1
|
Tsang TW, Allen T, Turner A, Bowyer J, Fitzpatrick J, Latimer J, Oscar J, Carter M, Elliott EJ. Ophthalmic Findings in Aboriginal Children with High Rates of Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder: The Lililwan Project. Ophthalmic Epidemiol 2024:1-8. [PMID: 38569083 DOI: 10.1080/09286586.2024.2331539] [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] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To describe ophthalmic findings in an Indigenous paediatric population and the associations between fetal alcohol spectrum disorder (FASD), prenatal alcohol exposure (PAE), and eye anomalies. METHODS Medical records were reviewed for eye problems, and eye assessments were conducted by an orthoptist or ophthalmologist in the Lililwan Project cohort, which comprised 108 (81%) of all children born between 2002 and 2003, and residing in the remote Fitzroy Valley, Western Australia in 2010. Values from ophthalmic assessments and prevalence of abnormalities were presented for the total cohort and stratified by group: FASD; PAE (no FASD); and No PAE. RESULTS Of children, 55% had PAE and 19% FASD. Most (98%) had normal vision; 15.6% had keratometry cylinder values indicating astigmatism and potential for improved vision with glasses. Strabismus (22.3%), short palpebral fissure length (PFL; 21.3%), upslanting palpebral fissures (12.0%), follicular trachomatous inflammation (6.9%), abnormal slit lamp assessments (6.7%), retinal tortuosity (6.7%), and blepharoptosis (5.6%) were identified. Strabismus and trachoma rates were higher than in the general child population. Ophthalmic findings were similar between groups except for prevalence of short PFL (FASD > No PAE; p = 0.003); abnormal keratometry cylinder values (FASD [29.4%] and PAE (no FASD) [20.0%] > No PAE [5.3%]; p = 0.031) and blepharoptosis (FASD [9.5%] > other groups [0%]; p = 0.040). CONCLUSION Despite the small sample, some eye abnormalities were higher in children with PAE and/or FASD. Access to eye services or assessment of vision and structural eye anomalies is essential for Indigenous children, particularly those with PAE or FASD to allow early effective treatment.
Collapse
Affiliation(s)
- Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
| | - Tiffany Allen
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Angus Turner
- Lions Eye Institute, Nedlands, Washington, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Joshua Bowyer
- Lions Eye Institute, Nedlands, Washington, Australia
- University of Western Australia, Perth, Western Australia, Australia
- St. John of God Hospital Midland, Midland, Western Australia, Australia
| | - James Fitzpatrick
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Jane Latimer
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
| |
Collapse
|
2
|
Iglesia MD, Jayasinghe RG, Chen S, Terekhanova NV, Herndon JM, Storrs E, Karpova A, Zhou DC, Al Deen NN, Shinkle AT, Lu RJH, Caravan W, Houston A, Zhao Y, Sato K, Lal P, Street C, Rodrigues FM, Southard-Smith AN, Targino da Costa ALN, Zhu H, Mo CK, Crowson L, Fulton RS, Wyczalkowski MA, Fronick CC, Fulton LA, Sun H, Davies SR, Appelbaum EL, Chasnoff SE, Carmody M, Brooks C, Liu R, Wendl MC, Oh C, Bender D, Cruchaga C, Harari O, Bredemeyer A, Lavine K, Bose R, Margenthaler J, Held JM, Achilefu S, Ademuyiwa F, Aft R, Ma C, Colditz GA, Ju T, Oh ST, Fitzpatrick J, Hwang ES, Shoghi KI, Chheda MG, Veis DJ, Chen F, Fields RC, Gillanders WE, Ding L. Differential chromatin accessibility and transcriptional dynamics define breast cancer subtypes and their lineages. bioRxiv 2023:2023.10.31.565031. [PMID: 37961519 PMCID: PMC10634973 DOI: 10.1101/2023.10.31.565031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Breast cancer is a heterogeneous disease, and treatment is guided by biomarker profiles representing distinct molecular subtypes. Breast cancer arises from the breast ductal epithelium, and experimental data suggests breast cancer subtypes have different cells of origin within that lineage. The precise cells of origin for each subtype and the transcriptional networks that characterize these tumor-normal lineages are not established. In this work, we applied bulk, single-cell (sc), and single-nucleus (sn) multi-omic techniques as well as spatial transcriptomics and multiplex imaging on 61 samples from 37 breast cancer patients to show characteristic links in gene expression and chromatin accessibility between breast cancer subtypes and their putative cells of origin. We applied the PAM50 subtyping algorithm in tandem with bulk RNA-seq and snRNA-seq to reliably subtype even low-purity tumor samples and confirm promoter accessibility using snATAC. Trajectory analysis of chromatin accessibility and differentially accessible motifs clearly connected progenitor populations with breast cancer subtypes supporting the cell of origin for basal-like and luminal A and B tumors. Regulatory network analysis of transcription factors underscored the importance of BHLHE40 in luminal breast cancer and luminal mature cells, and KLF5 in basal-like tumors and luminal progenitor cells. Furthermore, we identify key genes defining the basal-like ( PRKCA , SOX6 , RGS6 , KCNQ3 ) and luminal A/B ( FAM155A , LRP1B ) lineages, with expression in both precursor and cancer cells and further upregulation in tumors. Exhausted CTLA4-expressing CD8+ T cells were enriched in basal-like breast cancer, suggesting altered means of immune dysfunction among breast cancer subtypes. We used spatial transcriptomics and multiplex imaging to provide spatial detail for key markers of benign and malignant cell types and immune cell colocation. These findings demonstrate analysis of paired transcription and chromatin accessibility at the single cell level is a powerful tool for investigating breast cancer lineage development and highlight transcriptional networks that define basal and luminal breast cancer lineages.
Collapse
|
3
|
Singh AK, Dadey DY, Rau MJ, Fitzpatrick J, Shah HK, Saikia M, Townsend R, Thotala D, Hallahan DE, Kapoor V. Blocking the functional domain of TIP1 by antibodies sensitizes cancer to radiation therapy. Biomed Pharmacother 2023; 166:115341. [PMID: 37625322 DOI: 10.1016/j.biopha.2023.115341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) and glioblastoma (GB) have poor prognoses. Discovery of new molecular targets is needed to improve therapy. Tax interacting protein 1 (TIP1), which plays a role in cancer progression, is overexpressed and radiation-inducible in NSCLC and GB. We evaluated the effect of an anti-TIP1 antibody alone and in combination with ionizing radiation (XRT) on NSCLC and GB in vitro and in vivo. NSCLC and GB cells were treated with anti-TIP1 antibodies and evaluated for proliferation, colony formation, endocytosis, and cell death. The efficacy of anti-TIP1 antibodies in combination with XRT on tumor growth was measured in mouse models of NSCLC and GB. mRNA sequencing was performed to understand the molecular mechanisms involved in the action of anti-TIP1 antibodies. We found that targeting the functional domain of TIP1 leads to endocytosis of the anti-TIP1 antibody followed by reduced proliferation and increased apoptosis-mediated cell death. Anti-TIP1 antibodies bound specifically (with high affinity) to cancer cells and synergized with XRT to significantly increase cytotoxicity in vitro and reduce tumor growth in mouse models of NSCLC and GB. Importantly, downregulation of cancer survival signaling pathways was found in vitro and in vivo following treatment with anti-TIP1 antibodies. TIP1 is a new therapeutic target for cancer treatment. Antibodies targeting the functional domain of TIP1 exhibited antitumor activity and enhanced the efficacy of radiation both in vitro and in vivo. Anti-TIP1 antibodies interrupt TIP1 function and are effective cancer therapy alone or in combination with XRT in mouse models of human cancer.
Collapse
Affiliation(s)
- Abhay K Singh
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - David Ya Dadey
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael J Rau
- Center for Cellular Imaging, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - James Fitzpatrick
- Center for Cellular Imaging, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Departments of Cell Biology & Physiology and Neuroscience, Washington University School of Medicine, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO,USA
| | - Harendra K Shah
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Minakshi Saikia
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Reid Townsend
- Department of Medicine, Washington University in St. Louis, St. Louis, MO,USA; Siteman Cancer Center, St. Louis, MO, USA
| | - Dinesh Thotala
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Siteman Cancer Center, St. Louis, MO, USA
| | - Dennis E Hallahan
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Siteman Cancer Center, St. Louis, MO, USA.
| | - Vaishali Kapoor
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Siteman Cancer Center, St. Louis, MO, USA.
| |
Collapse
|
4
|
Parhizkar S, Gent G, Chen Y, Rensing N, Gratuze M, Strout G, Sviben S, Tycksen E, Zhang Q, Gilmore PE, Sprung R, Malone J, Chen W, Remolina Serrano J, Bao X, Lee C, Wang C, Landsness E, Fitzpatrick J, Wong M, Townsend R, Colonna M, Schmidt RE, Holtzman DM. Sleep deprivation exacerbates microglial reactivity and Aβ deposition in a TREM2-dependent manner in mice. Sci Transl Med 2023; 15:eade6285. [PMID: 37099634 PMCID: PMC10449561 DOI: 10.1126/scitranslmed.ade6285] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/07/2023] [Indexed: 04/28/2023]
Abstract
Sleep loss is associated with cognitive decline in the aging population and is a risk factor for Alzheimer's disease (AD). Considering the crucial role of immunomodulating genes such as that encoding the triggering receptor expressed on myeloid cells type 2 (TREM2) in removing pathogenic amyloid-β (Aβ) plaques and regulating neurodegeneration in the brain, our aim was to investigate whether and how sleep loss influences microglial function in mice. We chronically sleep-deprived wild-type mice and the 5xFAD mouse model of cerebral amyloidosis, expressing either the humanized TREM2 common variant, the loss-of-function R47H AD-associated risk variant, or without TREM2 expression. Sleep deprivation not only enhanced TREM2-dependent Aβ plaque deposition compared with 5xFAD mice with normal sleeping patterns but also induced microglial reactivity that was independent of the presence of parenchymal Aβ plaques. We investigated lysosomal morphology using transmission electron microscopy and found abnormalities particularly in mice without Aβ plaques and also observed lysosomal maturation impairments in a TREM2-dependent manner in both microglia and neurons, suggesting that changes in sleep modified neuro-immune cross-talk. Unbiased transcriptome and proteome profiling provided mechanistic insights into functional pathways triggered by sleep deprivation that were unique to TREM2 and Aβ pathology and that converged on metabolic dyshomeostasis. Our findings highlight that sleep deprivation directly affects microglial reactivity, for which TREM2 is required, by altering the metabolic ability to cope with the energy demands of prolonged wakefulness, leading to further Aβ deposition, and underlines the importance of sleep modulation as a promising future therapeutic approach.
