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Candy S, Reeve J, Dobson R, Whittaker R, Garrett J, Warren J, Calder A, Tane T, Robertson T, Rashid U, Taylor D. The Impact of Patient Preference on Attendance and Completion Rates at Centre-Based and mHealth Pulmonary Rehabilitation: A Non-Inferiority Pragmatic Clinical Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1419-1429. [PMID: 37465821 PMCID: PMC10350416 DOI: 10.2147/copd.s408423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Pulmonary rehabilitation (PR) is vital in the management of chronic respiratory disorders (CRDs) although uptake, attendance and completion are poor. Differing models of delivering PR are emerging in an attempt to increase the uptake and completion of this intervention. This study aimed to evaluate participant rate of attendance and completion of PR when given a preference regarding model of delivery (centre-based and mPR). Secondary aims were to evaluate the factors affecting patient preference for model of delivery and determine whether mPR is non-inferior to centre-based PR in health outcomes. Methods A multi-centre non-inferiority preference based clinical trial in Auckland, New Zealand. Participants with a CRD referred for PR were offered the choice of centre-based or mHealth PR (mPR). The primary outcome was completion rate of chosen intervention. Results A total of 105 participants were recruited to the study with 67 (64%) preferring centre-based and 38 (36%) mPR. The odds of completing the PR programme were higher in the centre-based group compared to mPR (odds ratio 1.90 95% CI [0.83-4.35]). Participants opting for mPR were significantly younger (p = 0.002) and significantly more likely to be working (p = 0.0001). Results showed that mPR was not inferior to centre-based regarding changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ). When services were forced to transition to telehealth services during COVID-19 restrictions, the attendance and completion rates were higher with telephone calls and video conferencing compared to mPR - suggesting that synchronous interpersonal interactions with clinicians may facilitate the best attendance and completion rates. Conclusion When offered the choice of PR delivery method, the majority of participants preferred centre-based PR and this facilitated the best completion rates. mPR was the preferred choice for younger, working participants suggesting that mPR may offer a viable alternative to centre-based PR for some participants, especially younger, employed participants.
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Affiliation(s)
- Sarah Candy
- Te Whatu Ora Counties Manukau Health, Auckland, New Zealand
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Julie Reeve
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | | | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Amanda Calder
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Taria Tane
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Usman Rashid
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Garrett J. Hargittai, Eszter, ed. Handbook of Digital Inequality. Cheltenham, UK; Northampton, MA: Edward Elgar Publishing, 2021. 386 p. Hardcover $265.00 (ISBN: 9781788116565); ebook $65.00 (ISBN: 9781788116572). LCCN: 2021-946075. CRL 2023. [DOI: 10.5860/crl.84.1.164] [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: 01/10/2023]
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Milne RJ, Hockey HU, Garrett J. Hospital Cost Savings for Sequential COPD Patients Receiving Domiciliary Nasal High Flow Therapy. Int J Chron Obstruct Pulmon Dis 2022; 17:1311-1322. [PMID: 35686212 PMCID: PMC9173724 DOI: 10.2147/copd.s350267] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To estimate the 5-year budget impact to Aotearoa New Zealand (NZ) hospitals of domiciliary nasal high flow (NHF) therapy to patients with chronic obstructive pulmonary disease (COPD) who require long term oxygen therapy. Methods Hospital admission counts along with length of stay were obtained from hospital records of 200 COPD patients enrolled in a 12-month randomized clinical trial of NHF in Denmark, both over a 12-month baseline and then in the study period while on randomized treatment (control or NHF). NZ costings from similar COPD patients were estimated using data from Middlemore Hospital, Auckland and were applied to the Danish trial. The budget impact of NHF was estimated over the predicted 5-year lifetime of the device when used by patients sequentially. Results Fifty-five of 100 patients in the NHF group and 44 of 100 patients in the control group were admitted to hospital with a respiratory diagnosis during the baseline year. They had 108 admissions in the treatment group vs 89 in the control group, with 632 vs 438 days in hospital, and modeled annual costs of $9443 vs $6512 per patient, respectively. During the study period there were 38 vs 44 patients with 67 vs 80 admissions and 302 vs 526 days in hospital, at a modeled annual cost of $6961 vs $9565 per patient respectively. Taking into account capital expenditure and running costs, this resulted in cost savings of $5535 per patient-year (95% CI, -$36 to -$11,034). With 90% usage over the estimated five-year lifetime of the NHF device, amortized capital costs of $594 per year and annual running costs of $662, we estimate a 5-year undiscounted cost saving per NHF device of $18,626 ($16,934 when discounted to net present value at 5% per annum). There would still be annual cost savings over a wide range of assumptions. Conclusion Domiciliary NHF therapy for patients with severe COPD has the potential to provide substantial hospital cost savings over the five-year lifetime of the NHF device.
