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Gauthier C, Kung J, Guy J. The Intrinsic Value of Diversity in Team Leadership. Clin Sports Med 2024; 43:293-297. [PMID: 38383111 DOI: 10.1016/j.csm.2023.12.001] [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] [Indexed: 02/23/2024]
Abstract
Despite the demonstrated benefit of diversity within a team structure, there is a lack of diversity among leadership in professional organizations. An increase in diversity among leadership teams would allow for more effective communication with team members, better problem-solving skills, increased trust within a team environment, and greater inspiration for future generations. Therefore, diversity should be a core concept within a leadership team.
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Affiliation(s)
- Chase Gauthier
- Department of Orthopedic Surgery, Prisma Health, 2 Medical Park Road, Suite 404, Columbia, SC 29203, USA
| | - Justin Kung
- Department of Orthopedic Surgery, Prisma Health, 2 Medical Park Road, Suite 404, Columbia, SC 29203, USA
| | - Jeffrey Guy
- Department of Orthopedic Surgery, Prisma Health, 2 Medical Park Road, Suite 404, Columbia, SC 29203, USA.
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Ye S, Li D, Yu T, Caroff DA, Guy J, Poland RE, Sands KE, Septimus EJ, Huang SS, Platt R, Wang R. The impact of surgical volume on hospital ranking using the standardized infection ratio. Sci Rep 2023; 13:7624. [PMID: 37165033 PMCID: PMC10172297 DOI: 10.1038/s41598-023-33937-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
The Centers for Medicare and Medicaid Services require hospitals to report on quality metrics which are used to financially penalize those that perform in the lowest quartile. Surgical site infections (SSIs) are a critical component of the quality metrics that target healthcare-associated infections. However, the accuracy of such hospital profiling is highly affected by small surgical volumes which lead to a large amount of uncertainty in estimating standardized hospital-specific infection rates. Currently, hospitals with less than one expected SSI are excluded from rankings, but the effectiveness of this exclusion criterion is unknown. Tools that can quantify the classification accuracy and can determine the minimal surgical volume required for a desired level of accuracy are lacking. We investigate the effect of surgical volume on the accuracy of identifying poorly performing hospitals based on the standardized infection ratio and develop simulation-based algorithms for quantifying the classification accuracy. We apply our proposed method to data from HCA Healthcare (2014-2016) on SSIs in colon surgery patients. We estimate that for a procedure like colon surgery with an overall SSI rate of 3%, to rank hospitals in the HCA colon SSI dataset, hospitals that perform less than 200 procedures have a greater than 10% chance of being incorrectly assigned to the worst performing quartile. Minimum surgical volumes and predicted events criteria are required to make evaluating hospitals reliable, and these criteria vary by overall prevalence and between-hospital variability.
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Affiliation(s)
- Shangyuan Ye
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Daniel Li
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, 02215, USA
| | - Tingting Yu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA
| | - Daniel A Caroff
- Department of Infectious Diseases, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA
| | - Jeffrey Guy
- Clinical Operations Group, HCA Healthcare, Nashville, TN, 37203, USA
| | - Russell E Poland
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA
- Clinical Operations Group, HCA Healthcare, Nashville, TN, 37203, USA
| | - Kenneth E Sands
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA
- Clinical Operations Group, HCA Healthcare, Nashville, TN, 37203, USA
| | - Edward J Septimus
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA
- Texas A &M College of Medicine, Houston, TX, 77030, USA
| | - Susan S Huang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA
- University of California Irvine School of Medicine, Irvine, CA, 92617, USA
| | - Richard Platt
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA
| | - Rui Wang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02215, USA.
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, 02215, USA.
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Andrews L, Goldin L, Shen Y, Korwek K, Kleja K, Poland RE, Guy J, Sands KE, Perlin JB. Discontinuation of atorvastatin use in hospital is associated with increased risk of mortality in COVID-19 patients. J Hosp Med 2022; 17:169-175. [PMID: 35504528 PMCID: PMC9088329 DOI: 10.1002/jhm.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Statins are a commonly used class of drugs, and reports have suggested that their use may affect COVID-19 disease severity and mortality risk. OBJECTIVE The purpose of this analysis was to determine the effect of discontinuation of previous atorvastatin therapy in patients hospitalized for COVID-19 on the risk of mortality and ventilation. METHODS Data from 146,413 hospitalized COVID-19 patients were classified according to statin therapy. Home + in hospital atorvastatin use (continuation of therapy); home + no in hospital atorvastatin use (discontinuation of therapy); no home + no in hospital atorvastatin use (no statins). Logistic regression was performed to assess the association between atorvastatin administration and either mortality or use of mechanical ventilation during the encounter. RESULTS Continuous use of atorvastatin (home and in hospital) was associated with a 35% reduction in the odds of mortality compared to patients who received atorvastatin at home but not in hospital (odds ratio [OR]: 0.65, 95% confidence interval [CI]: 0.59-0.72, p < .001). Similarly, the odds of ventilation were lower with continuous atorvastatin therapy (OR: 0.70, 95% CI: 0.64-0.77, p < .001). CONCLUSIONS Discontinuation of previous atorvastatin therapy is associated with worse outcomes for COVID-19 patients. Providers should consider maintaining existing statin therapy for patients with known or suspected previous use.
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Affiliation(s)
- Laura Andrews
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Laurel Goldin
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Yan Shen
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Kimberly Korwek
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Kacie Kleja
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | | | - Jeffrey Guy
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
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Razanamahery J, Samson M, Guy J, Francois S, Emile J, Cohen Aubart F, Papo M, Haroche J, Audia S, Bonnotte B. La répartition des sous-populations monocytaire dans l’histiocytose est proche de la leucémie myélomonocytaire chronique, est corrélée au phénotype et à l’activité de la maladie. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.289] [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: 11/29/2022]
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Goldin L, Elders T, Werhane L, Korwek K, Poland R, Guy J. Reactions and COVID-19 disease progression following SARS-CoV-2 monoclonal antibody infusion. Int J Infect Dis 2021; 112:73-75. [PMID: 34508863 PMCID: PMC8425746 DOI: 10.1016/j.ijid.2021.09.007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/01/2022] Open
Abstract
SARS-CoV-2 monoclonal antibodies (mAbs) have been proposed as a treatment for mild to moderate COVID-19, with favorable outcomes reported in clinical trials and an emergency use authorization granted by the Food and Drug Administration. Real-world data remain limited, however, and thus this analysis presents findings from over 6,500 outpatient administrations of mAb at facilities affiliated with a large healthcare organization in the United States. Within 48 hours of mAb infusion, 15.6% (1,043) of patients received a drug that was indicative of a possible reaction to the infusion; the majority of these were mild (e.g., acetaminophen). Approximately 5.2% of patients who received mAb (n=347) had a post-infusion emergency department visit or admission for COVID-19 disease progression. The results of this analysis indicate that patients who receive mAb have a low likelihood of both an immediate negative reaction to the treatment as well as future inpatient admission related to COVID-19 disease progression.