Collapse
Affiliation(s)
- Samira Parhizkar
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Grace Gent
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Yun Chen
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
| | - Nicholas Rensing
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Maud Gratuze
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory Strout
- Washington University Center for Cellular Imaging, Washington University School of Medicine, St. Louis, MO, USA
| | - Sanja Sviben
- Washington University Center for Cellular Imaging, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Tycksen
- Genome Technology Access Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Qiang Zhang
- Department of Medicine, Washington University Medical School, St. Louis, MO, USA
| | | | - Robert Sprung
- Department of Medicine, Washington University Medical School, St. Louis, MO, USA
| | - Jim Malone
- Department of Medicine, Washington University Medical School, St. Louis, MO, USA
| | - Wei Chen
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Javier Remolina Serrano
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Xin Bao
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Choonghee Lee
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Chanung Wang
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Landsness
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - James Fitzpatrick
- Washington University Center for Cellular Imaging, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael Wong
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Reid Townsend
- Department of Medicine, Washington University Medical School, St. Louis, MO, USA
| | - Marco Colonna
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
| | - Robert E Schmidt
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
| | - David M Holtzman
- Department of Neurology, Hope Center for Neurological Disorders, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
5
|
Butler E, Walsh JE, Grogan S, Lyons C, Whalley D, Fitzpatrick J, Gallagher L, Dockery F. 348 WHAT IS THE OLDER PATIENT’S VIEW ON RECEIVING DETAILED MEDICAL LETTERS? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.305] [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
Sending copies of clinic letters to patients involves additional work for medical staff in formatting letters, administrative staff in printing and posting and is an added cost to the healthcare service. Though seen largely as good practice in some specialities, it is not done routinely in Geriatric medical services. We introduced this practice as standard in our service and wished to evaluate whether from the patient perspective, it is worthwhile.
Methods
We sent a questionnaire to n=80 older patients who were evaluated in the home setting (by the Integrated Care Team for Older People – ICTOP) or recently attended CGA (Comprehensive Geriatric Assessment) clinic or FLS (Fracture Liaison Service) clinic. We asked their opinion on the detailed medical letter sent to their General Practitioner (GP), which they received a copy of. The questionnaire could be completed by patient/carer/relative, and returned anonymously.
Results
N=30/80 were returned. Two said they found the letter difficult to understand; 1/30 said the letter caused them to worry but all said they still preferred that they had received it. N= 2 said they would like to have contributed to the letter for accuracy. All said they felt they should receive copies of all their medical correspondence. Free text comments showed overwhelming support for the process, in allowing them to self-manage their health, enhance communication with other healthcare professionals and was a useful document to refer back to when they are trying to process information during short consultations.
Conclusion
Though a small survey and limited by low response rate, older people expressed high levels of satisfaction in receiving copies of medical letters about their health. It supports the ongoing practice and should be adopted widely.
Collapse
Affiliation(s)
- E Butler
- Beaumont Hospital , Dublin, Ireland
| | - JE Walsh
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | - S Grogan
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | - C Lyons
- Beaumont Hospital , Dublin, Ireland
| | - D Whalley
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | | | | | - F Dockery
- Beaumont Hospital , Dublin, Ireland
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| |
Collapse
|
6
|
Tan GKY, Symons M, Fitzpatrick J, Connor SG, Cross D, Pestell CF. Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia. BMC Pediatr 2022; 22:587. [PMID: 36217109 PMCID: PMC9549627 DOI: 10.1186/s12887-022-03654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders. Methods Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law. Results Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores. Conclusion ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03654-y.
Collapse
Affiliation(s)
- Grace Kuen Yee Tan
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia. .,Patches Australia, Subiaco, Australia. .,Telethon Kids Institute (TKI), Nedlands, Australia.
| | - Martyn Symons
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - James Fitzpatrick
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Patches Australia, Subiaco, Australia
| | | | - Donna Cross
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - Carmela F Pestell
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| |
Collapse
|
7
|
Iyengar KP, Azzopardi CA, Fitzpatrick J, Hill T, Haleem S, Panchal H, Botchu R. Calcaneal offset index to measure hindfoot alignment in pes planus. Skeletal Radiol 2022; 51:1631-1637. [PMID: 35146553 DOI: 10.1007/s00256-022-04011-x] [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: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pes planus is a common three-dimensional (3D) deformity characterised by forefoot abduction, the collapse of the medial longitudinal arch, and hindfoot valgus. Several radiological measurements such as anteroposterior talocalcaneal angle (Kite's) and 'Calcaneal pitch angle' (CPA) exist to calculate the degree of hindfoot alignment in these patients with variable intra- and interobserver reliability. OBJECTIVE To describe a new radiological ancillary method of measuring hindfoot alignment, the calcaneal offset index (COI). MATERIAL AND METHODS Anteroposterior (mortise) and lateral view weight-bearing (WB) ankle radiographs of 200 consecutive patients referred for foot and ankle pain were reviewed. Demographic details, clinical indication, and COI calculation were undertaken on the mortise view along with the measurement of CPA for each patient. A one-way analysis of variance (ANOVA) was performed. Intraclass correlation coefficient (ICC) analysis was evaluated to assess the intraclass reliability between observers. RESULTS There was a female preponderance of 2:1 in the study population with a mean age of 51.21 years (13-86 years). The calcaneal offset was increased in pes planus (hindfoot valgus). The p-value was 0.00023 on ANOVA. The COI gave an excellent interobserver correlation with ICC of 0.9 and moderate intraobserver reliability on the ICC analysis of 0.55. CONCLUSION The COI can be an additional index of measuring hindfoot alignment in patients with pes planus. Contrary to the traditional angular measurements, this linear transverse plane measure is easier to calculate and reproducible. COI measurement has shown moderate intraobserver reliability but excellent interobserver reliability.
Collapse
Affiliation(s)
- K P Iyengar
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - C A Azzopardi
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK
| | - J Fitzpatrick
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK
| | - T Hill
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - S Haleem
- Departments of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - H Panchal
- Sanyapixel Diagnostics, Ahmedabad, India
| | - R Botchu
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK.
| |
Collapse
|
8
|
Tan GKY, Pestell CF, Fitzpatrick J, Cross D, Adams I, Symons M. Exploring offending characteristics of young people with foetal alcohol spectrum disorder in Western Australia. Psychiatr Psychol Law 2022; 30:514-535. [PMID: 37484511 PMCID: PMC10360980 DOI: 10.1080/13218719.2022.2059028] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neurodevelopmental impairments resulting from Foetal Alcohol Spectrum Disorder (FASD) can increase the likelihood of justice system involvement. This study compared offence characteristics in young people with FASD to demographically matched controls (n = 500) in Western Australia. A novel approach (i.e. association rule mining) was adopted to uncover relationships between personal attributes and offence characteristics. For FASD participants (n = 100), file records were reviewed retrospectively. Mean age of the total sample was 15.60 years (range = 10-24), with 82% males and 88% Australian Aboriginal. After controlling for demographic factors, regression analyses showed FASD participants were more likely than controls to be charged with reckless driving (odds ratio, OR = 4.20), breach of bail/community orders (OR = 3.19), property damage (OR = 1.84), and disorderly behaviour (OR = 1.54). Overall, our findings suggest justice-involved individuals with FASD have unique offending profiles. These results have implications for sentencing, diversionary/crime prevention programs and interventions.
Collapse
Affiliation(s)
- Grace Kuen Yee Tan
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
| | - Carmela F. Pestell
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
| | - James Fitzpatrick
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
| | - Donna Cross
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
| | - Isabelle Adams
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
| | - Martyn Symons
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
9
|
Fitzpatrick J. 1. Livestock Science Matters for Human and Planetary Health. Animal - science proceedings 2022. [PMCID: PMC9090130 DOI: 10.1016/j.anscip.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
|
10
|
Pedruzzi RA, Hamilton O, Hodgson HHA, Connor E, Johnson E, Fitzpatrick J. ‘We do what we can as soon as we can’ Alcohol and Other Drug workforce perspectives on preventing and responding to prenatal alcohol exposure. Drugs: Education, Prevention and Policy 2021. [DOI: 10.1080/09687637.2020.1843600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rebecca A. Pedruzzi
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | | | | | - Elizabeth Connor
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | | | - James Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
11
|
Lemon D, Swan-Castine J, Connor E, van Dooren F, Pauli J, Boffa J, Fitzpatrick J, Pedruzzi RA. Vision, future, cycle and effect: A community life course approach to prevent prenatal alcohol exposure in central Australia. Health Promot J Austr 2021; 33:788-796. [PMID: 34716966 PMCID: PMC9541745 DOI: 10.1002/hpja.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/22/2020] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Issue addressed Prevention approaches specific to prenatal alcohol exposure (PAE) and foetal alcohol spectrum disorder (FASD) have been identified as urgently needed in Australia, including in Aboriginal and Torres Strait Islander communities. However, very little work has aimed to describe and evaluate health promotion initiatives, especially those developed in rural and remote areas. Methods A series of television commercial scripts (scripts) were developed with health promotion staff at an aboriginal and Torres Strait Islander Community Controlled Health Service and piloted with 35 community members across six yarning sessions. Results Scripts evoked responses in line with two predominant themes: “Strength” and “Community resonance.” This process led to the development of a four‐part television and radio campaign focusing on a life course approach to prevent prenatal alcohol exposure (PAE) – “Vision,” “Future,” “Cycle” and “Effect.” Conclusions Intergenerational influences on PAE were key elements of scripts positively received by community members. Strengths of this work included a flexible approach to development, local aboriginal men and women coordinating the yarning sessions, and the use of local actors and familiar settings. So what? Preventing PAE is extraordinarily complex. Initiatives that are culturally responsive and focus on collective responsibility and community action may be crucial to shifting prominent alcohol norms. Future work is necessary to determine the impact of this campaign.