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Affiliation(s)
- Richard J Milne
- Health Outcomes Associates Ltd, Auckland, New Zealand
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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Garrett J. Burning the Books: A History of the Deliberate Destruction of Knowledge. By Richard Ovenden. Cambridge, MA: Belknap Press of Harvard University Press, 2020. Pp. 308. $29.95 (cloth). ISBN 978-0-674-24120-6. The Library Quarterly 2022. [DOI: 10.1086/718603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Maltby S, McDonald VM, Upham JW, Bowler SD, Chung LP, Denton EJ, Fingleton J, Garrett J, Grainge CL, Hew M, James AL, Jenkins C, Katsoulotos G, King GG, Langton D, Marks GB, Menzies-Gow A, Niven RM, Peters M, Reddel HK, Thien F, Thomas PS, Wark PAB, Yap E, Gibson PG. Severe asthma assessment, management and the organisation of care in Australia and New Zealand: expert forum roundtable meetings. Intern Med J 2021; 51:169-180. [PMID: 32104958 DOI: 10.1111/imj.14806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
Severe asthma imposes a significant burden on individuals, families and the healthcare system. Treatment is complex, due to disease heterogeneity, comorbidities and complexity in care pathways. New approaches and treatments improve health outcomes for people with severe asthma. However, emerging multidimensional and targeted treatment strategies require a reorganisation of asthma care. Consensus is required on how reorganisation should occur and what areas require further research. The Centre of Excellence in Severe Asthma convened three forums between 2015 and 2018, hosting experts from Australia, New Zealand and the UK. The forums were complemented by a survey of clinicians involved in the management of people with severe asthma. We sought to: (i) identify areas of consensus among experts; (ii) define activities and resources required for the implementation of findings into practice; and (iii) identify specific priority areas for future research. Discussions identified areas of unmet need including assessment and diagnosis of severe asthma, models of care and treatment pathways, add-on treatment approaches and patient perspectives. We recommend development of education and training activities, clinical resources and standards of care documents, increased stakeholder engagement and public awareness campaigns and improved access to infrastructure and funding. Further, we propose specific future research to inform clinical decision-making and develop novel therapies. A concerted effort is required from all stakeholders (including patients, healthcare professionals and organisations and government) to integrate new evidence-based practices into clinical care and to advance research to resolve questions relevant to improving outcomes for people with severe asthma.
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Affiliation(s)
- Steven Maltby
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - John W Upham
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Department of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Simon D Bowler
- Immunity, Infection, and Inflammation Program, Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Li P Chung
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Eve J Denton
- Department of Respiratory Medicine, The Alfred Hospital and Austin Health, Melbourne, Victoria, Australia
| | - James Fingleton
- Capital and Coast District Health Board and Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Christopher L Grainge
- Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Mark Hew
- Department of Respiratory Medicine, The Alfred Hospital and Austin Health, Melbourne, Victoria, Australia
| | - Alan L James
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Australia and School of Medicine and Pharmacology, University of Western Australia, Western Australia, Australia
| | - Christine Jenkins
- Department of Thoracic Medicine, Concord Hospital, Concord Clinical School and Respiratory Discipline, University of Sydney, Concord, New South Wales, Australia.,The George Institute for Global Health, Newtown, New South Wales, Australia.,UNSW, Sydney, Liverpool, New South Wales, Australia
| | | | - Gregory G King
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - David Langton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Thoracic Medicine, Frankston Hospital, Frankston, Victoria, Australia
| | - Guy B Marks
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, UNSW, Australia
| | | | - Robert M Niven
- Division of Infection, Immunity & Respiratory Medicine, Manchester Academic Health Science Centre and North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia
| | - Helen K Reddel
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Francis Thien
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Department of Respiratory Medicine, Eastern Health and Monash University, Box Hill, Victoria, Australia
| | - Paul S Thomas
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter A B Wark
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Elaine Yap
- Middlemore Hospital, Auckland, New Zealand
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
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Whittaker R, Dobson R, Candy S, Tane T, Burrowes K, Reeve J, Tawhai M, Taylor D, Robertson T, Garrett J, Humphrey G, Brott T, Khan SR, Hu F, Warren J. Mobile Pulmonary Rehabilitation: Feasibility of Delivery by a Mobile Phone-Based Program. Front Comput Sci 2021. [DOI: 10.3389/fcomp.2021.546960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary rehabilitation (PR) has been proven effective but is not well accessed due to transport, time, cost, and physical limitations of patients. We have developed a mobile phone-based PR program (mPR) that could be offered as an alternative for those unable to attend in-person. This was developed following formative research with patients, their families and clinicians. mPR has a core text message program plus an app that includes an action plan, exercise videos, lung visualization, symptom score questionnaire and 1-min sit-to-stand test.Aims: To determine the feasibility of delivering pulmonary rehabilitation by mobile phone.Methods: A 9-week non-randomized (1-arm) pilot study was conducted. Participants were 26 adults with chronic obstructive pulmonary disease plus four family members, who were offered participation at first assessment or during group PR sessions. Outcomes included satisfaction, engagement with the program, and perceived impacts.Results: Eight people (31%) opted for text messages only, and 18 (69%) chose text messages plus the app. Three people stopped the program early, 20 said they would recommend it to others, 19 said it helped them to feel more supported, 17 said it helped them to change their behavior.Conclusion: It is feasible to deliver PR support via mobile phone, including exercise prescription and support. Our mPR program was appreciated by a small number of people with chronic respiratory disorders and family members. Suggestions for improvements are being used to inform the further development of the program, which will then be tested for effectiveness. Registered with the Australia New Zealand Clinical Trials Registry ACTRN12619000884101 (www.anzctr.org.au).