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Affiliation(s)
- Laurel Goldin
- Clinical Operations group, HCA Healthcare, Nashville, TN 37023, United States
| | - Ty Elders
- Clinical Operations group, HCA Healthcare, Nashville, TN 37023, United States
| | - Leslie Werhane
- Clinical Operations group, HCA Healthcare, Nashville, TN 37023, United States
| | - Kimberly Korwek
- Clinical Operations group, HCA Healthcare, Nashville, TN 37023, United States
| | - Russell Poland
- Clinical Operations group, HCA Healthcare, Nashville, TN 37023, United States
| | - Jeffrey Guy
- Clinical Operations group, HCA Healthcare, Nashville, TN 37023, United States.
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Morse J, Gay W, Korwek KM, McLean LE, Poland RE, Guy J, Sands K, Perlin JB. Hyperglycaemia increases mortality risk in non-diabetic patients with COVID-19 even more than in diabetic patients. Endocrinol Diabetes Metab 2021; 4:e00291. [PMID: 34505406 PMCID: PMC8420416 DOI: 10.1002/edm2.291] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 01/08/2023]
Abstract
Aim Diabetes has been identified as a risk factor for poor outcomes in patients with COVID‐19. We examined the association of hyperglycaemia, both in the presence and absence of pre‐existing diabetes, with severity and outcomes in COVID‐19 patients. Methods Data from 74,148 COVID‐19‐positive inpatients with at least one recorded glucose measurement during their inpatient episode were analysed for presence of pre‐existing diabetes diagnosis and any glucose values in the hyperglycaemic range (>180 mg/dl). Results Among patients with and without a pre‐existing diabetes diagnosis on admission, mortality was substantially higher in the presence of high glucose measurements versus all measurements in the normal range (70–180 mg/dl) in both groups (non‐diabetics: 21.7% vs. 3.3%; diabetics 14.4% vs. 4.3%). When adjusting for patient age, BMI, severity on admission and oxygen saturation on admission, this increased risk of mortality persisted and varied by diabetes diagnosis. Among patients with a pre‐existing diabetes diagnosis, any hyperglycaemic value during the episode was associated with a substantial increase in the odds of mortality (OR: 1.77, 95% CI: 1.52–2.07); among patients without a pre‐existing diabetes diagnosis, this risk nearly doubled (OR: 3.07, 95% CI: 2.79–3.37). Conclusion This retrospective analysis identified hyperglycaemia in COVID‐19 patients as an independent risk factor for mortality after adjusting for the presence of diabetes and other known risk factors. This indicates that the extent of glucose control could serve as a mechanism for modifying the risk of COVID‐19 morality in the inpatient environment.
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Affiliation(s)
- Jennifer Morse
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | - Wendy Gay
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | | | - Laura E McLean
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | | | - Jeffrey Guy
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | - Kenneth Sands
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
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Cooper MK, Burgess LH, Miller K, Baltz T, Moody J, Wiggins E, Guy J. Innovative Conservation of Inhaled Medication Devices During the COVID-19 Pandemic Through a Canister Reassignment Process. HCA Healthc J Med 2020; 1:419-424. [PMID: 37426842 PMCID: PMC10327978 DOI: 10.36518/2689-0216.1184] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background The ideal practice for patients requiring metered-dose inhalers (MDI) with coronavirus disease 2019 (COVID-19) is to use patient specific MDIs. However, this practice may not be possible during a time of increased usage throughout the country and limited availability of the medication. Nebulized medications are a concern due to the potential for aerosolized virus and increased exposure for health care workers. An alternative program of canister reassignment is proposed to address concerns for infection prevention, cross-contamination of MDI canisters and the shortage of MDI's due to the COVID-19 pandemic. Methods A comprehensive MDI canister reassignment process was developed for facilities affiliated with a large health care system in response to the COVID-19 pandemic. The MDI canister reassignment process consisted of 4 components: preservation of supply, reassignment workflow, canister cleaning and operational integration. Albuterol MDI administration data was monitored from January 1st to August 31st, 2020. Results Following development and rapid implementation of a comprehensive canister reassignment process, albuterol MDI administration data was reviewed from 162 hospitals affiliated with a large health care system. At baseline (prior to the COVID-19 pandemic), 98% of patients received a nebulizer vs. an MDI. After the implementation of the MDI reassignment process (during the COVID-19 pandemic), nebulizer usage decreased by 60% from March 6th to March 31st and was sustained with >50% reduction through August 31st. Conclusion MDI canister reassignment was an instrumental process to allow the continued delivery of pharmacologic bronchodilator therapy for COVID-19 patients. It also represents an important infection prevention strategy needed to protect our health care providers from the potential aerosolized virus associated with nebulizers.
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Affiliation(s)
- Mandelin K Cooper
- Clinical Pharmacy Operations, HCA Healthcare Clinical Operations Group, Nashville, TN
| | - L Hayley Burgess
- Clinical Pharmacy Operations, HCA Healthcare Clinical Operations Group, Nashville, TN
| | - Karla Miller
- Clinical Pharmacy Operations, HCA Healthcare Clinical Operations Group, Nashville, TN
| | - Theresa Baltz
- Clinical Pharmacy Operations, HCA Healthcare Clinical Operations Group, Nashville, TN
| | - Julia Moody
- Infection Prevention, HCA Healthcare Clinical Operations Group, Nashville, TN
| | - Elizabeth Wiggins
- Clinical Pharmacy Operations, HCA Healthcare Clinical Operations Group, Nashville, TN
| | - Jeffrey Guy
- Clinical Pharmacy Operations, HCA Healthcare Clinical Operations Group, Nashville, TN
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Williams K, Askew C, Mazoue C, Guy J, Torres-McGehee TM, Jackson Iii JB. Vitamin D3 Supplementation and Stress Fractures in High-Risk Collegiate Athletes - A Pilot Study. Orthop Res Rev 2020; 12:9-17. [PMID: 32161507 PMCID: PMC7051810 DOI: 10.2147/orr.s233387] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/07/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction Vitamin D is paramount to bone health and little is known about vitamin D’s role in the prevention of stress fractures in high-risk athletes. This study consists of a prospective, cross-sectional analysis accompanied by a retrospective review for control comparison of vitamin D3 supplementation in high-risk athletes. Our hypothesis is that supplemental vitamin D3 treatment will decrease the occurrence of stress fractures in high-risk collegiate athletes. Materials and Methods A total of 118 NCAA Division I athletes were recruited from 6 high-risk collegiate teams. Blood draws in August and February established baseline 25(OH)D levels. Subjects with serum 25(OH)D <30 ng/mL were supplemented with 50,000 IU of vitamin D3/week for 8 weeks. Treated subjects were re-tested to ensure serum 25(OH)D levels rose to sufficient status. All enrolled subjects were monitored for the development of stress fractures. A 5-year retrospective chart review of athletes from the same sports teams was conducted to determine the incidence of any reported stress fractures in the past. Results Prospective: 112 of the 118 enrolled subjects were tested in August. Sixty-one demonstrated vitamin D sufficiency (40.2 ng/mL ±8.28) and 51 were either insufficient or deficient (22.7 ng/mL ±4.89). Of the 118 enrolled subjects, 104 were tested in February. Fifty-six demonstrated vitamin D sufficiency (40.7 ng/mL ±9.47) and 48 were insufficient or deficient (21.6 ng/mL ±5.87). Two stress fractures were diagnosed amongst our cohort of 118 student athletes (1.69%). Retrospective: 34 stress fractures were diagnosed in 453 subjects from 01/2010-05/2015 (7.51%). Amongst our athletic teams, the cross-country team specifically demonstrated a statistically significant decrease in stress fracture incidence (p<0.05). We also found a statistically significant reduction in stress fracture incidence amongst the current overall cohort compared to our retrospective cohort (p<0.05). Conclusion In our population, almost half of the tested athletes proved to be vitamin D deficient. Hypovitaminosis D was prevalent throughout the winter months compared with the summer. With vitamin D3 supplementation, the stress fracture rate in our overall cohort demonstrated a statistically significant decrease from 7.51% to 1.65% (p=0.009).