Collapse
Affiliation(s)
- Donna Lemon
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Northern Territory, Australia
| | - Justine Swan-Castine
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Northern Territory, Australia
| | | | | | - Jenna Pauli
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Northern Territory, Australia
| | - John Boffa
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Northern Territory, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - James Fitzpatrick
- Telethon Kids Institute, Nedlands, Western Australia, Australia.,School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | | |
Collapse
|
12
|
Lomas J, Brown N, Fitzpatrick J, Fryers P, Barnard S. Comparison of all-cause mortality in England with Europe and the USA: January 2020 to February 2021. Eur J Public Health 2021. [PMCID: PMC8574263 DOI: 10.1093/eurpub/ckab165.252] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Assessing mortality during the COVID-19 pandemic is vital for informing public health strategies and policy decision making. All-cause excess mortality provides an objective measure of the impact of the pandemic including both the direct and indirect effects. Our study considers the burden of mortality in the UK, Europe and the USA. We examine variation between countries, by age and sex. We explore the extent to which this variation is associated with COVID-19 case rates and other population characteristics. Methods The study is a secondary analysis of routine administrative population and mortality data. Weekly death occurrences and population estimates were obtained from Eurostat and national statistical agencies. Contextual information on COVID-19 case rates, population-level risk factors and healthcare were obtained from various open-source databases. Weekly age-standardised mortality rates (ASMRs) were calculated and presented relative to a baseline average from the preceding 5-year period. Relative cumulative (rc) ASMRs were then calculated to provide a comparable assessment of excess mortality at a point in time. Results Preliminary results show that, by end of the analysis period, England had an overall rcASMR of 10.09%. Higher excess mortality was identified for some countries (eg USA 14.58%) and lower - even below average mortality - for others (eg Norway -6.8%). Under 65 rcASMR showed substantial variation between countries. Cumulative COVID-19 case rates showed a moderate effect size (R2 = 0.51) when used to explain the proportion of variation observed between rcASMRs. Other population factors showed a smaller effect. Conclusions The burden of mortality experienced between countries and populations over the COVID-19 pandemic period has shown significant variation. Factors which may have contributed to the position of some countries should be further explored in order to inform ongoing management of Covid-19 and future pandemic events. Key messages Significant variation in all-cause excess mortality has been identified across the COVID-19 pandemic period between nations and particularly in younger age groups. COVID-19 case rates are associated with relative cumulative all-cause excess mortality among the nations assessed.
Collapse
Affiliation(s)
- J Lomas
- Public Health England, London, UK
| | - N Brown
- Public Health England, London, UK
| | | | - P Fryers
- Public Health England, London, UK
| | | |
Collapse
|
13
|
Fryers PT, Barnard S, Burton PR, Fox S, Waller Z, Fitzpatrick J. Excess mortality in England during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574561 DOI: 10.1093/eurpub/ckab164.555] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Excess mortality monitoring is not dependent on completeness or consistency of coding of causes of death and captures deaths caused directly and indirectly by COVID-19. It takes account of existing inequalities in the baseline rates and shows the additional impact of COVID-19. We report weekly on excess mortality by age, gender, geographical area, deprivation, and ethnicity.
Methods
A quasi-Poisson model was fitted to deaths data for 2015-2019 to estimate expected mortality in population sub-groups each week during the COVID-19 pandemic. This was compared with observed mortality reported each week. Information on deaths registered was obtained from death certificates. Ethnicity was obtained from hospital records linked to deaths data.
Results
Early in the pandemic, excess deaths exceeded official reported COVID-19 deaths every week. Throughout the pandemic there were stark inequalities in excess death rates. Based on data from 21 March 2020 to 9 April 2021, people living in the most deprived areas in England experienced more excess (1.21 times; 95% CI 1.21-1.22) compared with people living in the least deprived areas (1.17; 1.16-1.18). Black (1.56; 1.53-1.58) and Asian groups (1.55; 1.53-1.56) experienced more excess than the White group (1.16; 1.16-1.17). There was wide variation between English regions.
Conclusions
Reporting overall excess mortality early in the pandemic is important to inform policy makers and public about the true scale of the death toll when coding is inconsistent and developing. This approach has highlighted the large increases in already established inequalities in mortality. It provides rapid surveillance of developing disparities for national and local decision makers. It has been used to inform policy around reducing disparities and to revise messaging to encourage hospital attendance for non- COVID-19 health problems.
Key messages
Excess deaths from all causes is a robust measure of overall impact, unaffected by coding consistency. COVID-19 has dramatically worsened established inequalities between ethnic groups and deprivation groups.
Collapse
Affiliation(s)
- PT Fryers
- Health Improvement, Public Health England, Sheffield, UK
| | - S Barnard
- Life Course Centre, Telethon Kids Institute, Perth, Australia
- Health Improvement, Public Health England, Sheffield, UK
| | - PR Burton
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Health Improvement, Public Health England, Sheffield, UK
| | - S Fox
- Health Improvement, Public Health England, Sheffield, UK
| | - Z Waller
- Health Improvement, Public Health England, Sheffield, UK
| | - J Fitzpatrick
- Health Improvement, Public Health England, Sheffield, UK
| |
Collapse
|
14
|
Zarei A, Ballard A, Cox L, Bayguinov P, Harris T, Davis JL, Roper P, Fitzpatrick J, Faccio R, Veis DJ. Osteolineage depletion of mitofusin2 enhances cortical bone formation in female mice. Bone 2021; 148:115941. [PMID: 33813068 PMCID: PMC8162829 DOI: 10.1016/j.bone.2021.115941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022]
Abstract
Mitochondria are essential organelles that form highly complex, interconnected dynamic networks inside cells. The GTPase mitofusin 2 (MFN2) is a highly conserved outer mitochondrial membrane protein involved in the regulation of mitochondrial morphology, which can affect various metabolic and signaling functions. The role of mitochondria in bone formation remains unclear. Since MFN2 levels increase during osteoblast (OB) differentiation, we investigated the role of MFN2 in the osteolineage by crossing mice bearing floxed Mfn2 alleles with those bearing Prx-cre to generate cohorts of conditional knock out (cKO) animals. By ex vivo microCT, cKO female mice, but not males, display an increase in cortical thickness at 8, 18, and 30 weeks, compared to wild-type (WT) littermate controls. However, the cortical anabolic response to mechanical loading was not different between genotypes. To address how Mfn2 deficiency affects OB differentiation, bone marrow-derived mesenchymal stromal cells (MSCs) from both wild-type and cKO mice were cultured in osteogenic media with different levels of β-glycerophosphate. cKO MSCs show increased mineralization and expression of multiple markers of OB differentiation only at the lower dose. Interestingly, despite showing the expected mitochondrial rounding and fragmentation due to loss of MFN2, cKO MSCs have an increase in oxygen consumption during the first 7 days of OB differentiation. Thus, in the early phases of osteogenesis, MFN2 restrains oxygen consumption thereby limiting differentiation and cortical bone accrual during homeostasis in vivo.
Collapse
Affiliation(s)
- Allahdad Zarei
- Musculoskeletal Research Center, Division of Bone and Mineral Disease, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Anna Ballard
- Musculoskeletal Research Center, Division of Bone and Mineral Disease, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Linda Cox
- Musculoskeletal Research Center, Division of Bone and Mineral Disease, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Peter Bayguinov
- Washington University Center for Cellular Imaging, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Taylor Harris
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Jennifer L Davis
- Musculoskeletal Research Center, Division of Bone and Mineral Disease, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Philip Roper
- Musculoskeletal Research Center, Division of Bone and Mineral Disease, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - James Fitzpatrick
- Washington University Center for Cellular Imaging, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA; Departments of Neuroscience and Cell Biology & Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Roberta Faccio
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; Shriners Hospitals for Children, St. Louis, MO 63110, USA
| | - Deborah J Veis
- Musculoskeletal Research Center, Division of Bone and Mineral Disease, Washington University School of Medicine, St. Louis, MO 63110, USA; Shriners Hospitals for Children, St. Louis, MO 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| |
Collapse
|
15
|
Rizvi I, Abroaf A, Veeratterapillay R, Rogers A, Shaw M, Fitzpatrick J. Management of acute ureteric colic in a large tertiary centre during the initial COVID-19 pandemic - How did our practice change? Eur Urol 2021. [PMCID: PMC8263123 DOI: 10.1016/s0302-2838(21)00636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
16
|
Smith M, Orchard JJ, La Gerche A, Gallagher R, Fitzpatrick J. Fit, Female or Fifty - is cardiac rehabilitation fit for purpose? A systematic review and meta-analysis with meta-regression. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention, aimed to address modifiable risk factors for coronary artery disease. It is recommended worldwide for patients following myocardial infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery. A growing body of evidence points towards a lack of uptake in CR in females and younger people.
Purpose
To examine the effectiveness of contemporary CR programs and assess whether they cater for all patients regardless of age, gender and prior level of fitness, via systematic review, meta-analysis and meta-regression.
Methods
MEDLINE was examined for studies involving exercise prescription or CR following MI, PCI and cardiac surgery from January 2010 to May 2020. RCTs and cohort studies of ≥10 patients were included for programs delivering phase II or III CR. Primary outcome measures were peakVO2max, 6-minute walk test (6MWT) and Metabolic Equivalent of Task (METs). Data were extracted using random effects meta-analysis. Epidemiological data were analysed for age, proportion of males to females and prior level of fitness. Baseline level of fitness was assessed by peakVO2max, 6MWT and METs values on entry into CR programs. Meta-regression was then used to determine change in fitness and the influence of age or gender.