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Good WR, Garrett J, Hockey HUP, Jayaram L, Wong C, Rea H. The role of high-flow nasal therapy in bronchiectasis: a post hoc analysis. ERJ Open Res 2021; 7:00711-2020. [PMID: 33585655 PMCID: PMC7869600 DOI: 10.1183/23120541.00711-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/23/2020] [Indexed: 12/02/2022] Open
Abstract
High-flow nasal therapy (HFNT) is a gas delivery system that provides heated and humidified air or supplemental oxygen by nasal cannula. The role of HFNT in airways disease has primarily focused on COPD. Studies in patients with COPD have demonstrated improvement in quality-of-life scores and reduced acute exacerbations with HFNT use [1, 2]. High-flow nasal therapy significantly reduces exacerbation rates and improves quality of life in patients with stable bronchiectasis. High-flow nasal therapy is therefore a potential treatment option for patients with bronchiectasis.https://bit.ly/2JFXuQc
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Affiliation(s)
- William R Good
- Dept of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Dept of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Otahuhu, New Zealand
| | - Jeffrey Garrett
- Dept of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Otahuhu, New Zealand
| | | | - Lata Jayaram
- Dept of Respiratory Medicine, Western Health, Melbourne, VIC, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Conroy Wong
- Dept of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Dept of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Otahuhu, New Zealand
| | - Harold Rea
- Dept of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Dept of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Otahuhu, New Zealand
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Page B, Fernandez K, Garrett J, Marcia M, Clements A, Schmitt N, Cunningham L. Feasibility of Portable Audiometry for Ototoxicity Monitoring in a Radiation Oncology Clinic for Head and Neck Cancer Patients Receiving Cisplatin-Based Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.289] [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: 10/23/2022]
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Chaurasia A, Brennan A, Mandia J, Garrett J, Cecil E, Kiess A, Quon H, Page B. Patient-Reported Quality of Life Outcomes after Head & Neck Cancer Radiation. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1484] [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: 10/23/2022]
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10
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Dobson R, Herbst P, Candy S, Brott T, Garrett J, Humphrey G, Reeve J, Tawhai M, Taylor D, Warren J, Whittaker R. Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews. JMIR Form Res 2019; 3:e15466. [PMID: 31859681 PMCID: PMC6942186 DOI: 10.2196/15466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. OBJECTIVE The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. METHODS A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. RESULTS Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. CONCLUSIONS These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population.
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Affiliation(s)
- Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Sarah Candy
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Tamzin Brott
- Waitemata District Health Board, Auckland, New Zealand
| | - Jeffrey Garrett
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Gayl Humphrey
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Julie Reeve
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Merryn Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Denise Taylor
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
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Ch (Chaudhry) IA, Tahirkheli N, Latif F, Usmani A, Tahirkheli M, Amil F, Chaudry S, Bhaktaram A, Whitehead A, Weitzel H, Ullah R, Qadar A, Wu PT, Ijaz H, Garrett J. EFFICACY OF DUAL ANTI-PLATELET THERAPY IN CORONARY ARTERY BYPASS GRAFT PATIENTS WITH STABLE ISCHEMIC HEART DISEASE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Baldonado JJAR, Amaral M, Garrett J, Moodie C, Robinson L, Keenan R, Toloza EM, Fontaine JP. Credentialing for robotic lobectomy: what is the learning curve? A retrospective analysis of 272 consecutive cases by a single surgeon. J Robot Surg 2018; 13:663-669. [PMID: 30560496 DOI: 10.1007/s11701-018-00902-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/02/2018] [Indexed: 11/25/2022]
Abstract
Credentialing processes for surgeons seeking robotic thoracic surgical privileges are not evidence-based, and the learning curve has not been reported. The goal of this study is to review our experience with robotic lobectomies and provide evidence for the development of a more uniform credentialing process. We performed a retrospective review of the first 272 consecutive robotic lobectomies performed between 2011 and 2017 by a single surgeon with prior video-assisted thoracoscopic (VATS) experience. Primary outcomes were operative duration, blood loss, chest tube duration, length of hospital stay, intraoperative complication, and conversion to thoracotomy. The patients were subdivided by surgical date into two cohorts of 120 consecutive patients to compare differences in outcomes, thereby illustrating the learning curve. Between 2011 and 2017, 272 patients (median age 67.5 years) underwent a robotic lobectomy by a single surgeon. The majority of patients (157/272) had early stage (T1N0) adenocarcinoma. For the entire cohort, median operative time was 160 min (83-317 min). The median blood loss was 75 mL (10-4000 mL). Median chest tube duration was 2 days (1-23 days) and median hospital stay was 3 days (1-25 days). Intraoperative complications occurred in seven patients. Only six patients required conversion to thoracotomy. Using multivariable logistic regression, it was found that the age, gender, and stage do not factor into conversion to thoracotomy, but BMI was found to be a significant covariate (p 0.043). As the surgeon performs more surgeries, there is a significantly shorter operative time (p < 0.001), decreased blood loss (p < 0.001), and shorter hospital stay (p < 0.014). When the first 120 and last 120 surgeries were compared, there was significantly less blood loss (234.6 vs 78.69 cc, p < 0.001), shorter operative time (181.9 vs 147.4 min, p < 0.001), shorter tube duration (3.49 vs 3.11 days, p 0.007), and shorter length of stay (4.03 vs 3.48 days, p < 0.001), respectively. More intraoperative complications were observed during the first 120 surgeries (6/120) compared to the last 120 surgeries (0/120; Fischer exact p = 0.029). Regression model plots did not show any apparent and significant change points, but rather a steady improvement. The more cases the surgeon does, the better is the outcome in terms of operative duration, blood loss, post-operative length of stay and intraoperative complications. The learning curve for robotic surgery for a surgeon with prior VATS experience is that of a continuous improvement with experience instead of a particular change point. Since most thoracic surgeons who perform robotic-assisted surgery have already gotten past their VATS learning curves, they no longer have a definable learning curve for robotic surgery. Hence, if a surgeon is already proficient and credentialed to perform VATS lung resections, he or she is no longer faced with a significant learning curve for robotic lung resections, and should be credentialed to do so once he or she has undergone the appropriate training with the equipment and technology.