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Affiliation(s)
- Kevin Williams
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | - Christian Askew
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | - Christopher Mazoue
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | - Jeffrey Guy
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | | | - J Benjamin Jackson Iii
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
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Baseggio L, Debliquis A, Jacob M, Bouyer S, Bennani H, Chapuis N, Garnache Ottou F, Genevieve F, Guy J, Harrivel V, Letestu R, Mayeur-Rousse C, Drenou B. MULTICENTRIC MFI30 STUDY: STANDARDIZATION OF CD30 EXPRESSION BY FLOW CYTOMETRY IN NON-HODGKIN LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.23_2630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- L. Baseggio
- Laboratoire d'Hématologie; Hospice Civils de Lyon/Groupement Hospitalier SUD; Pierre Benite France
| | - A. Debliquis
- Laboratoire Hématologie; Groupe Hospitalier de la Région Mulhouse Sud Alsace (GHRMSA); Mulhouse France
| | - M. Jacob
- Laboratoire Immunologie; CHU Grenoble; Grenoble France
| | - S. Bouyer
- Laboratoire de Biologie; CHU Poitiers; Poitiers France
| | - H. Bennani
- Laboratoire de Biologie; Hôpital Foch; Suresnes France
| | - N. Chapuis
- Laboratoire Hématologie; APHP-Cochin; Paris France
| | | | - F. Genevieve
- Laboratoire Hématologie/Institut de Biologie/Cytométrie en Flux; CH Angers; Angers France
| | - J. Guy
- Laboratoire Hématologie/Plateforme de Cytométrie; CHU-Dijon; Dijon France
| | - V. Harrivel
- Centre de Biologie Humaine; CHU Amiens; Amiens France
| | - R. Letestu
- Laboratoire Hématologie; APHP-Avicenne; Bobigny France
| | | | - B. Drenou
- Laboratoire Hématologie; Groupe Hospitalier de la Région Mulhouse Sud Alsace (GHRMSA); Mulhouse France
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De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Z, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, Kotseva K, De Backer G, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Bacquer DD, De Smedt D, De Sutter J, Deckers J, Dilic M, Dolzhenko M, Druais H, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Grobbee D, Gyberg V, Hasan Ali H, Heuschmann P, Hoes A, Jankowski P, Lalic N, Lehto S, Lovic D, Maggioni A, Mancas S, Marques-Vidal P, Mellbin L, Miličić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Rydén L, Stagmo M, Störk S, Sundvall J, Tokgözoğlu L, Tsioufis K, Vulic D, Wood D, Wood D, Kotseva K, Jennings C, Adamska A, Adamska S, Rydén L, Mellbin L, Tuomilehto J, Schnell O, Druais H, Fiorucci E, Glemot M, Larras F, Missiamenou V, Maggioni A, Taylor C, Ferreira T, Lemaitre K, Bacquer DD, De Backer G, Raman L, Sundvall J, DeSmedt D, De Sutter J, Willems A, De Pauw M, Vervaet P, Bollen J, Dekimpe E, Mommen N, Van Genechten G, Dendale P, Bouvier C, Chenu P, Huyberechts D, Persu A, Dilic M, Begic A, Durak Nalbantic A, Dzubur A, Hadzibegic N, Iglica A, Kapidjic S, Osmanagic Bico A, Resic N, Sabanovic Bajramovic N, Zvizdic F, Vulic D, Kovacevic-Preradovic T, Popovic-Pejicic S, Djekic D, Gnjatic T, Knezevic T, Kovacevic-Preradovic T, Kos L, Popovic-Pejicic S, Stanetic B, Topic G, Gotcheva N, Georgiev B, Terziev A, Vladimirov G, Angelov A, Kanazirev B, Nikolaeva S, Tonkova D, Vetkova M, Milicic D, Reiner Ž, Bosnic A, Dubravcic M, Glavina M, Mance M, Pavasovic S, Samardzic J, Batinic T, Crljenko K, Delic-Brkljacic D, Dula K, Golubic K, Klobucar I, Kordic K, Kos N, Nedic M, Olujic D, Sedinic V, Blazevic T, Pasalic A, Percic M, Sikic J, Bruthans J, Cífková R, Hašplová K, Šulc P, Wohlfahrt P, Mayer O, Cvíčela M, Filipovský J, Gelžinský J, Hronová M, Hasan-Ali H, Bakery S, Mosad E, Hamed H, Ibrahim A, Elsharef M, Kholef E, Shehata A, Youssef M, Elhefny E, Farid H, Moustafa T, Sobieh M, Kabil H, Abdelmordy A, Lehto S, Kiljander E, Kiljander P, Koukkunen H, Mustonen J, Cremer C, Frantz S, Haupt A, Hofmann U, Ludwig K, Melnyk H, Noutsias M, Karmann W, Prondzinsky R, Herdeg C, Hövelborn T, Daaboul A, Geisler T, Keller T, Sauerbrunn D, Walz-Ayed M, Ertl G, Leyh R, Störk S, Heuschmann P, Ehlert T, Klocke B, Krapp J, Ludwig T, Käs J, Starke C, Ungethüm K, Wagner M, Wiedmann S, Tsioufis K, Tolis P, Vogiatzi G, Sanidas E, Tsakalis K, Kanakakis J, Koutsoukis A, Vasileiadis K, Zarifis J, Karvounis C, Crowley J, Gibson I, Houlihan A, Kelly C, O'Donnell M, Bennati M, Cosmi F, Mariottoni B, Morganti M, Cherubini A, Di Lenarda A, Radini D, Ramani F, Francese M, Gulizia M, Pericone D, Davletov K, Aigerim K, Zholdin B, Amirov B, Assembekov B, Chernokurova E, Ibragimova F, Kodasbayev A, Markova A, Mirrakhimov E, Asanbaev A, Toktomamatov U, Tursunbaev M, Zakirov U, Abilova S, Arapova R, Bektasheva E, Esenbekova J, Neronova K, Asanbaev A, Baigaziev K, Toktomamatov U, Zakirov U, Baitova G, Zheenbekov T, Erglis A, Andrejeva T, Bajare I, Kucika G, Labuce A, Putane L, Stabulniece M, Dzerve V, Klavins E, Sime I, Badariene J, Gedvilaite L, Pečiuraite D, Sileikienė V, Skiauteryte E, Solovjova S, Sidabraite R, Briedis K, Ceponiene I, Jurenas M, Kersulis J, Martinkute G, Vaitiekiene A, Vasiljevaite K, Veisaite R, Plisienė J, Šiurkaitė V, Vaičiulis Ž, Jankowski P, Czarnecka D, Kozieł P, Podolec P, Nessler J, Gomuła P, Mirek-Bryniarska