Results
Thirty-three of the 713 studies (13 RCT, 20 cohort) were eligible and included in the review. Participants had a mean age of 60.0 years and 6/49 (12%) of study groups had a mean age <55 years. Male participants comprised 81.9% of those who completed CR and 41/58 (71%) participants were below average for cardiorespiratory fitness (CRF) when compared to normative values for those aged 60-69 years on entering CR.
CRF improved in all study groups by the end of CR programs (mean improvement in peakVO2 3.3mL/kg/min, 6MWT 90.8m and METs 1.7). Meta-regression analysis showed that males were more likely to have an increase in 6MWT distance compared to females (mean difference 3.16m (95% CI 0.44-5.89). However, gender and age did not independently affect peakVO2max or METs.
Conclusion
CR following MI, PCI or cardiac surgery improved mean CRF in all study groups. While males were more likely to show an improvement in 6MWT there was no appreciable difference in effect in other outcomes after controlling for age or gender differences.
Females, younger people and those of average or above CRF appear to be under-represented in data and attendance at cardiac rehabilitation. Given that CR outcomes are equal across gender and age, more effort should be made to encourage female and younger patients to attend. A ‘Precision Medicine’ model of exercise prescription may assist in this aim.
Collapse
Affiliation(s)
- M Smith
- Australasian College of Sports and Exercise Physicians, Melbourne, Australia
| | - JJ Orchard
- University of Sydney, Charles Perkins Centre, Sydney, Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - R Gallagher
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - J Fitzpatrick
- University of Melbourne, CHESM, Melbourne, Australia
| |
Collapse
|
17
|
Kopecky B, Lin C, Frye C, Dun H, Bayguinov P, Fitzpatrick J, Kreisel D, Lavine K. Modulation of Donor Cardiac Macrophages is Sufficient to Suppress Rejection and Extend Allograft Survival. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
18
|
Pedruzzi RA, Hamilton O, Hodgson HHA, Connor E, Johnson E, Fitzpatrick J. Navigating complexity to support justice-involved youth with FASD and other neurodevelopmental disabilities: needs and challenges of a regional workforce. Health Justice 2021; 9:8. [PMID: 33638742 PMCID: PMC7916306 DOI: 10.1186/s40352-021-00132-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Young people with Fetal Alcohol Spectrum Disorder (FASD) can face significant challenges in their lives, including overrepresentation in the justice system from a young age. Police questioning and court proceedings can be difficult for these young people to navigate. Practice and policy responses are necessary to identify these individuals, provide appropriate support/rehabilitation, and upskill the justice workforce. The aim of this research was to determine the unmet workforce development needs of a regional workforce providing care and support to youth involved with the justice system. Interviews were conducted with 29 participants from 14 organisations to understand the support provided to youth, existence and uptake of referral pathways, and unmet needs. RESULTS Results revealed a workforce that wants to see improvements to outcomes for young people with FASD and other neurodevelopmental disabilities who enter the youth justice system. However more support is required through training, ongoing funding, and assistance to develop FASD informed work practices. CONCLUSIONS The workforce supporting youth to navigate the justice system requires practical interventions to achieve best practice so that young people with FASD and other neurodevelopmental disabilities receive the support that they need. Following the interviews a model of care tool was developed and piloted in the sector. The tool includes current pathways through the justice system and provides resources to assist staff in achieving best practice care for young people with FASD and other neurodevelopmental disabilities.
Collapse
Affiliation(s)
| | | | | | - Elizabeth Connor
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872 Australia
| | - Elvira Johnson
- Mercy Services, 32 Union St, Newcastle, NSW 2297 Australia
| | - James Fitzpatrick
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia 6872 Australia
- School of Psychological Science, The University of Western Australia, Perth, 6009 Australia
| |
Collapse
|
19
|
Rustenhoven J, Drieu A, Mamuladze T, de Lima KA, Dykstra T, Wall M, Papadopoulos Z, Kanamori M, Salvador AF, Baker W, Lemieux M, Da Mesquita S, Cugurra A, Fitzpatrick J, Sviben S, Kossina R, Bayguinov P, Townsend RR, Zhang Q, Erdmann-Gilmore P, Smirnov I, Lopes MB, Herz J, Kipnis J. Functional characterization of the dural sinuses as a neuroimmune interface. Cell 2021; 184:1000-1016.e27. [PMID: 33508229 PMCID: PMC8487654 DOI: 10.1016/j.cell.2020.12.040] [Citation(s) in RCA: 268] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/17/2020] [Accepted: 12/22/2020] [Indexed: 01/02/2023]
Abstract
Despite the established dogma of central nervous system (CNS) immune privilege, neuroimmune interactions play an active role in diverse neurological disorders. However, the precise mechanisms underlying CNS immune surveillance remain elusive; particularly, the anatomical sites where peripheral adaptive immunity can sample CNS-derived antigens and the cellular and molecular mediators orchestrating this surveillance. Here, we demonstrate that CNS-derived antigens in the cerebrospinal fluid (CSF) accumulate around the dural sinuses, are captured by local antigen-presenting cells, and are presented to patrolling T cells. This surveillance is enabled by endothelial and mural cells forming the sinus stromal niche. T cell recognition of CSF-derived antigens at this site promoted tissue resident phenotypes and effector functions within the dural meninges. These findings highlight the critical role of dural sinuses as a neuroimmune interface, where brain antigens are surveyed under steady-state conditions, and shed light on age-related dysfunction and neuroinflammatory attack in animal models of multiple sclerosis.
Collapse
Affiliation(s)
- Justin Rustenhoven
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA.
| | - Antoine Drieu
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Tornike Mamuladze
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kalil Alves de Lima
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Taitea Dykstra
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Morgan Wall
- Department of Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Zachary Papadopoulos
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Neuroscience Graduate Program, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Mitsuhiro Kanamori
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Andrea Francesca Salvador
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; Neuroscience Graduate Program, University of Virginia, Charlottesville, VA 22908, USA
| | - Wendy Baker
- Department of Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Mackenzie Lemieux
- Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Medical Scientist Training Program (MSTP), School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Sandro Da Mesquita
- Department of Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Andrea Cugurra
- Department of Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; Gutenberg Research Fellowship Group of Neuroimmunology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - James Fitzpatrick
- Washington University Center for Cellular Imaging, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Departments of Neuroscience and Cell Biology and Physiology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Sanja Sviben
- Washington University Center for Cellular Imaging, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Ross Kossina
- Washington University Center for Cellular Imaging, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Peter Bayguinov
- Washington University Center for Cellular Imaging, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Reid R Townsend
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Qiang Zhang
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Petra Erdmann-Gilmore
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Igor Smirnov
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Maria-Beatriz Lopes
- Department of Pathology, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Jasmin Herz
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jonathan Kipnis
- Center for Brain Immunology and Glia (BIG), Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; Neuroscience Graduate Program, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Neuroscience Graduate Program, University of Virginia, Charlottesville, VA 22908, USA; Gutenberg Research Fellowship Group of Neuroimmunology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| |
Collapse
|
20
|
Fitzpatrick J, Dudley A, Pedruzzi RA, Councillor J, Bruce K, Walker R. Development of a referral pathway framework for foetal alcohol spectrum disorder in the Pilbara. Rural Remote Health 2020; 20:5503. [PMID: 32402204 DOI: 10.22605/rrh5503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/03/2022] Open
Abstract
INTRODUCTION This article describes the process of mapping referral pathways to develop a localised resource to enhance the journey to diagnosis, treatment and support for foetal alcohol spectrum disorder (FASD) in a regional community setting. METHODS Over a 6-month period, a research officer engaged service providers in Port and South Hedland, Western Australia, using participatory action research methods. An iterative process included a service environment scan, interviews with service leaders and refinement of progressive drafts of the pathway through the Hedland FASD Network. A community reference group advised on cultural issues. RESULTS Referral pathways for interagency sectors (health, education, justice) were developed. Three pathway schematics and a companion four-page referral protocol were endorsed. The pathways were disseminated to all service providers and consensus was reached to trial the pathways within existing service systems. CONCLUSION The process of referral pathway development provided a service mapping and gapping exercise to facilitate service integration. Evaluation of the resource will be conducted using the RE-AIM framework. The referral pathways template has been adapted and trialled by health and other professionals in several sites across Australia. The model developed for FASD can be applied to other neurodevelopmental disorders.
Collapse
Affiliation(s)
- James Fitzpatrick
- Telethon Kids Institute, PO Box 855, West Perth, WA 6872, Australia; and School of Psychological Science, The University of Western Australia, Perth, WA 6009, Australia
| | - Angela Dudley
- Telethon Kids Institute, PO Box 855, West Perth, WA 6872, Australia
| | | | - June Councillor
- Wirraka Maya Health Service Aboriginal Corporation, 17 Hamilton Road, South Hedland, WA 6722, Australia
| | - Kaashifah Bruce
- Telethon Kids Institute, PO Box 855, West Perth, WA 6872, Australia
| | - Roz Walker
- Telethon Kids Institute, PO Box 855, West Perth, WA 6872, Australia; Centre for Child Health, The University of Western Australia, Perth, WA 6009, Australia
| |
Collapse
|
21
|
Naughton C, Ezhova I, Hayes N, Fitzpatrick J. 77 Developing and Testing An Education-Career Pathway in Healthcare for Older People (ECHO) to Promote Retention in Early-Career Gerontological Nurses. Age Ageing 2020. [DOI: 10.1093/ageing/afz191.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The NHS Long Term Plan (2019) sets specific targets for multidisciplinary services for frail older people over the next ten years. Delivery and sustainability is crucially dependant on the capability and capacity of gerontological nursing. High cost cities such as London experience high staff vacancy rates in acute care older adult services.
Aim
The study took a regional approach, working with NHS Trusts to develop a multicomponent intervention to increase retention and competencies of early career nurses working in gerontological services. The study examined the acceptability and feasibility of the intervention and tested a quasi-experiential evaluation design. Ethical approval was obtained from the University Ethics committee.