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Affiliation(s)
| | - M Amaral
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Garrett
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - C Moodie
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - L Robinson
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - R Keenan
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - E M Toloza
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J P Fontaine
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Long G, Hauschild A, Santinami M, Atkinson V, Mandala M, Chiarion-Sileni V, Larkin J, Robert C, Schadendorf D, Dasgupta K, Shilkrut M, Garrett J, Brase J, Kefford R, Kirkwood J, Dummer R. Updated relapse-free survival (RFS) and biomarker analysis in the COMBI-AD trial of adjuvant dabrafenib + trametinib (D + T) in patients (pts) with resected BRAF V600–mutant stage III melanoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McDonald VM, Hiles SA, Godbout K, Harvey ES, Marks GB, Hew M, Peters M, Bardin PG, Reynolds PN, Upham JW, Baraket M, Bhikoo Z, Bowden J, Brockway B, Chung LP, Cochrane B, Foxley G, Garrett J, Jayaram L, Jenkins C, Katelaris C, Katsoulotos G, Koh MS, Kritikos V, Lambert M, Langton D, Lara Rivero A, Middleton PG, Nanguzgambo A, Radhakrishna N, Reddel H, Rimmer J, Southcott AM, Sutherland M, Thien F, Wark PAB, Yang IA, Yap E, Gibson PG. Treatable traits can be identified in a severe asthma registry and predict future exacerbations. Respirology 2018; 24:37-47. [PMID: 30230137 DOI: 10.1111/resp.13389] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/18/2018] [Accepted: 07/31/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE A new taxonomic and management approach, termed treatable traits, has been proposed for airway diseases including severe asthma. This study examined whether treatable traits could be identified using registry data and whether particular treatable traits were associated with future exacerbation risk. METHODS The Australasian Severe Asthma Web-Based Database (SAWD) enrolled 434 participants with severe asthma and a comparison group of 102 participants with non-severe asthma. Published treatable traits were mapped to registry data fields and their prevalence was described. Participants were characterized at baseline and every 6 months for 24 months. RESULTS In SAWD, 24 treatable traits were identified in three domains: pulmonary, extrapulmonary and behavioural/risk factors. Patients with severe asthma expressed more pulmonary and extrapulmonary treatable traits than non-severe asthma. Allergic sensitization, upper-airway disease, airflow limitation, eosinophilic inflammation and frequent exacerbations were common in severe asthma. Ten traits predicted exacerbation risk; among the strongest were being prone to exacerbations, depression, inhaler device polypharmacy, vocal cord dysfunction and obstructive sleep apnoea. CONCLUSION Treatable traits can be assessed using a severe asthma registry. In severe asthma, patients express more treatable traits than non-severe asthma. Traits may be associated with future asthma exacerbation risk demonstrating the clinical utility of assessing treatable traits.
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Affiliation(s)
- Vanessa M McDonald
- Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Sarah A Hiles
- Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Krystelle Godbout
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Erin S Harvey
- Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia
| | - Mark Hew
- Difficult Asthma Clinic, Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Concord, NSW, Australia
| | - Philip G Bardin
- Lung and Sleep Medicine, Monash University and Medical Centre, Clayton, VIC, Australia
| | - Paul N Reynolds
- Department of Lung Research, Hanson Institute, Adelaide, SA, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John W Upham
- The University of Queensland Diamantina Institute, Woolloongabba, QLD, Australia.,Department of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Melissa Baraket
- Department of Respiratory Medicine, Liverpool Hospital and School of Medicine, UNSW Sydney, Liverpool, NSW, Australia
| | | | - Jeffrey Bowden
- Department of Respiratory, Allergy and Sleep Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Ben Brockway
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Li Ping Chung
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Belinda Cochrane
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Campbelltown, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Gloria Foxley
- Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia
| | - Jeffrey Garrett
- Respiratory Department, Middlemore Hospital, Auckland, New Zealand
| | - Lata Jayaram
- Department of Medicine, Melbourne Clinical School, University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Disorders Medicine, Western Health, Footscray, VIC, Australia
| | - Christine Jenkins
- Department of Thoracic Medicine, Concord Hospital, Concord, NSW, Australia.,Concord Clinical School and Respiratory Discipline, University of Sydney, Concord, NSW, Australia.,Respiratory Group, The George Institute for Global Health, Newtown, NSW, Australia.,Respiratory Medicine, UNSW Sydney, Liverpool, NSW, Australia
| | - Constance Katelaris
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.,Immunology Department, Campbelltown Hospital, Campbelltown, NSW, Australia
| | | | - Mariko S Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Duke - National University Singapore Medical School, Singapore
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, Quality Use of Respiratory Medicines, The University of Sydney, Glebe, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Marina Lambert
- Respiratory Services, MidCentral Health, Palmerston North Hospital, Palmerston North, New Zealand
| | - David Langton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Department of Thoracic Medicine, Frankston Hospital, Frankston, VIC, Australia
| | | | - Peter G Middleton
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Ludwig Engel Centre for Respiratory Research, Westmead Institute of Medical Research, Westmead, NSW, Australia.,Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Aldoph Nanguzgambo
- Respiratory Services, MidCentral Health, Palmerston North Hospital, Palmerston North, New Zealand
| | - Naghmeh Radhakrishna
- Difficult Asthma Clinic, Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Helen Reddel
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,Thoracic Medicine, St Vincent's Clinic, Darlinghurst, NSW, Australia
| | - Anne Marie Southcott
- Department of Respiratory and Sleep Disorders Medicine, Western Health, Footscray, VIC, Australia
| | - Michael Sutherland
- Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, VIC, Australia
| | - Francis Thien
- Department of Respiratory Medicine, Eastern Health and Monash University, Box Hill, VIC, Australia
| | - Peter A B Wark
- Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Ian A Yang
- The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside West, QLD, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Chermside, QLD, Australia
| | - Elaine Yap
- Respiratory Department, Middlemore Hospital, Auckland, New Zealand
| | - Peter G Gibson
- Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Gerard R, Nguyen D, Velez-Cubian F, Amaral M, Moodie C, Garrett J, Fontaine J, Toloza E. PD.2.04 Effect of Nodal Skip Metastasis on Outcomes after Robotic-Assisted Pulmonary Lobectomy for Primary Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.036] [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: 11/26/2022]
