patient, particularly when the patient's social life is affected with malodour and pain associated with venous leg ulcers, thereby reducing quality of life. There is a psychosocial consideration when the bandaging system is bulky, hot and difficulty is found with the fitting of shoes. An alternative and clinically effective solution is essential if the wound is to heal. In this case study, the patient was provided with a cohesive and short-stretch compression bandage (Actico), which allowed her to continue her social life while effectively treating her ulcer.
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Affiliation(s)
- J Hawkins
- Wound Care Clinic, West Middlesex University Hospital, Iselworth, Middlesex
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Li J, Hawkins J. A system for evaluating inpatient care cost-efficiency in hospital. Proc AMIA Symp 2001:369-72. [PMID: 11825212 PMCID: PMC2243448] [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: 02/23/2023] Open
Abstract
The cost-efficiency evaluation is one important aspect in the health care organization performance assessment. This paper introduces the ratio of exact cost to Relative Intensity Weights, cost per case weight, as one indicator. A statistical approach for cost-efficiency analyses is presented in this paper. The analyses would be done at the population level and patient level. The linkage between population and individual patients provides the capability to review the distributions of several cost-efficiency measures and to do further studies, including factor adjustment. A well established health care data warehouse is to accomplish a timely and evaluation of the cost-efficiency in hospital.
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Affiliation(s)
- J Li
- Health Care Improvement Unit, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Affiliation(s)
- J Hawkins
- Department of Molecular Design and Diversity, Merck Research Laboratories, Rahway, New Jersey 07065, USA
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Abstract
BACKGROUND We examined the effects of passive containment of the cardiac ventricles with a surgically placed epicardial prosthetic wrap on indexes of left ventricular (LV) remodeling in dogs with heart failure. METHODS Heart failure (LV ejection fraction 30% to 40%) was produced in 12 dogs by intracoronary microembolization. Six dogs underwent mid-sternotomy and pericardiotomy with placement of a preformed-knitted polyester device (Acorn Cardiac Support Device [CSD], Acorn Cardiovascular, Inc, St. Paul, MN) snugly around the ventricles and anchored to the atrioventricular groove. Six dogs did not undergo surgery and served as controls. Dogs were followed for 3 months prior to sacrifice. RESULTS In controls, LV end-diastolic volume increased after 3 months (67 +/- 12 versus 83 +/- 8 ml; p = 0.04), while in CSD-treated dogs, it decreased (68 +/- 10 versus 61 +/- 10 ml; p = 0.002). CSD-containment of LV size was associated with increased LV systolic fractional area of shortening, while in controls, fractional area of shortening decreased. CSD-treated dogs also showed amelioration of myocyte hypertrophy and attenuation of interstitial fibrosis compared to controls. CONCLUSIONS In dogs with heart failure, passive epicardial containment of the ventricles with the Acorn CSD ameliorates LV remodeling and improves LV systolic function.
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Affiliation(s)
- P A Chaudhry
- Department of Medicine and Surgery, Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, Michigan, USA
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Hawkins J. Midwives make a difference ... but who knows? Pract Midwife 2000; 3:4-5. [PMID: 12026439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Abstract
Investigators encounter many legal and ethical issues when they conduct research on partner abuse. Balancing abused women's rights to privacy with legally mandated reporting requirements involves considerable thought and planning. Failure to protect participants may result in escalation of abuse as well as loss of children to protective services. Various perspectives on maintaining participant privacy while conforming to legal mandates to report child abuse, homicidality, and suicidality are discussed. The role of confidentiality certificates in providing legal immunity for researchers and the method of obtaining the certificates are presented. In addition, the authors describe the strategies for participant protection that are implemented in a federally funded study of abuse, women's self-care, and pregnancy outcomes. The decision to clearly and specifically inform abused women of the limits of confidentiality allows participants to make informed decisions about disclosures, but may result in diminished recruitment.