E, Bogacki P, Wiśniewski A, Pająk A, Wolfshaut-Wolak R, Bućko J, Kamiński K, Łapińska M, Paniczko M, Raczkowski A, Sawicka E, Stachurska Z, Szpakowicz M, Musiał W, Dobrzycki S, Bychowski J, Kosior D, Krzykwa A, Setny M, Kosior D, Rak A, Gąsior Z, Haberka M, Gąsior Z, Haberka M, Szostak-Janiak K, Finik M, Liszka J, Botelho A, Cachulo M, Sousa J, Pais A, Aguiar C, Durazzo A, Matos D, Gouveia R, Rodrigues G, Strong C, Guerreiro R, Aguiar J, Abreu A, Cruz M, Daniel P, Morais L, Moreira R, Rosa S, Rodrigues I, Selas M, Gaita D, Mancas S, Apostu A, Cosor O, Gaita L, Giurgiu L, Hudrea C, Maximov D, Moldovan B, Mosteoru S, Pleava R, Ionescu M, Parepa I, Pogosova N, Arutyunov A, Ausheva A, Isakova S, Karpova A, Salbieva A, Sokolova O, Vasilevsky A, Pozdnyakov Y, Antropova O, Borisova L, Osipova I, Lovic D, Aleksic M, Crnokrak B, Djokic J, Hinic S, Vukasin T, Zdravkovic M, Lalic N, Jotic A, Lalic K, Lukic L, Milicic T, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Djordjevic D, Kostic S, Tasic I, Vukovic A, Fras Z, Jug B, Juhant A, Krt A, Kugonjič U, Chipayo Gonzales D, Gómez Barrado J, Kounka Z, Marcos Gómez G, Mogollón Jiménez M, Ortiz Cortés C, Perez Espejo P, Porras Ramos Y, Colman R, Delgado J, Otero E, Pérez A, Fernández-Olmo M, Torres-LLergo J, Vasco C, Barreñada E, Botas J, Campuzano R, González Y, Rodrigo M, de Pablo C, Velasco E, Hernández S, Lozano C, González P, Castro A, Dalmau R, Hernández D, Irazusta F, Vélez A, Vindel C, Gómez-Doblas J, García Ruíz V, Gómez L, Gómez García M, Jiménez-Navarro M, Molina Ramos A, Marzal D, Martínez G, Lavado R, Vidal A, Rydén L, Boström-Nilsson V, Kjellström B, Shahim B, Smetana S, Hansen O, Stensgaard-Nake E, Deckers J, Klijn A, Mangus T, Peters R, Scholte op Reimer W, Snaterse M, Aydoğdu S, Ç Erol, Otürk S, Tulunay Kaya C, Ahmetoğlu Y, Ergene O, Akdeniz B, Çırgamış D, Akkoyun H Kültürsay S, Kayıkçıoğlu M, Çatakoğlu A, Çengel A, Koçak A, Ağırbaşlı M, Açıksarı G, Çekin M, Tokgözoğlu L, Kaya E, Koçyiğit D, Öngen Z, Özmen E, Sansoy V, Kaya A, Oktay V, Temizhan A, Ünal S, İ Yakut, Kalkan A, Bozkurt E, Kasapkara H, Dolzhenko M, Faradzh C, Hrubyak L, Konoplianyk L, Kozhuharyova N, Lobach L, Nesukai V, Nudchenko O, Simagina T, Yakovenko L, Azarenko V, Potabashny V, Bazylevych A, Bazylevych M, Kaminska K, Panchenko L, Shershnyova O, Ovrakh T, Serik S, Kolesnik T, Kosova H, Wood D, Adamska A, Adamska S, Jennings C, Kotseva K, Hoye P Atkin A, Fellowes D, Lindsay S, Atkinson C, Kranilla C, Vinod M, Beerachee Y, Bennett C, Broome M, Bwalya A, Caygill L, Dinning L, Gillespie A, Goodfellow R, Guy J, Idress T, Mills C, Morgan C, Oustance N, Singh N, Yare M, Jagoda J, Bowyer H, Christenssen V, Groves A, Jan A, Riaz A, Gill M, Sewell T, Gorog D, Baker M, De Sousa P, Mazenenga T, Porter J, Haines F, Peachey T, Taaffe J, Wells K, Ripley D, Forward H, McKie H, Pick S, Thomas H, Batin P, Exley D, Rank T, Wright J, Kardos A, Sutherland SB, Wren L, Leeson P, Barker D, Moreby B, Sawyer J, Stirrup J, Brunton M, Brodison A, Craig J, Peters S, Kaprielian R, Bucaj A, Mahay K, Oblak M, Gale C, Pye M, McGill Y, Redfearn H, Fearnley M. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
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Guy J, O'Kane E, Eggleton A. Steroids, atosiban and pulmonary oedema: are or may be a cause? Int J Obstet Anesth 2018; 34:115. [PMID: 29602690 DOI: 10.1016/j.ijoa.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/05/2018] [Accepted: 03/11/2018] [Indexed: 10/17/2022]
Affiliation(s)
- J Guy
- Department of Anaesthesia, Ulster Hospital, Dundonald, Northern Ireland, United Kingdom
| | - E O'Kane
- Department of Anaesthesia, Ulster Hospital, Dundonald, Northern Ireland, United Kingdom
| | - A Eggleton
- Department of Anaesthesia, Ulster Hospital, Dundonald, Northern Ireland, United Kingdom.
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Williams KA, Askew C, Mazoue C, Guy J, Torres-McGehee TM, Jackson JB. Vitamin D3 Supplementation and Stress Fracture Occurrence in High-Risk Collegiate Athletes. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519597.35267.9a] [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: 11/21/2022]
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Collier B, Diaz J, Forbes R, Morris J, May A, Guy J, Ozdas A, Dupont W, Miller R, Jensen G. The Impact of a Normoglycemic Management Protocol on Clinical Outcomes in the Trauma Intensive Care Unit. JPEN J Parenter Enteral Nutr 2017; 29:353-8; discussion 359. [PMID: 16107598 DOI: 10.1177/0148607105029005353] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality. METHODS A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated > or =24 hours and > or =15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. RESULTS Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was > or =150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose > or =150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. CONCLUSIONS Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels > or =150 mg/dL were associated with worse outcome.
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Affiliation(s)
- Bryan Collier
- Department of Biostatistics, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, 243 Medical Center South, 2100 Pierce Avenue, Nashville, TN 37212, USA.