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16
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Hiles SA, Harvey ES, McDonald VM, Peters M, Bardin P, Reynolds PN, Upham JW, Baraket M, Bhikoo Z, Bowden J, Brockway B, Chung LP, Cochrane B, Foxley G, Garrett J, Hew M, Jayaram L, Jenkins C, Katelaris C, Katsoulotos G, Koh MS, Kritikos V, Lambert M, Langton D, Lara Rivero A, Marks GB, Middleton PG, Nanguzgambo A, Radhakrishna N, Reddel H, Rimmer J, Southcott AM, Sutherland M, Thien F, Wark PAB, Yang IA, Yap E, Gibson PG. Working while unwell: Workplace impairment in people with severe asthma. Clin Exp Allergy 2018; 48:650-662. [DOI: 10.1111/cea.13153] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
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17
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Glover J, Reynolds S, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. P178 Smoking history as a risk factor for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy. Chest 2017. [DOI: 10.1016/j.chest.2017.04.081] [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: 11/12/2022] Open
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18
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Groshev A, Velez-Cubian F, Gerard R, Toosi K, Moodie C, Garrett J, Fontaine J, Toloza E. P189 Perioperative outcomes after robotic-assisted pulmonary lobectomy for upper versus lower lobe lung malignancies. Chest 2017. [DOI: 10.1016/j.chest.2017.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Groshev A, Velez-Cubian F, Gerard R, Toosi K, Moodie C, Garrett J, Fontaine J, Toloza E. P179 Outcomes for right versus left lung malignancies after robotic-assisted pulmonary lobectomy. Chest 2017. [DOI: 10.1016/j.chest.2017.04.082] [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] Open
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20
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Reynolds S, Glover J, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. P187 Diabetes predisposes patients to atrial fibrillation after robotic-assisted video-thoracoscopic pulmonary lobectomy. Chest 2017. [DOI: 10.1016/j.chest.2017.04.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Reynolds S, Glover J, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. Diabetes predisposes patients to atrial fibrillation after robotic-assisted video-thoracoscopic pulmonary lobectomy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx085.005] [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: 11/12/2022] Open
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Glover J, Reynolds S, Ng E, Echavarria M, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. Effect of age on risk for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx085.008] [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: 11/12/2022] Open
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23
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Glover J, Reynolds S, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. Smoking history as a risk factor for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx085.006] [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: 11/14/2022] Open
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24
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Garrett J, Li Y, Li K, Chen G. WE-DE-207B-06: Artifact Reduction in Digital Breast Tomosynthesis with the Denoised Ordered-Subset Statistically Penalized Algebraic Reconstruction Technique (DOS-SPART) Algorithm. Med Phys 2016. [DOI: 10.1118/1.4957866] [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: 11/07/2022] Open
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25
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Garrett J, Ge Y, Li K, Chen G. TU-CD-207-12: Impact of Anatomical Noise On Detection Performance of Microcalcifications in Multi-Contrast Breast Imaging. Med Phys 2015. [DOI: 10.1118/1.4925631] [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: 11/07/2022] Open
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26
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Ng E, Rodriguez K, Velez-Cubian FO, Thau MR, Zhang WW, Moodie CC, Garrett J, Fontaine JP, Robinson L, Toloza E. P-171 * DOES SOCIO-ECOMOMIC STATUS MATTER WITH PERIOPERATIVE OUTCOMES AFTER ROBOTIC-ASSISTED PULMONARY LOBECTOMY? Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.171] [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: 11/12/2022] Open
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27
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Toloza E, Moodie CC, Garrett J, Meredith K. P-216 * CONCURRENT ROBOTIC-ASSISTED RIGHT UPPER LOBECTOMY FOR LUNG CANCER AND ROBOTIC-ASSISTED EXCISION OF OESOPHAGEAL LEIOMYOMA: A CASE REPORT. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Toloza E, Splittgerber M, Zhang WW, Moodie CC, Garrett J, Hiro M, Dayicioglu D. P-233 * NOVEL APPROACHES TO COMPLEX CHEST WALL RECONSTRUCTION USING A COMBINATION OF TWO TITANIUM-BASED PLATING-SYSTEMS: A CASE REPORT. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.233] [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: 11/12/2022] Open
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29
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Yap E, Chua WM, Jayaram L, Zeng I, Vandal AC, Garrett J. Can we predict sputum eosinophilia from clinical assessment in patients referred to an adult asthma clinic? Intern Med J 2013; 43:46-52. [PMID: 21790924 DOI: 10.1111/j.1445-5994.2011.02565.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/26/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is overwhelming evidence that asthma guidelines aimed at reducing airway inflammation are superior to those based on clinical symptoms alone. This involves targeting eosinophilic inflammation with inhaled corticosteroids. AIM Because induced sputum is not readily available, our study set out to investigate whether the collective or singular use of routine asthma investigations can predict sputum eosinophilia. METHODS Eighty patients underwent skin prick testing, blood tests (IgE, full blood count), spirometry, exhaled fraction nitric oxide (FeNO), PD15 to hypertonic saline, and induced sputum testing at first assessment. A predictive model for sputum eosinophilia (defined as ≥3% eosinophils) was sought using routinely available tests. RESULTS Fifty-four subjects underwent both induced sputum and FeNO testing. Seventeen (30%) revealed eosinophilic inflammation, nine (16%) neutrophilic, four (7%) mixed granulocytic and 26 (46%) paucigranulocytic. Positive predictors for sputum eosinophilia included low forced expiratory volume in 1 s (FEV(1))% predicted, raised serum eosinophil, positive smoking history, Polynesian ethnicity and negative asthma family history. There was a non-statistically significant trend for FeNO predicting sputum eosinophilia. The best combination of predictors was low FEV(1)% predicted, raised serum eosinophil, positive smoking history and negative family history of asthma. CONCLUSION This study demonstrates that the serum eosinophil count and FEV(1) combined with aspects of a clinical history may provide a simple and practical alternative to assessment of airway (sputum) eosinophilia in the clinical setting. A full blood count can be performed at a substantially lesser cost and with greater accessibility than induced sputum. We feel the time has come for the clinical utility of the serum eosinophil count to be revisited.