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Ward RV, Jennings KH, Jepras R, Neville W, Owen DE, Hawkins J, Christie G, Davis JB, George A, Karran EH, Howlett DR. Fractionation and characterization of oligomeric, protofibrillar and fibrillar forms of beta-amyloid peptide. Biochem J 2000; 348 Pt 1:137-44. [PMID: 10794724 PMCID: PMC1221046] [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: 02/16/2023]
Abstract
The beta-amyloid (Abeta) peptide, a major component of senile plaques in Alzheimer's disease brain, has been shown previously to undergo a process of polymerization to produce neurotoxic forms of amyloid. Recent literature has attempted to define precisely the form of Abeta responsible for its neurodegenerative properties. In the present study we describe a novel density-gradient centrifugation method for the isolation and characterization of structurally distinct polymerized forms of Abeta peptide. Fractions containing protofibrils, fibrils, sheet structures and low molecular mass oligomers were prepared. The fractionated forms of Abeta were characterized structurally by transmission electron microscopy. The effects on cell viability of these fractions was determined in the B12 neuronal cell line and hippocampal neurons. Marked effects on cell viability in the cells were found to correspond to the presence of protofibrillar and fibrillar structures, but not to monomeric peptide or sheet-like structures of polymerized Abeta. Biological activity correlated with a positive reaction in an immunoassay that specifically detects protofibrillar and fibrillar Abeta; those fractions that were immunoassay negative had no effect on cell viability. These data suggest that the effect of Abeta on cell viability is not confined to a single conformational form but that both fibrillar and protofibrillar species have the potential to be active in this assay.
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Affiliation(s)
- R V Ward
- Department of Neuroscience, SmithKline Beecham Pharmaceuticals, New Frontiers Science Park, Harlow CM19 5AW, U.K
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See A, Kron T, Johansen J, Hamilton C, Bydder SA, Hawkins J, Roff M, Denham JW. Decision-making models in the analysis of portal films: a clinical pilot study. Australas Radiol 2000; 44:72-83. [PMID: 10761263 DOI: 10.1046/j.1440-1673.2000.00775.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Portal films continue to play an important role in the verification of radiotherapy treatment. There is still some discussion, however, as to what action should be taken after a port film has shown a radiation field deviation from the prescribed volume. It was the aim of the present pilot study to investigate the performance of three decision-making models ('Amsterdam', 'Quebec' and 'Newcastle') and an expert panel basing their decision on intuition rather than formal rules after portal film acquisition in a clinical setting. Portal films were acquired on every day during the first week of treatment for five head and neck and five prostate cancer patients (diagnostic phase). If required, the field position was modified according to our normal practice following the recommendation of the expert panel. In order to analyse the results of the models, however, additional port films were taken in the following 3 treatment weeks with the patient moved as required by the different models (intervention phase). The portal films were taken over 4 consecutive days, positioning the patient according to each of the different models on one day each. None of the models diagnosed a field misplacement in the head and neck patients, while the 'Amsterdam' and 'Quebec' models predicted a move in one prostate patient. The 'Newcastle' model, which is based on Hotelling's T2 statistic, proved to be more sensitive and diagnosed a systematic displacement for three prostate patients. The intervention phase confirmed the diagnosis of the model, even if the three portal films taken with the patient position adjusted as required by the model proved to be insufficient to demonstrate an improvement. The 'Newcastle' model does not rely on assumptions about the random movement of patients and requires five portal films before a decision can be reached. This approach lends itself well to incorporation into electronic portal imaging 'packages', where repeated image acquisitions present no logistical difficulty.
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Affiliation(s)
- A See
- Department of Radiation Oncology, Newcastle Mater Misericordiae Hospital, Waratah, New South Wales, Australia
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Hawkins J, Romero V. Practical ethics. How much to tell a recruit. Hosp Health Netw 2000; 74:24. [PMID: 11393189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Cascio MG, Gaiser RR, Camann WR, Venkateswaran P, Hawkins J, McCarthy D. Comparative evaluation of four different infusion rates of ropivacaine (2 mg/mL) for epidural labor analgesia. Reg Anesth Pain Med 1998; 23:548-53. [PMID: 9840848 DOI: 10.1016/s1098-7339(98)90079-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have reported comparable efficacy for ropivacaine and bupivacaine when used for labor analgesia at concentrations of 2.5 mg/mL. In this multicenter study, we assessed ropivacaine at the commercially available concentration of 2 mg/mL (0.2%) for labor pain management. METHODS After Institutional Review Board approval and informed consent, 128 women at term were randomly assigned to receive ropivacaine at one of the four infusion rates via a lumbar epidural catheter. Analgesia was initiated with a 5-mL test dose, followed by injections of 5-15 mL of 2 mg/mL ropivacaine. The continuous infusion was then started at 4, 6, 8, or 10 rmL/hour. Rescue analgesia was provided with 5-mL "top-up" injections as necessary to provide maternal comfort. Pain relief was assessed by using a visual analog pain scale (VAPS) and motor block was assessed by using a modified Bromage scale. RESULTS All infusion regimens effectively decreased VAPS, and most patients in all groups had minimal or no motor block at the end of the first stage of labor. Mean total number of the top-up injections required per patient were 3, 2, 1.5, and 1.4, respectively, in the 4, 6, 8, and 10-mL/hour groups (P < .05, 4 mL/hour vs. all other groups). Despite receiving more total bolus dosages, the 4-mL/hour group had less motor block in the lower extremities (P < .05). Apgar scores and neurological adaptive capacity scores were similar for all groups. CONCLUSIONS The 2 mg/mL of ropivacaine produces satisfactory labor analgesia at epidural infusion rates of 4, 6, 8, and 10 mL/hour, provided supplemental bolus dosages are available. Clinically, a rate of 6 mL/hour may be the lowest effective rate that provides the best combination of pain relief, motor block, and rebolusing, although rates of 8 and 10 mL/hour produced similar results.