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Espenel S, Garcia M, Trone J, Langrand-Escure J, Guy J, Vallard A, Rancoule C, Ben Mrad M, Chauleur C, de Laroche G, Magné N. Cancers du col utérin localement évolués de stades IB2 à IIIB : une expérience mono-institutionnelle. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.050] [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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Lagrand-Escure J, Diao P, Vallard A, Garcia M, Espenel S, Guy J, Trone J, Wang G, Rancoule C, Magné N. Radiothérapie externe et cancer rectal : facteurs prédictifs de survie et réponse histologique. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.040] [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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Langrand-Escure J, Diao P, Vallard A, Garcia M, Espenel S, Guy J, Trone J, Ben Mrad M, Rancoule C, Magné N. Cancer du rectum métastatique synchrone : la radiothérapie au service du contrôle local. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.041] [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: 11/27/2022]
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Guy J, Méry B, Rancoule C, Vallard A, Espenel S, Wozny A, Ardail D, Alphonse G, Rodriguez-Lafrasse C, Magné N. Ciblage de la famille HER dans les cancers ORL : efficacité biologique de l’association de cétuximab et de pertuzumab combinée à l’irradiation photonique. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.078] [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: 11/24/2022]
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Guy J, Nottingham S. Fillet Yield, Biochemical Composition, and Consumer Acceptance of Farmed and Wild Mulloway. Journal of Aquatic Food Product Technology 2014. [DOI: 10.1080/10498850.2012.750636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mosher J, Guy J, Kessler R, Astier P, Marriner J, Betoule M, Sako M, El-Hage P, Biswas R, Pain R, Kuhlmann S, Regnault N, Frieman JA, Schneider DP. COSMOLOGICAL PARAMETER UNCERTAINTIES FROM SALT-II TYPE IA SUPERNOVA LIGHT CURVE MODELS. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/793/1/16] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Guy J, Mottron L, Bertone A. The role of development in locally-oriented visual perception: an investigation spatial contrast sensitivity in Autism Spectrum Disorder. J Vis 2014. [DOI: 10.1167/14.10.674] [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: 11/24/2022] Open
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Chihib N, Guy J, Coucheney F, Guez J, Coutte F, Béchet M, Jacques P. Engineering of Bacillus subtilis physiological functionalities towards the production of mycosubtilin anteiso-C17. N Biotechnol 2012. [DOI: 10.1016/j.nbt.2012.08.222] [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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Guy J, Morin K, Habak C, Wilson HR, Mottron L, Bertone A. Face Perception in School-Aged Children with Autism: A Look at Visual Processing Strategies. J Vis 2012. [DOI: 10.1167/12.9.1354] [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: 11/24/2022] Open
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Leinonen I, Williams A, Wiseman J, Guy J, Kyriazakis I. Predicting the environmental impacts of chicken systems in the United Kingdom through a life cycle assessment: Broiler production systems. Poult Sci 2012; 91:8-25. [DOI: 10.3382/ps.2011-01634] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leinonen I, Williams A, Wiseman J, Guy J, Kyriazakis I. Predicting the environmental impacts of chicken systems in the United Kingdom through a life cycle assessment: Egg production systems. Poult Sci 2012; 91:26-40. [DOI: 10.3382/ps.2011-01635] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Harrington D, Robinson K, Guy J, Sparagano O. Characterization of the immunological response to Dermanyssus gallinae infestation in domestic fowl. Transbound Emerg Dis 2010; 57:107-10. [PMID: 20537120 DOI: 10.1111/j.1865-1682.2010.01109.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermanyssus gallinae is a haematophagous ectoparasite of birds, which adversely affects both production and welfare of commercial poultry. Poultry in commercial production systems chronically exposed to D. gallinae do not appear to develop immunity to the mite. The objective of the current study was to determine the initial immune response of domestic fowl following exposure to D. gallinae. Two groups of birds (11 birds/group) had mite chambers secured to their backs. Controls received no mites, while infested birds received 200 unfed female D. gallinae on day 0 which were then removed on day 1 or 2. Spleen samples were collected on days -1, 1, 2 and 5. The expression of Th1 (IFNgamma, CXCLi2, IL6 and IL18), Th2 (IL4, IL10 and IL13) cytokines/chemokines normalized against a reference gene, GAPDH, were determined by semi-quantitative RT-PCR. Although there were no significant differences between treatments, numerical trends were observed. Th2 cytokine expression was not detected in any birds on any day. IL6, CXCLi2, IFNgamma and IL18 expression was increased on day 1 in the infested group, while on day 2 CXCLi2 and IFNgamma were lower and IL6 and IL18 levels were similar between treatments. The IL18 expression was similar between treatments on day 5, while IL6 and IFNgamma levels were increased and CXCLi2 expression was decreased in the infested group. Data suggest that D. gallinae feeding stimulates Th1 and pro-inflammatory cytokines/chemokines initially (day 1) followed by their subsequent down regulation. This study is the first report of the characterization of the immunological response of the domestic fowl to controlled numbers of D. gallinae.
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Affiliation(s)
- D Harrington
- School of Agriculture, Food and Rural Development, Newcastle University, UK
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Zajac IT, Whibley AH, Cole SR, Byrne D, Guy J, Morcom J, Young GP. Endorsement by the primary care practitioner consistently improves participation in screening for colorectal cancer: a longitudinal analysis. J Med Screen 2010; 17:19-24. [PMID: 20356941 DOI: 10.1258/jms.2010.009101] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the effect of general practice (GP) and general practitioner (GPR) endorsement for faecal occult blood test (FOBT)-based screening on maintenance of participation in screening over four successive screening rounds. SETTING South Australian residents aged > or = 50 years. METHODS Random selection of four groups (n = 600 per group): one from the Commonwealth electoral roll (ER) and three from the combined patient lists of two collaborating GPs (GP1, GP2, GP3). Subjects were mailed offers to screen using a faecal immunochemical test over four successive rounds, spaced approximately 18 months apart. The GP1 and ER groups were invited to screen without any endorsement from a GPR or medical practice; GP2 invitees received an invitation indicating support for screening from their medical practice; and GP3 invitations were printed on practice letterhead and were signed by a GPR. RESULTS Multivariate analyses indicated that initial participation as well as re-participation over four successive rounds was significantly enhanced in the GP2 (39%, 42%, 45% and 44%) and GP3 groups (42%, 47%, 48% and 49%) relative to the ER group (33%, 37%, 40% and 36%). The analyses also indicated that 60-69 year olds were most likely to participate in all rounds (relative risk [RR] 1.49, 1.39, 1.43 and 1.25), and men were generally less likely to participate than women in all screening rounds (RR 0.86, 0.84, 0.80 and 0.83). CONCLUSIONS Associating a GPR or medical practice of recent contact with an invitation to screen achieves better participation and re-participation than does an invitation from a centralized screening unit. Furthermore, enhanced participation can be achieved by practice endorsement alone without requiring actual GPR involvement.
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Affiliation(s)
- I T Zajac
- Department of Medicine, Flinders University, Bedford Park, 5042, Australia.