Methods
A co-design approach with stakeholders, early career nurses, educationalists and nurse managers, produced a multicomponent intervention: education module (masters level), gerontological competency booklet, external clinical learning opportunities, career coaching and mentorship delivered over a six-month period. The evaluation involved a mix-methods pre-post survey and focus group interviews.
Results
Twenty-nine early career nurses were recruited from five Trusts. The multicomponent intervention was well received, but there were difficulties facilitating external learning opportunities and providing career mentors. The primary outcome was intention to remain in gerontological nursing (measured using a point Likert scale). Pre-post the intervention this remained high (mean score 6 IQR 5-7), p=0.78. There was a significant increase in gerontological knowledge: at baseline the median score was 87 (IQR 81-102) compared to 107 (IQR 98-112) post-intervention, p=0.006. In focus groups participants identified three main mechanism of action for ECHO: building gerontological knowledge and skills; professional identity as older adult nurse; and networking to broaden horizons.
Conclusions
The study has demonstrated the potential of Trusts to work collaboratively with education providers to deliver a model of career-education pathway that may help attract and retain early career nurses to work in gerontology.
Collapse
|
22
|
Dossetor PJ, Thorburn K, Oscar J, Carter M, Fitzpatrick J, Bower C, Boulton J, Fitzpatrick E, Latimer J, Elliott EJ, Martiniuk AL. Review of Aboriginal child health services in remote Western Australia identifies challenges and informs solutions. BMC Health Serv Res 2019; 19:758. [PMID: 31655576 PMCID: PMC6815358 DOI: 10.1186/s12913-019-4605-0] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. We aimed to identify and map child health services in the very remote Fitzroy Valley, West Kimberley, and document barriers to effective service delivery. METHODS Identification and review of all regional child health services and staffing in 2013. Verification of data by interview with senior managers and staff of key providers in the Western Australian Country Health Service, Kimberley Population Health Unit, Nindilingarri Cultural Health Services and non-government providers. RESULTS We identified no document providing a comprehensive overview of child health services in the Fitzroy Valley. There were inadequate numbers of health professionals, facilities and accommodation; high staff turnover; and limited capacity and experience of local health professionals. Funding and administrative arrangements were complex and services poorly coordinated and sometimes duplicated. The large geographic area, distances, extreme climate and lack of public and private transport challenge service delivery. The need to attend to acute illness acts to deprioritise crucial primary and preventative health care and capacity for dealing with chronic, complex disorders. Some services lack cultural safety and there is a critical shortage of Aboriginal Health Workers (AHW). CONCLUSIONS Services are fragmented and variable and would benefit from a coordinated approach between government, community-controlled agencies, health and education sectors. A unifying model of care with emphasis on capacity-building in Aboriginal community members and training and support for AHW and other health professionals is required but must be developed in consultation with communities. Innovative diagnostic and care models are needed to address these challenges, which are applicable to many remote Australian settings outside the Fitzroy Valley, as well as other countries globally. Our results will inform future health service planning and strategies to attract and retain health professionals to work in these demanding settings. A prospective audit of child health services is now needed to inform improved planning of child health services with a focus on identifying service gaps and training needs and better coordinating existing services to improve efficiency and potentially also efficacy.
Collapse
Affiliation(s)
- Philippa J Dossetor
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, ACT, Canberra, 2605, Australia.
| | - Kathryn Thorburn
- Nulungu Research Institute, University of Notre Dame, Broome, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Crossing, Fitzroy, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Crossing, Fitzroy, Australia
| | - James Fitzpatrick
- University of Sydney, Sydney Medical School, Sydney, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | - Emily Fitzpatrick
- University of Sydney, Sydney Medical School, Sydney, Australia.,The Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Jane Latimer
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - Elizabeth J Elliott
- University of Sydney, Sydney Medical School, Sydney, Australia.,The Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Alexandra Lc Martiniuk
- University of Sydney, Sydney Medical School, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia.,The University of Toronto, Toronto, Canada
| |
Collapse
|
23
|
McRae T, Adams E, Clifton E, Fitzpatrick J, Bruce K, Councillor J, Pearson G, Walker R. Overcoming the challenges of caring for a child with foetal alcohol spectrum disorder: a Pilbara community perspective. Rural Remote Health 2019; 19:5206. [PMID: 31619043 DOI: 10.22605/rrh5206] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Foetal alcohol spectrum disorder (FASD) is a neurodevelopmental impairment that may result in individuals experiencing poor development, cognitive issues and disruptive behaviours. In Australia, the prevalence of FASD is unknown; however, two studies have revealed the prevalence of FASD in high risk populations in Western Australia. Individuals with FASD may experience higher rates of negative outcomes including poor school performance, involvement with the justice system and incarceration, substance use and are at risk of being placed in out-of-home care. Caregivers of children with FASD can experience challenges and high levels of stress due to the disruptive behaviours displayed by many children diagnosed with FASD. Whilst experiences of caregivers raising children with FASD have been documented globally, little is known about the experiences of caregivers in a remote Australian context, particularly from an Australian Aboriginal perspective. This study aimed to investigate the experiences of caregivers in a remote Australian context. The findings will be valuable to inform programs at the family, community and broader policy levels that can help enhance children's development and wellbeing. METHODS Participants (n=7) in this qualitative study were recruited through a FASD diagnostic clinic and family support organisation in the Port Hedland region of Western Australia. Eligible participants were previous or current caregivers of children with a FASD diagnosis or risk of FASD and provided informed consent before participating in semi-structured interviews using a phenomenological approach. The interviews were 30-60 minutes in duration and were audio-recorded and transcribed verbatim using NVivo 11 computer software, with all identifying information removed. RESULTS The caregivers provided rich, descriptive narratives revealing the challenges and stress they experienced when they first started caring for their child with FASD. Caregivers articulated how they developed and adapted strategies through trial and error that enabled them to better manage disruptive behaviours and maintain a stable, calm environment. A thematic analysis revealed four major themes: the importance of routine and structure for the child and family, the importance of family support, the benefits of peer support groups and various social issues impacting children's development. Maintaining routine and structure had helped many caregivers mitigate stress and reduce disruptive behaviours, and family support allowed caregivers some respite whilst ensuring children remained connected to their biological families and culture. The caregivers also shared that peer support groups would be beneficial to share stories and strategies with others experiencing similar circumstances. Broader societal issues requiring attention at the community level were discussed, in addition to caregivers having awareness of the complexities impacting the children's biological families. CONCLUSION The caregivers in this study have gained valuable knowledge and wisdom through caring for a child with FASD that can benefit health professionals and the broader community. Whilst the caregivers in this study have overcome challenges through developing and adapting their own strategies, support services providing tailored programs for caregivers when they first start caring for a child with FASD would be beneficial. Furthermore, formal respite was not utilised by the caregivers in this study due to safety issues, inconsistent parenting and interrupted routines, therefore investigation into training respite caregivers in the area of FASD would be beneficial. Furthermore, respite services should consider provisions to include extended families and kinship relationships in a formal context to enable ongoing cultural and family connection, consistent parenting strategies and routines.
Collapse
Affiliation(s)
- Tracy McRae
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, Australia
| | - Emma Adams
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, Australia
| | - Elaine Clifton
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, Australia
| | - James Fitzpatrick
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, Australia
| | - Kaashifah Bruce
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, Australia
| | - June Councillor
- Wirraka Maya Health Service Aboriginal Corporation, 17 Hamilton Road, South Hedland, WA 6722, Australia
| | - Glenn Pearson
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, Australia
| | - Roz Walker
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, Australia
| |
Collapse
|
24
|
Fitzpatrick J, Mavissakalian M, Luciani T, Xu Y, Mazurek A. Economic Impact of Early Inpatient Palliative Care Intervention in a Community Hospital Setting. J Palliat Med 2018; 21:933-939. [PMID: 29649405 DOI: 10.1089/jpm.2017.0416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/13/2022] Open
Abstract
BACKGROUND Inpatient palliative care programs have demonstrated financial benefit for the hospital and improved quality of care for patients with advanced disease. Previous studies on this subject have focused on comparisons between palliative and traditional care. The financial and clinical effects of early versus late palliative care intervention are less well documented. OBJECTIVE The aims of this study are to review the financial and quality outcomes that early palliative care intervention has on appropriate inpatients in the community hospital setting. MATERIALS AND METHODS This retrospective study analyzed 449 palliative care patients. The independent variable was days to palliative care consultation, characterized as early palliative care (≤3 days) and late palliative care (>3 days). Dependent variables included length of stay (LOS) and financial considerations. The two groups were further stratified according to case mix index, medical versus surgical, as well as certain disease groups, such as sepsis, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) exacerbation. The patient's functional status, measured by the Victoria Palliative Performance Scale (PPSv2) was calculated to determine if this variable independently influenced the timing of consultation. RESULTS Patients in the early intervention group realized a reduction in LOS and a significant cost reduction. In the analysis of the entire group, the average LOS with early intervention was 6.09 days versus 16.5 days with late intervention (p < 0.001). The early intervention group demonstrated an earlier transition to comfort care, earlier referral to outpatient hospice, and did not have a negative effect on mortality. The patient's PPSv2 score did not influence the timing of intervention (p 0.25). CONCLUSION Early intervention with inpatient palliative care consultation correlated with financial benefit as well as earlier referral to more appropriate levels of care. These effects were achieved with minimal expense in a medium-sized community hospital.