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Affiliation(s)
- E Yap
- Respiratory Department, Middlemore Hospital, Auckland, New Zealand.
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30
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Li K, Garrett J, Ge Y, Chen GH. WE-G-103-03: BEST IN PHYSICS (IMAGING) - The Feasibility of An X-Ray Differential Phase Contrast Tomosynthesis System Adapted From a Clinical Digital Breast Tomosynthesis System. Med Phys 2013. [DOI: 10.1118/1.4815663] [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: 11/07/2022] Open
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31
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Mercier RJ, Garrett J, Thorp J, Siega-Riz AM. Pregnancy intention and postpartum depression: secondary data analysis from a prospective cohort. BJOG 2013; 120:1116-22. [PMID: 23651010 DOI: 10.1111/1471-0528.12255] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [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: 02/11/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the relationship between unintended pregnancy and postpartum depression. DESIGN Secondary analysis of data from a prospective pregnancy cohort. SETTING The study was performed at the University of North Carolina prenatal care clinics. POPULATION/SAMPLE Pregnant women enrolled for prenatal care at the University of North Carolina Hospital Center. METHODS Participants were questioned about pregnancy intention at 15-19 weeks of gestation, and classified as having an intended, mistimed or unwanted pregnancy. They were evaluated for postpartum depression at 3 and 12 months postpartum. Log binomial regression was used to assess the relationship between unintended pregnancy and depression, controlling for confounding by demographic factors and reproductive history. MAIN OUTCOME MEASURES Depression at 3 and 12 months postpartum, defined as Edinburgh Postpartum Depression Scale score >13. RESULTS Data were analysed for 688 women at 3 months and 550 women at 12 months. Depression was more likely in women with unintended pregnancies at both 3 months (risk ratio [RR] 2.1, 95% confidence interval [95% CI] 1.2-3.6) and 12 months (RR 3.6, 95% CI 1.8-7.1). Using multivariable analysis adjusting for confounding by age, poverty and education level, women with unintended pregnancies were twice as likely to have postpartum depression at 12 months (RR 2.0, 95% CI 0.96-4.0). CONCLUSION While many elements may contribute to postpartum depression, unintended pregnancy could also be a contributing factor. Women with unintended pregnancy may have an increased risk of depression up to 1 year postpartum.
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Affiliation(s)
- R J Mercier
- Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC 27599, USA.
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O'Neill E, Tang J, Garrett J, Hubacher D. Characteristics of Kenyan women who continue subdermal contraceptive implants at 18 months. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Garrett J. The British Isles, Vol. 1: England. Guides to Dutch Atlas Maps. Eds. Peter van der Krogt and Elger Heere. Houten, Netherlands: Hes & De Graaf; New Castle, Del.: Oak Knoll Press, 2012. 256p. alk. paper, $115 (ISBN 9781584563006). LC 2011-592008. CRL 2012. [DOI: 10.5860/0730507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garrett J, Tang J, Zhang Y, Ruth C, Jing Z, Chen GH. TU-E-217BCD-10: Dose Reduction in Digital Breast Tomosynthesis with the Dose Reduction Prior Image Constrained Compressed Sensing (DR-PICCS) Algorithm. Med Phys 2012; 39:3916. [DOI: 10.1118/1.4735982] [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: 11/07/2022] Open
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Abstract
The complex anatomy of the pelvis and acetabulum have historically made classification and interpretation of acetabular fractures difficult for orthopedic trainees. The addition of 3-dimensional (3-D) computed tomography (CT) scan has gained popularity in preoperative planning, identification, and education of acetabular fractures given their complexity. Therefore, the authors examined the value of 3-D CT compared with conventional radiography in classifying acetabular fractures at different levels of orthopedic training. Their hypothesis was that 3-D CT would improve correct identification of acetabular fractures compared with conventional radiography.The classic Letournel fracture pattern classification system was presented in quiz format to 57 orthopedic residents and 20 fellowship-trained orthopedic traumatologists. A case consisted of (1) plain radiographs and 2-dimensional axial CT scans or (2) 3-D CT scans. All levels of training showed significant improvement in classifying acetabular fractures with 3-D vs 2-D CT, with the greatest benefit from 3-D CT found in junior residents (postgraduate years 1-3).Three-dimensional CT scans can be an effective educational tool for understanding the complex spatial anatomy of the pelvis, learning acetabular fracture patterns, and correctly applying a widely accepted fracture classification system.