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Audia S, Lakomy D, Guy J, Leguy-Seguin V, Berthier S, Aho S, Lorcerie B, Bonnotte B. Traitement du purpura thrombopénique immunologique : étude rétrospective de 40 patients. Rev Med Interne 2010; 31:337-44. [DOI: 10.1016/j.revmed.2009.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 10/06/2009] [Accepted: 11/25/2009] [Indexed: 01/06/2023]
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Fogerty M, Guy J, Barbul A, Nanney LB, Abumrad NN. African Americans show increased risk for pressure ulcers: A retrospective analysis of acute care hospitals in America. Wound Repair Regen 2009; 17:678-84. [DOI: 10.1111/j.1524-475x.2009.00522.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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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Callier P, Faivre L, Marle N, Thauvin-Robinet C, Guy J, Mosca AL, D'Athis P, Masurel-Paulet A, Assous D, Teyssier JR, Huet F, Mugneret F. Detection of an interstitial 3q21.1-q21.3 deletion in a child with multiple congenital abnormalities, mental retardation, pancytopenia, and myelodysplasia. Am J Med Genet A 2009; 149A:1323-6. [PMID: 19449416 DOI: 10.1002/ajmg.a.32857] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P Callier
- Département de Génétique, Hôpital Le Bocage, Dijon, France.
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Callier P, Faivre L, Thauvin-Robinet C, Marle N, Mosca AL, D'Athis P, Guy J, Masurel-Paulet A, Joly L, Guiraud S, Teyssier JR, Huet F, Mugneret F. Array-CGH in a series of 30 patients with mental retardation, dysmorphic features, and congenital malformations detected an interstitial 1p22.2-p31.1 deletion in a patient with features overlapping the Goldenhar syndrome. Am J Med Genet A 2008; 146A:2109-15. [PMID: 18629884 DOI: 10.1002/ajmg.a.32447] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Genosensor Array 300 (Abbott) is a multiplex platform for array-based comparative genomic hybridization that detects unbalanced genomic aberrations including whole chromosome gains/losses, microdeletions, duplications and unbalanced subtelomeric rearrangements. A series of 30 patients with unexplained mental retardation, dysmorphic features, congenital abnormalities and normal high resolution karyotype and FISH subtelomeric studies were analyzed using Genosensor Array 300 array-CGH. We identified a chromosomal aberration in one patient with an interstitial 1p31.1 deletion. FISH analysis with BACs specific probes of the 1p region confirmed the interstitial 1p22.2-p31.1 deletion. The patient was a 20-year-old man with short stature, facial dysmorphism including asymmetry, scoliosis, severe psychomotor delay and an epibulbar dermoid cyst. The phenotype was compatible with Goldenhar syndrome despite the absence of asymmetric ears. This observation is of interest since it could be a clue in the search for the genes responsible for Goldenhar syndrome. This study demonstrates the utility of the array-CGH technology in detecting interstitial deletions.
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Affiliation(s)
- P Callier
- Département de Génétique, Hôpital Le Bocage, Dijon, France.
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Park DSW, Hupert ML, Witek MA, You BH, Datta P, Guy J, Lee JB, Soper SA, Nikitopoulos DE, Murphy MC. A titer plate-based polymer microfluidic platform for high throughput nucleic acid purification. Biomed Microdevices 2008; 10:21-33. [PMID: 17659445 DOI: 10.1007/s10544-007-9106-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 96-well solid-phase reversible immobilization (SPRI) reactor plate was designed to demonstrate functional titer plate-based microfluidic platforms. Nickel, large area mold inserts were fabricated using an SU-8 based, UV-LIGA technique on 150 mm diameter silicon substrates. Prior to UV exposure, the prebaked SU-8 resist was flycut to reduce the total thickness variation to less than 5 mum. Excellent UV lithography results, with highly vertical sidewalls, were obtained in the SU-8 by using an UV filter to remove high absorbance wavelengths below 350 nm. Overplating of nickel in the SU-8 patterns produced high quality, high precision, metal mold inserts, which were used to replicate titer plate-based SPRI reactors using hot embossing of polycarbonate (PC). Optimized molding conditions yielded good feature replication fidelity and feature location integrity over the entire surface area. Thermal fusion bonding of the molded PC chips at 150 degrees C resulted in leak-free sealing, which was verified in leakage tests using a fluorescent dye. The assembled SPRI reactor was used for simple, fast purification of genomic DNA from whole cell lysates of several bacterial species, which was verified by PCR amplification of the purified genomic DNA.
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Affiliation(s)
- D S-W Park
- Center for Bio-Modular Multi-Scale Systems, Louisiana State University, Baton Rouge, LA 70803, USA
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Diaz JJ, Guy J, Berkes MB, Guillamondegui O, Miller RS. Acellular dermal allograft for ventral hernia repair in the compromised surgical field. Am Surg 2006; 72:1181-7; discussion 1187-8. [PMID: 17216816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A ventral hernia and a contaminated surgical field are a difficult surgical combination. We hypothesize that acellular human dermis (AHD) can be a suitable biological tissue alternative in the repair of a ventral hernia. The study involved a retrospective review of the use of AHD in the repair of ventral hernia from 2001-2004. Inclusion criteria included a ventral hernia repair in a clean-contaminated (CC) or contaminated-dirty (CD) surgical field. The primary outcome of the study was wound infection and mesh removal. Patients were stratified into CC and CD, and management of a wound infection [medically managed (MM) or surgically managed (SM)]. Seventy-five patients met the study criteria. The most common comorbidity was hypertension (45.3%). There was one death in the study (from multiple organ dysfunction syndrome). The overall wound infection rate was 33.3 per cent: 11 MM (14.7%) and 14 SM (18.7%). The average length of stay was 16.7 days (+/-20.8) with a mean follow-up of 275 (+/-209) days. Subgroup analysis: CC (n = 64) had 9 wound infections that were MM (14.1%) and 12 wound infections that were SM (18.8%); CD (n = 11) had 2 wound infections that were MM (18.2%) and 2 wound infections that were SM (18.2%). Five of 14 SM (35.7%) wound infections required removal of the mesh. Wound infection in the contaminated surgical field occurred 33.3 per cent of the time. Some (18.7%) of the cases required SM management, and 35.7 per cent of these required removal of the AHD.
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Affiliation(s)
- Jose J Diaz
- Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA
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Abstract
A ventral hernia and a contaminated surgical field are a difficult surgical combination. We hypothesize that acellular human dermis (AHD) can be a suitable biological tissue alternative in the repair of a ventral hernia. The study involved a retrospective review of the use of AHD in the repair of ventral hernia from 2001–2004. Inclusion criteria included a ventral hernia repair in a clean-contaminated (CC) or contaminated-dirty (CD) surgical field. The primary outcome of the study was wound infection and mesh removal. Patients were stratified into CC and CD, and management of a wound infection [medically managed (MM) or surgically managed (SM)]. Seventy-five patients met the study criteria. The most common comorbidity was hypertension (45.3%). There was one death in the study (from multiple organ dysfunction syndrome). The overall wound infection rate was 33.3 per cent: 11 MM (14.7%) and 14 SM (18.7%). The average length of stay was 16.7 days (±20.8) with a mean follow-up of 275 (±209) days. Subgroup analysis: CC (n = 64) had 9 wound infections that were MM (14.1%) and 12 wound infections that were SM (18.8%); CD (n = 11) had 2 wound infections that were MM (18.2%) and 2 wound infections that were SM (18.2%). Five of 14 SM (35.7%) wound infections required removal of the mesh. Wound infection in the contaminated surgical field occurred 33.3 per cent of the time. Some (18.7%) of the cases required SM management, and 35.7 per cent of these required removal of the AHD.