Collapse
Affiliation(s)
| | | | | | - Yijing Xu
- 2 Catholic Health of Buffalo , Buffalo, New York
| | | |
Collapse
|
25
|
Bower C, Elliott EJ, Zimmet M, Doorey J, Wilkins A, Russell V, Shelton D, Fitzpatrick J, Watkins R. Australian guide to the diagnosis of foetal alcohol spectrum disorder: A summary. J Paediatr Child Health 2017; 53:1021-1023. [PMID: 28975754 PMCID: PMC5658660 DOI: 10.1111/jpc.13625] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 04/30/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Carol Bower
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Elizabeth J Elliott
- Department of Paediatrics and Child HealthSydney Medical School, University of SydneySydneyNew South WalesAustralia,Kid's Research InstituteSydney Children's Hospitals Network at WestmeadSydneyNew South WalesAustralia
| | - Marcel Zimmet
- Department of Paediatrics and Child HealthSydney Medical School, University of SydneySydneyNew South WalesAustralia
| | - Juanita Doorey
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Amanda Wilkins
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Vicki Russell
- FASD Consultants AustraliaDevonportTasmaniaAustralia
| | - Doug Shelton
- Community Child HealthGold Coast HealthBrisbaneQueenslandAustralia
| | - James Fitzpatrick
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Rochelle Watkins
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| |
Collapse
|
26
|
Ziver AK, Shahdatullah S, Eaton MD, de Oliviera CRE, Ackroyd RT, Umpleby AP, Pain CC, Goddard AJH, Fitzpatrick J. Deterministic and Monte Carlo Neutron Transport Calculations of the Dounreay Fast Breeder Reactor. NUCL TECHNOL 2017. [DOI: 10.13182/nt04-a3562] [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]
Affiliation(s)
- A. Kemal Ziver
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - Sabu Shahdatullah
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - Matthew D. Eaton
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - Cassiano R. E. de Oliviera
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - Ron T. Ackroyd
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - Adrian P. Umpleby
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - Christopher C. Pain
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - Antony J. H. Goddard
- Imperial College of Science, Technology, and Medicine Department of Earth Sciences and Engineering Computational Physics and Geophysics Group Prince Consort Road, London SW72BP, United Kingdom
| | - James Fitzpatrick
- RM-Consultants Limited, Suite 7, Hitching Court Abingdon, Oxon, United Kingdom
| |
Collapse
|
27
|
Tsang TW, Laing-Aiken Z, Latimer J, Fitzpatrick J, Oscar J, Carter M, Elliott EJ. Digital assessment of the fetal alcohol syndrome facial phenotype: reliability and agreement study. BMJ Paediatr Open 2017; 1:e000137. [PMID: 29637153 PMCID: PMC5862229 DOI: 10.1136/bmjpo-2017-000137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To examine the three facial features of fetal alcohol syndrome (FAS) in a cohort of Australian Aboriginal children from two-dimensional digital facial photographs to: (1) assess intrarater and inter-rater reliability; (2) identify the racial norms with the best fit for this population; and (3) assess agreement with clinician direct measures. METHODS Photographs and clinical data for 106 Aboriginal children (aged 7.4-9.6 years) were sourced from the Lililwan Project. Fifty-eight per cent had a confirmed prenatal alcohol exposure and 13 (12%) met the Canadian 2005 criteria for FAS/partial FAS. Photographs were analysed using the FAS Facial Photographic Analysis Software to generate the mean PFL three-point ABC-Score, five-point lip and philtrum ranks and four-point face rank in accordance with the 4-Digit Diagnostic Code. Intrarater and inter-rater reliability of digital ratings was examined in two assessors. Caucasian or African American racial norms for PFL and lip thickness were assessed for best fit; and agreement between digital and direct measurement methods was assessed. RESULTS Reliability of digital measures was substantial within (kappa: 0.70-1.00) and between assessors (kappa: 0.64-0.89). Clinician and digital ratings showed moderate agreement (kappa: 0.47-0.58). Caucasian PFL norms and the African American Lip-Philtrum Guide 2 provided the best fit for this cohort. CONCLUSION In an Aboriginal cohort with a high rate of FAS, assessment of facial dysmorphology using digital methods showed substantial inter- and intrarater reliability. Digital measurement of features has high reliability and until data are available from a larger population of Aboriginal children, the African American Lip-Philtrum Guide 2 and Caucasian (Strömland) PFL norms provide the best fit for Australian Aboriginal children.
Collapse
Affiliation(s)
- Tracey W Tsang
- The University of Sydney, Discipline of Child and Adolescent Health, Sydney Medical School, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe Laing-Aiken
- The University of Sydney, Discipline of Child and Adolescent Health, Sydney Medical School, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - James Fitzpatrick
- The University of Sydney, Discipline of Child and Adolescent Health, Sydney Medical School, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Discipline of Child and Adolescent Health, Sydney Medical School, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Clinical School at The Children's Hospital at Westmead, The Sydney Children's Hospital Networks (Westmead), Westmead, New South Wales, Australia
| |
Collapse
|
28
|
Wagner B, Fitzpatrick J, Symons M, Jirikowic T, Cross D, Latimer J. The development of a culturally appropriate school based intervention for Australian Aboriginal children living in remote communities: A formative evaluation of the Alert Program ® intervention. Aust Occup Ther J 2016; 64:243-252. [PMID: 27966224 DOI: 10.1111/1440-1630.12352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Although previous research has demonstrated the benefits of targeting self-regulation in non-Aboriginal children, it is unclear whether such programs would be effective for Aboriginal children attending school in remote communities. Some of these children have been diagnosed with a fetal alcohol spectrum disorder (FASD) impairing their ability to self-regulate. The aim of this article is to describe a three phase formative process to develop and pilot a curriculum version of the Alert Program® , a promising intervention for improving self-regulation that could be used in remote community schools. This modified version of the program will be subsequently tested in a cluster randomised controlled trial. METHODS A mixed methods approach was used. RESULTS Modifications to the Alert Program® , its delivery and evaluation were made after community and stakeholder consultation facilitated by a senior Aboriginal community researcher. Changes to lesson plans and program resources were made to reflect the remote community context, classroom environment and the challenging behaviours of children. Standardised study outcome measures were modified by removing several questions that had little relevance to the lives of children in remote communities. Program training for school staff was reduced in length to reduce staff burden. CONCLUSIONS This study identified aspects of the Alert Program® training, delivery and measures for evaluation that need modification before their use in assessing the efficacy of the Alert Program® in remote Aboriginal community primary schools.
Collapse
Affiliation(s)
- Bree Wagner
- Telethon Kids Institute, The University of Western Australia, Australia
| | - James Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Martyn Symons
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Tracy Jirikowic
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Donna Cross
- Faculty of Medicine, Dentistry and Health Science, Telethon Kids Institute, The University of Western Australia, Australia.,Edith Cowan University, Perth, Western Australia, Australia
| | - Jane Latimer
- The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
29
|
Fitzpatrick J, Fox E, Hoffman A, Dehlendorf C. Differences in social communication about contraception by age and race/ethnicity: baseline results from a randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Abstract
A kit for serum calcium determination (Calcium Rapid Stat Kit), based on a methyl thymol blue method, has been investigated and the results compared with those obtained from an AutoAnalyzer cresolphthalein complexone method. The kit technique is simple, requires a small amount of serum and has a better precision than the AutoAnalyzer method, with which it correlates well. The standards supplied should be checked before use.
Collapse
Affiliation(s)
- J. M. Cossar
- Area Laboratory, Ballochymyle Hospital, Mauchline, Ayrshire
| | - J. Fitzpatrick
- Area Laboratory, Ballochymyle Hospital, Mauchline, Ayrshire
| |
Collapse
|
31
|
Morris M, O'Neill A, Gillis A, Charania S, Fitzpatrick J, Redmond A, Rosli S, Ridgway P. Prepared for Practice? Interns' Experiences of Undergraduate Clinical Skills Training in Ireland. J Med Educ Curric Dev 2016; 3:10.4137_JMECD.S39381. [PMID: 29349313 PMCID: PMC5736273 DOI: 10.4137/jmecd.s39381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice. METHODS The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year. RESULTS Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC) lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure. CONCLUSION These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.
Collapse
Affiliation(s)
- M. Morris
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
| | - A. O'Neill
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - A. Gillis
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - S. Charania
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - J. Fitzpatrick
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - A. Redmond
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - S. Rosli
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - P.F. Ridgway
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| |
Collapse
|
32
|
Kramar A, Negrier S, Sylvester R, Joniau S, Mulders P, Powles T, Bex A, Bonnetain F, Bossi A, Bracarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell P, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P, Escudier B, Filleron T, Kramar A, Sylvester R, Filleron T, Negrier S, Joniau S, Mulders P, Powles T, Escudier B, Bex A, Bonnetain F, Bossi A, Braccarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell PJ, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P. Guidelines for the definition of time-to-event end points in renal cell cancer clinical trials: results of the DATECAN project. Ann Oncol 2015; 26:2392-8. [DOI: 10.1093/annonc/mdv380] [Citation(s) in RCA: 23] [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] [Received: 05/11/2015] [Accepted: 07/24/2015] [Indexed: 12/19/2022] Open
|
33
|
Fitzpatrick J, Biju D, Amer T, Hutton R, Nair B. Timing of second resection in high-grade non-muscle-invasive bladder cancer: Does delay adversely affect outcome? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.597] [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: 11/17/2022]
|
34
|
Fitzpatrick J, Nolke L, Redmond M, McGuinness J. Oxygen requirements on admission predict longer length of stay in paediatric empyema: Findings from a nine-year national referral centre retrospective study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.121] [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: 10/22/2022]
|
35
|
Fitzpatrick J, Anderson N, Kuppermann M, Steinauer J, Wittman A, Dehlendorf C. Pilot study of “My Birth Control,” a contraceptive counseling decision support tool. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
El-Mokadem I, Fitzpatrick J, Bondad J, Rauchhaus P, Cunningham J, Pratt N, Fleming S, Nabi G. Chromosome 9p deletion in clear cell renal cell carcinoma predicts recurrence and survival following surgery. Br J Cancer 2014; 111:1381-90. [PMID: 25137021 PMCID: PMC4183850 DOI: 10.1038/bjc.2014.420] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/25/2014] [Accepted: 07/01/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Wider clinical applications of 9p status in clear cell renal cell carcinoma (ccRCC) are limited owing to the lack of validation and consensus for interphase fluorescent in situ hybridisation (I-FISH) scoring technique. The aim of this study was to analytically validate the applicability of I-FISH in assessing 9p deletion in ccRCC and to clinically assess its long-term prognostic impact following surgical excision of ccRCC. Methods: Tissue microarrays were constructed from 108 renal cell carcinoma (RCC) tumour paraffin blocks. Interphase fluorescent in situ hybridisation analysis was undertaken based on preset criteria by two independent observers to assess interobserver variability. 9p status in ccRCC tumours was determined and correlated to clinicopathological variables, recurrence-free survival and disease-specific survival. Results: There were 80 ccRCCs with valid 9p scoring and a median follow-up of 95 months. Kappa statistic for interobserver variability was 0.71 (good agreement). 9p deletion was detected in 44% of ccRCCs. 9p loss was associated with higher stage, larger tumours, necrosis, microvascular and renal vein invasion, and higher SSIGN (stage, size, grade and necrosis) score. Patients with 9p-deleted ccRCC were at a higher risk of recurrence (P=0.008) and RCC-specific mortality (P=0.001). On multivariate analysis, 9p deletion was an independent predictor of recurrence (hazard ratio 4.323; P=0.021) and RCC-specific mortality (hazard ratio 4.603; P=0.007). The predictive accuracy of SSIGN score improved from 87.7% to 93.1% by integrating 9p status to the model (P=0.001). Conclusions: Loss of 9p is associated with aggressive ccRCC and worse prognosis in patients following surgery. Our findings independently confirm the findings of previous reports relying on I-FISH to detect 9p (CDKN2A) deletion.