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Affiliation(s)
- M G Cascio
- Department of Anesthesiology, Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
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Bromidge SM, Brown F, Cassidy F, Clark MS, Dabbs S, Hadley MS, Hawkins J, Loudon JM, Naylor CB, Orlek BS, Riley GJ. Design of [R-(Z)]-(+)-alpha-(methoxyimino)-1-azabicyclo[2.2.2]octane-3-acetonitri le (SB 202026), a functionally selective azabicyclic muscarinic M1 agonist incorporating the N-methoxy imidoyl nitrile group as a novel ester bioisostere. J Med Chem 1997; 40:4265-80. [PMID: 9435896 DOI: 10.1021/jm9702903] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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: 02/05/2023]
Abstract
Loss of cholinergic function is believed to be implicated in the cognitive decline associated with senile dementia of the Alzheimer type (SDAT). The disease is characterized by progressive loss of muscarinic receptors located on nerve terminals while postsynaptic muscarinic M1 receptors appear to remain largely intact. Muscarinic agonists acting directly on postsynaptic receptors offer the prospect of countering the cholinergic deficit in SDAT. This study describes a novel series of azabicyclic muscarinic agonists, which incorporate an oxime ether or modified oxime ether group as an ester bioisostere. Modification of the oxime ether function by the introduction of electron withdrawing groups led to the finding that the (Z)-N-methoxy imidoyl nitrile group serves as a stable methyl ester bioisostere. This culminated in the discovery of the quinuclidinyl N-methoxy imidoyl nitrile R-(+)-(Z)-5g which is a functionally selective muscarinic M1 partial agonist currently in phase III clinical trials for the treatment of SDAT. The selective profile of R-(+)-(Z)-5g can be rationalized in terms of the relative affinity of the compound at muscarinic receptor subtypes, the degree of agonist efficacy, and brain penetrancy.
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Affiliation(s)
- S M Bromidge
- Department of Medicinal Chemistry, SmithKline Beecham Pharmaceuticals, Harlow, Essex, U.K
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Loudon JM, Bromidge SM, Brown F, Clark MS, Hatcher JP, Hawkins J, Riley GJ, Noy G, Orlek BS. SB 202026: a novel muscarinic partial agonist with functional selectivity for M1 receptors. J Pharmacol Exp Ther 1997; 283:1059-68. [PMID: 9399977] [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: 02/05/2023] Open
Abstract
The finding that ascending cholinergic systems are severely degenerated in Alzheimer's disease has driven the search for a cholinomimetic therapy. Adverse effects observed with cholinesterase inhibitors and high-efficacy muscarinic agonists led us to design compounds with an improved profile. SB 202026 (R-(Z)-(+)-alpha-(methoxyimino)-1-azabicyclo[2.2.2] octane-3-acetonitrile) displaced [3H]-oxotremorine-M from muscarinic receptors in the rat brain with high affinity (IC50 = 14 nM), a potency similar to that of oxotremorine-M itself (IC50 = 13 nM), but exhibited low affinity for cholinergic nicotinic receptors and other neuroreceptors. In studies using cloned human muscarinic receptors, SB 202026 possessed approximately equal affinity in displacing [3H]-quinuclidinyl benzilate from all muscarinic receptor subtypes. In functional models in vitro, SB 202026 caused maximal depolarization of the rat superior cervical ganglion at low concentrations (300 nM) (M1-mediated effect), while producing a lower maximal effect than the high-efficacy agonists oxotremorine-M and carbachol on M2-mediated release of ACh and M3-mediated smooth muscle contraction (guinea pig ileum), respectively. The functional selectivity and partial agonist profile seen in vitro were reflected in vivo through potent cognition-related activity (M1-induced increase in hippocampal EEG power) combined with low efficacy, compared with arecoline or oxotremorine, on induction of bradycardia (M2-mediated response), hypotension (via M3-mediated vasorelaxation) and tremor (thought to be mediated by M3 receptors). The foregoing profile of SB 202026 predicted that cognition-enhancing activity would be achieved at doses below those that initiate undesirable side effects, and this has subsequently been demonstrated in rodents, marmosets and humans.