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Affiliation(s)
- Jose J. Diaz
- From the Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey Guy
- From the Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marshall B. Berkes
- From the Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Oscar Guillamondegui
- From the Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard S. Miller
- From the Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Aharonian FA, Akhperjanian AG, Aye KM, Bazer-Bachi AR, Beilicke M, Benbow W, Berge D, Berghaus P, Bernlöhr K, Bolz O, Boisson C, Borgmeier C, Breitling F, Brown AM, Gordo JB, Chadwick PM, Chitnis VR, Chounet LM, Cornils R, Costamante L, Degrange B, Djannati-Ataï A, Drury LO, Ergin T, Espigat P, Feinstein F, Fleury P, Fontaine G, Funk S, Gallant YA, Giebels B, Gillessen S, Goret P, Guy J, Hadjichristidis C, Hauser M, Heinzelmann G, Henri G, Hermann G, Hinton JA, Hofmann W, Holleran M, Horns D, De Jager OC, Jung I, Khélifi B, Komin N, Konopelko A, Latham IJ, Le Gallou R, Lemoine M, Lemière A, Leroy N, Lohse T, Marcowith A, Masterson C, McComb TJL, De Naurois M, Nolan SJ, Noutsos A, Orford KJ, Osborne JL, Ouchrif M, Panter M, Pelletier G, Pita S, Pohl M, Pühlhofer G, Punch M, Raubenheimer BC, Raue M, Raux J, Rayner SM, Redondo I, Reimer A, Reimer O, Ripken J, Rivoal M, Rob L, Rolland L, Rowell G, Sahakian V, Saugé L, Schlenker S, Schlickeiser R, Schuster C, Schwanke U, Siewert M, Sol H, Steenkamp R, Stegmann C, Tavernet JP, Théoret CG, Tluczykont M, Van Der Walt DJ, Vasileiadis G, Vincent P, Visser B, Völk HJ, Wagner SJ. High-energy particle acceleration in the shell of a supernova remnant. Nature 2004; 432:75-7. [PMID: 15525982 DOI: 10.1038/nature02960] [Citation(s) in RCA: 408] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Accepted: 08/17/2004] [Indexed: 11/09/2022]
Abstract
A significant fraction of the energy density of the interstellar medium is in the form of high-energy charged particles (cosmic rays). The origin of these particles remains uncertain. Although it is generally accepted that the only sources capable of supplying the energy required to accelerate the bulk of Galactic cosmic rays are supernova explosions, and even though the mechanism of particle acceleration in expanding supernova remnant (SNR) shocks is thought to be well understood theoretically, unequivocal evidence for the production of high-energy particles in supernova shells has proven remarkably hard to find. Here we report on observations of the SNR RX J1713.7 - 3946 (G347.3 - 0.5), which was discovered by ROSAT in the X-ray spectrum and later claimed as a source of high-energy gamma-rays of TeV energies (1 TeV = 10(12) eV). We present a TeV gamma-ray image of the SNR: the spatially resolved remnant has a shell morphology similar to that seen in X-rays, which demonstrates that very-high-energy particles are accelerated there. The energy spectrum indicates efficient acceleration of charged particles to energies beyond 100 TeV, consistent with current ideas of particle acceleration in young SNR shocks.
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Affiliation(s)
- F A Aharonian
- Max-Planck-Institut für Kernphysik, PO Box 103980, D 69029 Heidelberg, Germany
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Humphray SJ, Oliver K, Hunt AR, Plumb RW, Loveland JE, Howe KL, Andrews TD, Searle S, Hunt SE, Scott CE, Jones MC, Ainscough R, Almeida JP, Ambrose KD, Ashwell RIS, Babbage AK, Babbage S, Bagguley CL, Bailey J, Banerjee R, Barker DJ, Barlow KF, Bates K, Beasley H, Beasley O, Bird CP, Bray-Allen S, Brown AJ, Brown JY, Burford D, Burrill W, Burton J, Carder C, Carter NP, Chapman JC, Chen Y, Clarke G, Clark SY, Clee CM, Clegg S, Collier RE, Corby N, Crosier M, Cummings AT, Davies J, Dhami P, Dunn M, Dutta I, Dyer LW, Earthrowl ME, Faulkner L, Fleming CJ, Frankish A, Frankland JA, French L, Fricker DG, Garner P, Garnett J, Ghori J, Gilbert JGR, Glison C, Grafham DV, Gribble S, Griffiths C, Griffiths-Jones S, Grocock R, Guy J, Hall RE, Hammond S, Harley JL, Harrison ESI, Hart EA, Heath PD, Henderson CD, Hopkins BL, Howard PJ, Howden PJ, Huckle E, Johnson C, Johnson D, Joy AA, Kay M, Keenan S, Kershaw JK, Kimberley AM, King A, Knights A, Laird GK, Langford C, Lawlor S, Leongamornlert DA, Leversha M, Lloyd C, Lloyd DM, Lovell J, Martin S, Mashreghi-Mohammadi M, Matthews L, McLaren S, McLay KE, McMurray A, Milne S, Nickerson T, Nisbett J, Nordsiek G, Pearce AV, Peck AI, Porter KM, Pandian R, Pelan S, Phillimore B, Povey S, Ramsey Y, Rand V, Scharfe M, Sehra HK, Shownkeen R, Sims SK, Skuce CD, Smith M, Steward CA, Swarbreck D, Sycamore N, Tester J, Thorpe A, Tracey A, Tromans A, Thomas DW, Wall M, Wallis JM, West AP, Whitehead SL, Willey DL, Williams SA, Wilming L, Wray PW, Young L, Ashurst JL, Coulson A, Blöcker H, Durbin R, Sulston JE, Hubbard T, Jackson MJ, Bentley DR, Beck S, Rogers J, Dunham I. DNA sequence and analysis of human chromosome 9. Nature 2004; 429:369-74. [PMID: 15164053 PMCID: PMC2734081 DOI: 10.1038/nature02465] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Accepted: 03/08/2004] [Indexed: 11/09/2022]
Abstract
Chromosome 9 is highly structurally polymorphic. It contains the largest autosomal block of heterochromatin, which is heteromorphic in 6-8% of humans, whereas pericentric inversions occur in more than 1% of the population. The finished euchromatic sequence of chromosome 9 comprises 109,044,351 base pairs and represents >99.6% of the region. Analysis of the sequence reveals many intra- and interchromosomal duplications, including segmental duplications adjacent to both the centromere and the large heterochromatic block. We have annotated 1,149 genes, including genes implicated in male-to-female sex reversal, cancer and neurodegenerative disease, and 426 pseudogenes. The chromosome contains the largest interferon gene cluster in the human genome. There is also a region of exceptionally high gene and G + C content including genes paralogous to those in the major histocompatibility complex. We have also detected recently duplicated genes that exhibit different rates of sequence divergence, presumably reflecting natural selection.