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Affiliation(s)
- Jeffrey Garrett
- Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, Florida, USA
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Paregallo R, Prabhakaran S, Garrett J. Haitian women with unmet contraceptive need without intention to use contraceptives: should we address this unmet need? Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.106] [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: 11/29/2022]
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Dieterich S, Chuang C, Cohen A, Taylor D, Wu X, Garrett J, Lowenstein J, Lee C, Cavedon C, Yu C, DˈSouza M. WE-B-BRA-03: TG135 - QA for Robotic Radiosurgery. Med Phys 2011. [DOI: 10.1118/1.3613302] [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: 11/07/2022] Open
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Cook RS, Rinehart C, Garrett J, Chakravarti A, Arteaga CL. Abstract P5-06-10: ErbB Signaling Is Required for Activation of Phosphatidylinositol-3 Kinase and Transformation of Mammary Epithelial Cells by Polyomavirus Middle T Antigen. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-06-10] [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: 11/16/2022]
Abstract
Abstract
Summary
Polyomavirus middle T (PyVmT) transforms cells through phosphatidylinositol 3-kinase (PI3K). Overexpression of ErbB2/ErbB3 heterodimers, potent activators of PI3K, occurs in PyVmT-driven mouse mammary tumors, but without known cause and consequence. Inhibition of ErbB2 with lapatinib, or genetically engineered loss of ErbB3, decreased PI3K signaling and tumor growth in mice, suggesting ErbB2/ErbB3 is required by PyVmT. ErbB2/ErbB3 formed signaling complexes containing PyVmT, p85 and Src. EZN-3920, a novel high-affinity oligonucleotide targeting ErbB3 transcripts, impaired ErbB3 expression in vivo, decreased PI3K signaling, cell survival, and growth of tumors, and improved response to lapatinib. Therefore, PyVmT utilizes ErbB2/ErbB3 overexpression to drive PI3K signaling. Furthermore, the challenge of ErbB3 as a kinase-inactive therapeutic target can be overcome by targeting ErbB3 mRNA transcripts in vivo. Significance
Given the widespread use of, and knowledge gained from the MMTV-PyVmT transgenic mouse breast cancer model, understanding how PyVmT utilizes existing cell signaling programs is necessary to interpret how results impact our understanding/treatment of human breast cancers. We found that ErbB2/ErbB3 heterodimers were a necessary part of PyVmT signaling complexes involving Src and PI3K, and that PyVmT depends on ErbB3 in the breast epithelium for PI3K activity and tumor growth. Because ErbB3 harbors a weak/inactive tyrosine kinase, therapeutic anti-ErbB3 interventions present with challenges. Further, anti-ErbB3 antibodies that block ligand interaction with ErbB3 do not alter ligand-independent ErbB3 signaling. However. these challenges were overcome using high-affinity oligonucleotides targeting ErbB3 mRNA. Use of the oligonucleotide EZN-3920 effectively reduced ErbB3 expression, inhibited PyVmT tumor growth, and improved the response of tumors to lapatinib. These results support oligonucleotide knock-down of targets as potential therapeutic strategy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-06-10.
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Affiliation(s)
- RS Cook
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - C Rinehart
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - J Garrett
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - A Chakravarti
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - CL. Arteaga
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
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Garrett J. Obstructive sleep apnoea syndrome. N Z Med J 2010; 123:6-8. [PMID: 20927151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Dieterich S, Cavedon C, Chuang C, Cohen A, Garrett J, Lee C, Lowenstein J, D'Souza M, Taylor D, Wu X, Yu C. TU-B-203-03: QA of Radiation Delivery Systems - TG-135 QA for Robotic Radiosurgery. Med Phys 2010. [DOI: 10.1118/1.3469184] [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: 11/07/2022] Open
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Garrett J, Naimi D, Le T. Predictive Value Of Combining Food-specific IgE Level With Skin Prick Test And Oral Food Challenge Outcome. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garrett J, Olivares M, Rinehart C, Dave B, Cook R, Chang J, Arteaga C. Transcriptional and Post-Translational Upregulation of HER3 (ErbB3) Counteracts Antitumor Effect of HER2 Tyrosine Kinase Inhibitors. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-63] [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] [Indexed: 11/16/2022]
Abstract
Abstract
We hypothesized that sustained inhibition of HER3 and its output to PI3K/Akt is required for the optimal antitumor effect of HER2 inhibitors. Therefore, we examined the temporal effect of the HER2 tyrosine kinase inhibitor (TKI) lapatinib (lap) on feedback upregulation of active HER3 in HER2-overexpressing breast cancer cells. A time course with lap-treated cells showed 3 to 5-fold upregulation of HER3 RNA and protein, beginning at 4 h and increasing through 48 h. P-Tyr immunoblot of HER3 immunoprecipitates revealed recovery of HER3 phosphorylation at and beyond 13 h of treatment. Site-specific antibodies revealed HER3 phosphorylation at Y1197 and Y1289, two of the six p85 binding sites in HER3. Recovery of P-HER3 correlated temporally with recovery of T308 P-Akt. The upregulation of HER3 RNA upon treatment with lap suggested that inhibition of active HER2 and PI3K/Akt derepresses the transcription factor FoxO3a. Putative FoxO3a binding sites were identified within the 5' flanking region upstream of the HER3 transcription start site. Transfection with FoxO3a siRNA reduced basal and lap-induced HER3 RNA levels 2 to 5-fold compared to control cells. Conversely, overexpression of FoxO3a increased HER3 RNA 2.5-fold, which could be further enhanced by lap treatment. In addition to these transcriptional mechanisms, the recovery of P-HER3 upon lap-induced inhibition of HER2 suggested engagement of another tyrosine kinase transactivating HER3 and/or that HER2 had been incompletely inhibited by the TKI. However, IGF-IR, Src, and MET TKIs did not inhibit the recovery of P-HER3. On the other hand, the addition of trastuzumab (tz) to lap-treated cells prevented recovery of P-HER3, suggesting that disruption of a ligand-independent HER2-HER3 interaction was involved in partial maintenance of HER3 phosphorylation.The upregulation of HER3 RNA and partial maintenance of P-HER3 and P-Akt suggested that combined inhibition of HER2 and HER3 will synergistically inhibit tumor cell viability. Transfection with HER3 siRNA sensitized HER2+ breast cancer cells to each lap and tz as assessed by Apo-BrdU (apoptosis) and 3D-Matrigel growth assays. Further, treatment with AMG-888, a HER3 monoclonal antibody (AMGEN-U3), sensitized cells to each lap and tz. Ongoing studies include the treatment of BT474 xenografts in athymic mice with lap ± AMG-888 using [18F]-FDG-PET as a non-invasive imaging biomarker to predict treatment outcome. Finally, we examined HER3 levels by immunohistochemistry in sections from tumor blocks of patients enrolled in a neoadjuvant trial where lap was given alone during the first 6 weeks of therapy. The percent and intensity of tumor cell staining was calculated as a histoscore (Human Pathol. 26:291, 1995). On week 2 of therapy, HER3 levels increased 135% above pre-therapy levels (n=8; p=0.03, Mann-Whitney). These data suggest that upon inhibition of the HER2 tyrosine kinase, HER2+ breast cancers 1) upregulate HER3 by transcriptional mechanisms and partially maintain HER3 function by post-translational mechanisms; 2) this compensatory phosphorylation of HER3 partially maintains PI3K/Akt; and 3) inhibition of HER3 sensitizes HER2-dependent breast cancer cells to HER2 inhibitors.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 63.