Collapse
Affiliation(s)
- I El-Mokadem
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Fitzpatrick
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Bondad
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - P Rauchhaus
- Division of Population Sciences, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Cunningham
- Department of Clinical Genetics, NHS Tayside Health Board, Dundee DD1 9SY, UK
| | - N Pratt
- Department of Clinical Genetics, NHS Tayside Health Board, Dundee DD1 9SY, UK
| | - S Fleming
- Department of Pathology, Medical Research Institute, School of Medicine, Dundee DD1 9SY, UK
| | - G Nabi
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| |
Collapse
|
37
|
Kricka W, Fitzpatrick J, Bond U. Metabolic engineering of yeasts by heterologous enzyme production for degradation of cellulose and hemicellulose from biomass: a perspective. Front Microbiol 2014; 5:174. [PMID: 24795706 PMCID: PMC4001029 DOI: 10.3389/fmicb.2014.00174] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [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: 01/30/2014] [Accepted: 03/31/2014] [Indexed: 11/13/2022] Open
Abstract
This review focuses on current approaches to metabolic engineering of ethanologenic yeast species for the production of bioethanol from complex lignocellulose biomass sources. The experimental strategies for the degradation of the cellulose and xylose-components of lignocellulose are reviewed. Limitations to the current approaches are discussed and novel solutions proposed.
Collapse
Affiliation(s)
- William Kricka
- School of Genetics and Microbiology, Department of Microbiology, Trinity College Dublin Dublin, Ireland
| | - James Fitzpatrick
- School of Genetics and Microbiology, Department of Microbiology, Trinity College Dublin Dublin, Ireland
| | - Ursula Bond
- School of Genetics and Microbiology, Department of Microbiology, Trinity College Dublin Dublin, Ireland
| |
Collapse
|
38
|
Fitzpatrick J, Kricka W, James TC, Bond U. Expression of three Trichoderma reesei cellulase genes in Saccharomyces pastorianus for the development of a two-step process of hydrolysis and fermentation of cellulose. J Appl Microbiol 2014; 117:96-108. [PMID: 24666670 DOI: 10.1111/jam.12494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
Abstract
AIMS To compare the production of recombinant cellulase enzymes in two Saccharomyces species so as to ascertain the most suitable heterologous host for the degradation of cellulose-based biomass and its conversion into bioethanol. METHOD AND RESULTS cDNA copies of genes representing the three major classes of cellulases (Endoglucanases, Cellobiohydrolases and β-glucosidases) from Trichoderma reesei were expressed in Saccharomyces pastorianus and Saccharomyces cerevisiae. The recombinant enzymes were secreted by the yeast hosts into the medium and were shown to act in synergy to hydrolyse cellulose. The conditions required to achieve maximum release of glucose from cellulose by the recombinant enzymes were defined and the activity of the recombinant enzymes was compared to a commercial cocktail of T. reesei cellulases. CONCLUSIONS We demonstrate that significantly higher levels of cellulase activity were achieved by expression of the genes in S. pastorianus compared to S. cerevisiae. Hydrolysis of cellulose by the combined activity of the recombinant enzymes was significantly better at 50°C than at 30°C, the temperature used for mesophilic yeast fermentations, reflecting the known temperature profiles of the native enzymes. SIGNIFICANCE AND IMPACT OF THE STUDY The results demonstrate that host choice is important for the heterologous production of cellulases. On the basis of the low activity of the T. reesei recombinant enzymes at fermentation temperatures, we propose a two-step process for the hydrolysis of cellulose and its fermentation into alcohol using cellulases produced in situ.
Collapse
Affiliation(s)
- J Fitzpatrick
- School of Genetics and Microbiology, Moyne Institute, Trinity College Dublin, College Green, Dublin 2, Ireland
| | | | | | | |
Collapse
|
39
|
Canning C, Martin Z, Colgan MP, Abdulrahim O, McCafferty M, Fitzpatrick J, Haider SN, Madhavan P, O'Neill S. Fenestrated endovascular repair of complex aortic aneurysms. Ir J Med Sci 2014; 184:249-55. [PMID: 24599499 DOI: 10.1007/s11845-014-1095-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 02/18/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fenestrated endovascular aneurysm repair (FEVAR) provides an endovascular solution for patients with large abdominal aortic aneurysms and challenging neck anatomy in addition to repair of endoleaks and pseudoaneurysms. This article reports the midterm outcomes of FEVAR from a single-tertiary referral centre in Ireland. METHODS From 2006 to 2012, nine consecutive asymptomatic patients with neck anatomy unfavourable for standard EVAR underwent endovascular repair with a customised fenestrated Zenith stent graft. An additional three patients had fenestrated grafts for repair of pseudoaneurysms (n = 2) following open AAA repair and a type I endoleak (n = 1). All patients were prospectively enrolled in a computerised database. Outcomes including mortality, morbidity, renal function, target vessel patency, endoleak and reintervention were analysed. FINDINGS The mean age and aneurysm size in the primary repair group were 74 years (65-84 years) and 6 cm (5-8.3 cm), respectively, and in the secondary repair group, the mean age was 66 years (61-75 years). No procedures required open conversion, and no visceral arteries were lost. On completion angiography, two patients in group 1 had a type I endoleak and one had a type III endoleak. There were no endoleaks in the secondary repair group. Follow-up ranged from 30 days to 6 years. There was one death within 30 days (8 %) and two deaths at 3 years from non-aneurysm-related causes. Six patients required secondary interventions. Three patients had a transient post-operative creatinine rise of >30 %. CONCLUSION Our study supports FEVAR as a feasible and effective therapy in the management of patients with complex aortic aneurysms.
Collapse
Affiliation(s)
- C Canning
- St James's Hospital, Dublin, Ireland,
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Yu NYC, Gdalevitch M, Murphy CM, Mikulec K, Peacock L, Fitzpatrick J, Cantrill LC, Ruys AJ, Cooper-White JJ, Little DG, Schindeler A, Schindeler A. Spatial control of bone formation using a porous polymer scaffold co-delivering anabolic rhBMP-2 and anti-resorptive agents. Eur Cell Mater 2014; 27:98-109; discussion 109-111. [PMID: 24488823 DOI: 10.22203/ecm.v027a08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Current clinical delivery of recombinant human bone morphogenetic proteins (rhBMPs) utilises freeze-dried collagen. Despite effective new bone generation, rhBMP via collagen can be limited by significant complications due to inflammation and uncontrolled bone formation. This study aimed to produce an alternative rhBMP local delivery system to permit more controllable and superior rhBMP-induced bone formation. Cylindrical porous poly(lactic-co-glycolic acid) (PLGA) scaffolds were manufactured by thermally-induced phase separation. Scaffolds were encapsulated with anabolic rhBMP-2 (20 µg) ± anti-resorptive agents: zoledronic acid (5 µg ZA), ZA pre-adsorbed onto hydroxyapatite microparticles, (5 µg ZA/2% HA) or IkappaB kinase (IKK) inhibitor (10 µg PS-1145). Scaffolds were inserted in a 6-mm critical-sized femoral defect in Wistar rats, and compared against rhBMP-2 via collagen. The regenerate region was examined at 6 weeks by 3D microCT and descriptive histology. MicroCT and histology revealed rhBMP-induced bone was more restricted in the PLGA scaffolds than collagen scaffolds (-92.3% TV, p < 0.01). The regenerate formed by PLGA + rhBMP-2/ZA/HA showed comparable bone volume to rhBMP-2 via collagen, and bone mineral density was +9.1% higher (p < 0.01). Local adjunct ZA/HA or PS-1145 significantly enhanced PLGA + rhBMP-induced bone formation by +78.2% and +52.0%, respectively (p ≤ 0.01). Mechanistically, MG-63 human osteoblast-like cells showed cellular invasion and proliferation within PLGA scaffolds. In conclusion, PLGA scaffolds enabled superior spatial control of rhBMP-induced bone formation over clinically-used collagen. The PLGA scaffold has the potential to avoid uncontrollable bone formation-related safety issues and to customise bone shape by scaffold design. Moreover, local treatment with anti-resorptive agents incorporated within the scaffold further augmented rhBMP-induced bone formation.