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Affiliation(s)
- J M Loudon
- Department of Neurosciences, SmithKline Beecham Pharmaceuticals, Third Avenue, Harlow, Essex CM19 5AW, United Kingdom
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Hawkins J. New ruling finalizes IRS position on physician recruitment incentives. Med Netw Strategy Rep 1997; 6:8-9. [PMID: 10167821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- J Hawkins
- Merritt, Hawkins & Associates, Irving, TX, USA
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Petryshen P, Stevens B, Hawkins J, Stewart M. Comparing nursing costs for preterm infants receiving conventional vs. developmental care. Nurs Econ 1997; 15:138-45, 150. [PMID: 9305114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The incremental costs incurred by VLBW (less than 1,500 grams) infants during the first year of life accounted for one-third of the $11.4 billion spent in the U.S. on health care. Developmental care for VLBW infants focuses on light and noise management, coordination of interventions to minimize sleep interruptions and positioning/bundling the infant to prevent disorganizaiton and promote self-regulation. When compared to 60 VLBW infants receiving conventional NICU care, improved physiologic stability measures and fewer days in the NICU were recorded for the 60 VLBW infants cared for by nurses and trained developmental care specialists. Because the move from the NICU to the transitional unit occurred earlier for the developmental group of VLBW infants, and their nursing intensity needs were lower, the average cost savings achieved for this group was $4,340 per infant during the first 35 days of life or less if discharged.
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Abstract
There is a growing body of evidence, including data from human genetic and T-cell receptor function studies, which implicate a zeta-associated protein of M(r) 70,000 (Zap-70) as a critical protein tyrosine kinase in T-cell activation and development. During T-cell activation, Zap-70 becomes associated via its src homology type 2 (SH2) domains with tyrosine-phosphorylated immune-receptor tyrosine activating motif (ITAM) sequences in the cytoplasmic zeta chain of the T-cell receptor. An intriguing conundrum is how Zap-70 is catalytically activated for downstream phosphorylation events. To address this question, we have used purified Zap-70, tyrosine phosphorylated glutathione S-transferase (GST)-Zeta, and GST-Zeta-1 cytoplasmic domains, and various forms of ITAM-containing peptides to see what effect binding of zeta had upon Zap-70 tyrosine kinase activity. The catalytic activity of Zap-70 with respect to autophosphorylation increased approximately 5-fold in the presence of 125 nM phosphorylated GST-Zeta or GST-Zeta-1 cytoplasmic domain. A 20-fold activity increase was observed for phosphorylation of an exogenous substrate. Both activity increases showed a GST-Zeta concentration dependence. The increase in activity was not produced with nonphosphorylated GST-Zeta, phosphorylated zeta, or phosphorylated ITAM-containing peptides. The increase in Zap-70 activity was SH2 mediated and was inhibited by phenylphosphate, Zap-70 SH2, and an antibody specific for Zap-70 SH2 domains. Since GST-Zeta and GST-Zeta-1 exist as dimers, the data suggest Zap-70 is activated upon binding a dimeric form of phosphorylated zeta and not by peptide fragments containing a single phosphorylated ITAM. Taken together, these data indicate that the catalytic activity of Zap-70 is most likely activated by a trans-phosphorylation mechanism.
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Affiliation(s)
- P V LoGrasso
- Department of Molecular Design and Diversity, Merck Research Laboratories, Rahway, NJ 07065, USA.
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Hawkins J. Managed care calls for new physician compensation formulas. Med Netw Strategy Rep 1996; 5:7-9. [PMID: 10161626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- J Hawkins
- Merritt, Hawkins & Associates, Irving, TX, USA
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