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Affiliation(s)
| | | | | | - B. Dave
- 2Baylor College of Medicine, TX,
| | - R. Cook
- 1Vanderbilt-Ingram Cancer Center, TN,
| | - J. Chang
- 2Baylor College of Medicine, TX,
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Garrett J. Why Burn a Library? Books on Fire: The Destruction of Libraries throughout History. By Lucien X. Polastron. Translated from the French by, Jon E. Graham. Rochester, VT: Inner Traditions, 2007. Pp. xii+371. $24.95 (cloth). ISBN 978‐159477167‐5. Originally published as Livres en feu (Paris: Editions Denoël, 2004). Burning Books and Leveling Libraries: Extremist Violence and Cultural Destruction. By Rebecca Knuth. Westport, CT: Praeger, 2006. Pp. xiv+233. $39.95 (cloth). ISBN 0‐275‐99007–9. A Universal History of the Destruction of Books: From Ancient Sumer to Modern Iraq. By Fernando Báez. Translated from the Spanish by, Alfred MacAdam. New York: Atlas, 2008. Pp. xii+355. $25.00 (cloth). ISBN 1‐934633‐01‐4. Originally published as De las tablillas sumerias a la Guerra de Irak (Barcelona: Ediciones Destino, 2004). The Library Quarterly 2009. [DOI: 10.1086/605386] [Citation(s) in RCA: 2] [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: 11/04/2022]
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Dieterich S, Cavedon C, Chuang C, Cohen A, Garrett J, Lee C, Lowenstein J, D'Souza M, Taylor D, Wu X, Yu C. TU-E-BRB-03: Performance-Based QA for Radiotherapy: TG-135 - QA for Robotic Radiosurgery. Med Phys 2009. [DOI: 10.1118/1.3182412] [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: 11/07/2022] Open
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Jones A, Brown M, Trzeciak S, Shapiro N, Garrett J, Heffner A, Kline J. 207: The Effect of a Quantitative Resuscitation Strategy on Mortality in Patients With Sepsis: A Meta-Analysis. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Garrett J. Google and the Myth of Universal Knowledge. By Jean‐Noël Jeanneney. Translated from the French by, Teresa Lavendar Fagan. Chicago: University of Chicago Press, 2007. $18.00 (cloth). Pp. xvii+92. ISBN 0‐226‐39577‐4. The Library Quarterly 2008. [DOI: 10.1086/588411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nowak E, Brousseau R, Garrett J, Masson L, Maynard C, Trevors J, Edge T. Characterization of formulated microbial products by denaturing gradient gel electrophoresis, total cellular fatty acid analysis, and DNA microarray analysis. Can J Microbiol 2008; 54:380-90. [DOI: 10.1139/w08-015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two commercial products, Biotize and Cycle, containing bacteria as an active ingredient were characterized for species identification and batch-to-batch variation by denaturing gradient gel electrophoresis (DGGE), total cellular fatty acid analysis (FAA), and a taxonomic DNA microarray. DGGE was useful at assessing the stability of consortia in different batches, and cluster analysis differentiated each batch even when only slight differences in species composition were observed. DGGE, FAA, and DNA microarray results indicated little batch-to-batch variation in Biotize and some batch variation in Cycle. The 3 methods agreed well with species identification in Biotize but generated conflicting results in the species composition of Cycle. This multi-method approach was useful in determining if the observed bacterial species present in the products matched the expected species composition.
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Affiliation(s)
- E. Nowak
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - R. Brousseau
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - J. Garrett
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - L. Masson
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - C. Maynard
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - J.T. Trevors
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - T.A. Edge
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
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Garrett J. <b>Markham, Sheila.</b> <i>A Book of Booksellers: Conversations with the Antiquarian Book Trade 1991–2003</i>. 1st pbk. ed. London: Sheila Markham Rare Books; New Castle, Del.: Oak Knoll, 2007. 323p. $29.95 (ISBN 1584562072). LC 2007-18615. CRL 2008. [DOI: 10.5860/crl.69.2.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sierpinski P, Garrett J, Ma J, Apel P, Klorig D, Smith T, Koman LA, Atala A, Van Dyke M. The use of keratin biomaterials derived from human hair for the promotion of rapid regeneration of peripheral nerves. Biomaterials 2008; 29:118-28. [DOI: 10.1016/j.biomaterials.2007.08.023] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Accepted: 08/11/2007] [Indexed: 12/12/2022]
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Garrett J. Wershler-Henry, Darren. The Iron Whim: A Fragmented History of Typewriting. Ithaca and London: Cornell University Press, 2007. First published in Canada by McClelland & Stewart, 2005. 331p. alk. paper, $29.95 (ISBN 0801445868). LC 2007-002217. CRL 2007. [DOI: 10.5860/crl.68.6.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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