Collapse
Affiliation(s)
- N Y C Yu
- Orthopaedic Research & Biotechnology, Research Building, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Geier S, Parekh H, Li Y, Alvarez R, Hamad E, Tsai E, Fitzpatrick J, Nikolaidis L, Ahmed M. A Multi-Modailty Approach to Antibody Mediated Rejection. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
42
|
Hu YS, Zhu Q, Fitzpatrick J, Verma IM, Cang H. Imaging heterochromatin in human embryonic stem cells with light-sheet Bayesian microscopy. Epigenetics Chromatin 2013. [PMCID: PMC3620577 DOI: 10.1186/1756-8935-6-s1-p109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
43
|
Affiliation(s)
- Matthew Tsang
- Department of Dermatopathology; University of Colorado; Aurora; CO; USA
| | - Amanda Marsch
- Department of Dermatology; University of Illinois; Chicago; IL; USA
| | | | - Whitney High
- Department of Dermatopathology; University of Colorado; Aurora; CO; USA
| | - James Fitzpatrick
- Department of Dermatopathology; University of Colorado; Aurora; CO; USA
| | - Lori Prok
- Department of Dermatopathology; University of Colorado; Aurora; CO; USA
| |
Collapse
|
44
|
Abstract
Aboriginal women in the remote Fitzroy Valley region in Western Australia's Kimberley were concerned about high rates of alcohol use in pregnancy and its possible impact on child development. They successfully lobbied for restricted access to alcohol in 2007. In 2009 they developed a strategy for the diagnosis and prevention of Fetal Alcohol Spectrum Disorders (FASD) and the support of parents and carers of affected children. Aboriginal organisations then partnered with research and clinical groups from Sydney to conduct a FASD prevalence study. This commenced in 2010 following extensive community consultation and receipt of community consent. Data from this study are still being collected and will be used by the community to advocate for improved services and new models of health care. Prevention of FASD is important to optimise health and development for future generations of Aboriginal children and to ensure the transfer of culture and language from one generation to the next.
Collapse
Affiliation(s)
- Elizabeth Elliott
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
45
|
Lim AKP, Patel N, Eckersley RJ, Fitzpatrick J, Crossey MME, Hamilton G, Goldin RD, Thomas HC, Vennart W, Cosgrove DO, Taylor-Robinson SD. A comparison of 31P magnetic resonance spectroscopy and microbubble-enhanced ultrasound for characterizing hepatitis c-related liver disease. J Viral Hepat 2011; 18:e530-4. [PMID: 21914073 DOI: 10.1111/j.1365-2893.2011.01455.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We compared in vivo hepatic (31) P magnetic resonance spectroscopy ((31) P MRS) and hepatic vein transit times (HVTT) using contrast-enhanced ultrasound with a microbubble agent to assess the severity of hepatitis C virus (HCV)-related liver disease. Forty-six patients with biopsy-proven HCV-related liver disease and nine healthy volunteers had (31) P MRS and HVTT performed on the same day. (31) P MR spectra were obtained at 1.5 T. Peak areas were calculated for metabolites, including phosphomonoesters (PME) and phosphodiesters (PDE). Patients also had the microbubble ultrasound contrast agent, Levovist (2 g), injected into an antecubital vein, and time-intensity Doppler ultrasound signals of the right and middle hepatic veins were measured. The HVTT was calculated as the time from injection to a sustained rise in Doppler signal 10% greater than baseline. The shortest times were used for analysis. Based on Ishak histological scoring, there were 15 patients with mild hepatitis, 20 with moderate/severe hepatitis and 11 with cirrhosis. With increasing severity of disease, the PME/PDE ratio was steadily elevated, while the HVTT showed a monotonic decrease. Both imaging modalities could separate patients with cirrhosis from the mild and moderate/severe hepatitis groups. No statistical difference was observed in the accuracy of each test to denote mild, moderate/severe hepatitis and cirrhosis (Fisher's exact test P =1.00). (31) P MRS and HVTT show much promise as noninvasive imaging tests for assessing the severity of chronic liver disease. Both are equally effective and highly sensitive in detecting cirrhosis.
Collapse
Affiliation(s)
- A K P Lim
- Imaging Sciences Department, Institute of Clinical Sciences Centre, Faculty of Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Schukken YH, Günther J, Fitzpatrick J, Fontaine MC, Goetze L, Holst O, Leigh J, Petzl W, Schuberth HJ, Sipka A, Smith DGE, Quesnell R, Watts J, Yancey R, Zerbe H, Gurjar A, Zadoks RN, Seyfert HM. Host-response patterns of intramammary infections in dairy cows. Vet Immunol Immunopathol 2011; 144:270-89. [PMID: 21955443 DOI: 10.1016/j.vetimm.2011.08.022] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/28/2011] [Accepted: 08/26/2011] [Indexed: 01/12/2023]
Abstract
Many different bacterial species have the ability to cause an infection of the bovine mammary gland and the host response to these infections is what we recognize as mastitis. In this review we evaluate the pathogen specific response to the three main bacterial species causing bovine mastitis: Escherichia coli, Streptococcus uberis and Staphylococcus aureus. In this paper we will review the bacterial growth patterns, host immune response and clinical response that results from the intramammary infections. Clear differences in bacterial growth pattern are shown between bacterial species. The dominant pattern in E. coli infections is a short duration high bacteria count infection, in S. aureus this is more commonly a persistent infection with relative low bacteria counts and in S. uberis a long duration high bacteria count infection is often observed. The host immune response differs significantly depending on the invading bacterial species. The underlying reasons for the differences and the resulting host response are described. Finally we discuss the clinical response pattern for each of the three bacterial species. The largest contrast is between E. coli and S. aureus where a larger proportion of E. coli infections cause potentially severe clinical symptoms, whereas the majority of S. aureus infections go clinically unnoticed. The relevance of fully understanding the bovine host response to intramammary infection is discussed, some major gaps in our knowledge are highlighted and directions for future research are indicated.
Collapse
Affiliation(s)
- Ynte H Schukken
- Quality Milk Production Services, Cornell University, 240 Farrier Road, Ithaca, NY 14853, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Pyörälä S, Hovinen M, Simojoki H, Fitzpatrick J, Eckersall PD, Orro T. Acute phase proteins in milk in naturally acquired bovine mastitis caused by different pathogens. Vet Rec 2011; 168:535. [DOI: 10.1136/vr.d1120] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S. Pyörälä
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - M. Hovinen
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - H. Simojoki
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - J. Fitzpatrick
- Moredun Research Institute; Pentlands Science Park, Bush Loan Penicuik Midlothian EH2 0PZ
| | - P. D. Eckersall
- Division of Animal Production and Public Health; Faculty of Veterinary Medicine; University of Glasgow; Bearsden Road Glasgow G61 1QH
| | - T. Orro
- Department of Animal Health and Environment; Institute of Veterinary Medicine and Animal Sciences; Estonian University of Life Sciences; Kreutzwaldi 62 51014 Tartu Estonia
| |
Collapse
|
48
|
Fitzpatrick J, Aoki H, Koh S, deBarbadillo C, Midorikawa I, Miyazaki M, Omori A, Shimizu T. Phosphorus Recovery with New Ultra-Low Adsorption Process. ACTA ACUST UNITED AC 2011. [DOI: 10.2175/193864711802867270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
49
|
Fitzpatrick J, Weaver T, Boner M, Anderson M, O'Bryan C, Tarallo S. Wet-Weather Piloting Toward the Largest Compressible Media Filter on the Planet. ACTA ACUST UNITED AC 2011. [DOI: 10.2175/193864711802766218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
50
|
Mercer D, Morrell NT, Fitzpatrick J, Silva S, Child Z, Miller R, DeCoster TA. The course of the distal saphenous nerve: a cadaveric investigation and clinical implications. Iowa Orthop J 2011; 31:231-235. [PMID: 22096447 PMCID: PMC3215141] [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: 05/31/2023]
Abstract
INTRODUCTION Injury to the saphenous nerve at the ankle has been described as a complication resulting from incision and dissection over the distal tibia and medial malleolus. However, the exact course and location of the distal saphenous nerve is not well described in the literature. The purpose of this study was to determine the distal limit of the saphenous nerve and its anatomic relationship to commonly identified orthopaedic landmarks and surgical incisions. METHODS Sixteen cadaveric ankles were examined at the level of the distal tibia medial malleolus. An incision was made along the medial aspect of the lower extremity from the knee to the hallux to follow the course and branches of the saphenous nerve under direct visualization. We recorded the shortest distance from the most distal visualized portion of the saphenous nerve to the tip of the medial malleolus, to the antero-medial arthroscopic portal site, and to the tibialis anterior tendon. RESULTS The saphenous nerve runs posterior to the greater saphenous vein in the leg and divides into an anterior and posterior branch approximately 3 cm proximal to the tip of the medial malleolus. These branches terminate in the integument proximal to the tip of the medial malleolus, while the vein continues into the foot. The anterior branch ends at the anterior aspect of the medial malleolus near the posterior edge of the greater saphenous vein. The posterior branch ends near the posterior aspect of the medial malleolus. The average distance from the distal-most visualized aspect of the saphenous nerve to the tip of the medial malleolus measured 8mm +/-; 5mm; from the nerve to the medial arthroscopic portal measured 14mm +/-2mm; and from the nerve to the tibialis anterior measured 16mm +/-3mm. In only one case (of 16) was there an identifiable branch of the saphenous nerve extending to the foot and in this specimen it extended to the first metatarsophalangeal joint. The first metatarsophalangeal joint was innervated by the superficial peroneal nerve in all cases. Small variations were also noted. DISCUSSION AND CONCLUSIONS This study highlights the proximity of the distal saphenous nerve to common landmarks in orthopaedic surgery. This has important clinical implications in ankle arthroscopy, tarsal tunnel syndrome, fixation of distal tibia medial malleolar fractures, and other procedures centered about the medial malleolus. While the distal course of the saphenous nerve is generally predictable, variations exist and thus the orthopaedic surgeon must operate cautiously to prevent iatrogenic injury. To avoid saphenous nerve injury, incisions should stay distal to the tip of the medial malleolus. The medial arthroscopic portal should be more than one centimeter from the anterior aspect of the medial malleolus which will also avoid the greater saphenous vein. Incision over the anterior tibialis tendon should stay within one centimeter of the medial edge of the tendon.
Collapse
Affiliation(s)
- D Mercer
- The University of New Mexico Albuquerque, NM 87131-0001, USA
| | | | | | | | | | | | | |
Collapse
|