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Affiliation(s)
- S J Humphray
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
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Diaz JJ, Gray BW, Dobson JM, Grogan EL, May AK, Miller R, Guy J, O'Neill P, Morris JA. Repair of giant abdominal hernias: does the type of prosthesis matter? Am Surg 2004; 70:396-401; discussion 401-2. [PMID: 15156946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (> or = 20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non-Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized chi2 test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (+/- 16.3), males out-numbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study (n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non-Gore-Tex subgroup comparison results were as follows: GT (n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG (n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance.
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Affiliation(s)
- Jose J Diaz
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA
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37
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Abstract
A multi-professional project was carried out in order to identify the interventions that nurses and pharmacists make in relation to drug administration (an intervention refers to 'the process of querying a prescription with a prescriber'). The project highlights the importance of both these occupational groups in identifying prescribing errors and preventing them from being translated into actual medication errors. It also identifies the need for adequate training for nursing and medical staff, along with system changes, in order to minimize the risk of medication errors.
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Diaz JJ, Gillman C, Morris JA, May AK, Carrillo YM, Guy J. Are Five-View Plain Films of the Cervical Spine Unreliable? A Prospective Evaluation in Blunt Trauma Patients with Altered Mental Status. ACTA ACUST UNITED AC 2003; 55:658-63; discussion 663-4. [PMID: 14566119 DOI: 10.1097/01.ta.0000088120.99247.4a] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Clearing the cervical spine in a time-sensitive fashion is difficult. We hypothesized that admission computed tomographic scan of the occiput to T1 (CTS) with multiplanar reformatted images will replace five-view (odontoid, anteroposterior, lateral, and oblique) plain films of the cervical spine (CSX) in the initial evaluation of blunt trauma patients with altered mental status. METHODS Between January and July 2001, all patients aged 16 years or older with altered mental status undergoing both CTS and CSX were prospectively entered into the study group. Attending physician interpretation defined the presence of cervical spine injury. Unstable fractures were defined as requiring surgical or halo stabilization. RESULTS One thousand six patients met study criteria. One hundred sixteen patients had 172 cervical spine injuries (CSIs) (fracture and subluxation). CSX missed 90 of 172 (52.3%) CSIs in 65 of 172 (56.0%) patients. Anatomically, CSX failed to identify 14 of 15 occipital fractures (93.3%), 17 of 36 (47.2%) C1-3 fractures, and 59 of 121 (48.8%) C4-T1 CSIs. CSX failed to identify 5 of 29 (17.2%) patients with unstable CSIs. CTS failed to diagnose 3 of 172 (1.7%) CSIs that were stable (spinous process fractures at C6-7). Two patients exhibited spinal cord injury without radiologic abnormality missed by both modalities. CTS had a sensitivity of 97.4%, a specificity of 100%, a prevalence of 11.5%, a positive predictive value of 100%, and a negative predictive value of 99.7%. CSX had a sensitivity of 44.0%, a specificity of 100%, a prevalence of 11.5%, a positive predictive value of 100%, and a negative predictive value of 93.2%. CONCLUSION CTS outperformed five-view CSX in a group of patients with altered mental status or distracting injuries. Five-view CSX failed to diagnose 52.3% of cervical spine fractures identified by CTS. Five-view CSX failed to diagnose five patients with unstable cervical fractures and failed to identify 93.3% of patients with occipital condyle fractures.
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Affiliation(s)
- Jose J Diaz
- Department of Surgery, Trauma Paatient Care Center, Banderbilt University Medical Center, Nashville, Tennessee 37212, USA.
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39
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Affiliation(s)
- Jason Shipman
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA
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40
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Riordan CL, McDonough M, Davidson JM, Corley R, Perlov C, Barton R, Guy J, Nanney LB. Noncontact Laser Doppler Imaging in Burn Depth Analysis of the Extremities. ACTA ACUST UNITED AC 2003; 24:177-86. [PMID: 14501410 DOI: 10.1097/01.bcr.0000075966.50533.b0] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [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] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine the accuracy and practical utility of a noncontact laser Doppler imager (PIM-II, Lisca Development AB, Linköping, Sweden) in the estimation of burn depth in the upper and lower extremities. At 48 hours after burn injury, we performed scans of 35 burns in 22 patients and obtained histological samples for burn determination with hematoxylin and eosin and vimentin immunohistochemical staining. Additionally, sequential scans and tissue specimens were obtained on 10 burns at 24, 48, and 72 hours. A statistically significant inverse relationship was noted between burn depth and the laser Doppler perfusion index. Laser Doppler perfusion index values greater than 1.3 predicted a superficial dermal burn with 95% sensitivity and 94% specificity. Superficial dermal burns exhibited increased perfusion in the early burn period. Wounds showed a progressive decline in perfusion and a progressive increase in the depth of injury during a 72-hour period. This study demonstrates the advantage and accuracy of using a noncontact laser Doppler to differentiate deep dermal from superficial partial thickness burns in the extremities.
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Affiliation(s)
- Colin L Riordan
- Department of Plastic Surgery, Vanderbilt School of Medicine, Nashville, Tennessee 37232, USA
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Guy J. Rontgen's rays and his Scottish disciples. Rep Proc Scott Soc Hist Med 2001:14-22. [PMID: 11623956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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42
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Guy J. A revealing examination paper: Ralph Bathurst and the Oxford Circle in the mid-seventeenth century. Hist Sci Med 2001; 17:130-3. [PMID: 11612275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Gallagher M, Pearson P, Drinkwater C, Guy J. Managing patient demand: a qualitative study of appointment making in general practice. Br J Gen Pract 2001; 51:280-5. [PMID: 11458480 PMCID: PMC1313977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY A qualitative study using participant observation. SETTING Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. METHOD Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. RESULTS Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. CONCLUSION Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.
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Affiliation(s)
- M Gallagher
- Department of Primary Care, University of Newcastle upon Tyne.
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44
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Abstract
MBD2 and MBD3 are closely related proteins with consensus methyl-CpG binding domains. MBD2 is a transcriptional repressor that specifically binds to methylated DNA and is a component of the MeCP1 protein complex. In contrast, MBD3 fails to bind methylated DNA in murine cells, and is a component of the Mi-2/NuRD corepressor complex. We show by gene targeting that the two proteins are not functionally redundant in mice, as Mbd3-/- mice die during early embryogenesis, whereas Mbd2-/- mice are viable and fertile. Maternal behavior of Mbd2-/- mice is however defective and, at the molecular level, Mbd2-/- mice lack a component of MeCP1. Mbd2-mutant cells fail to fully silence transcription from exogenous methylated templates, but inappropriate activation of endogenous imprinted genes or retroviral sequences was not detected. Despite their differences, Mbd3 and Mbd2 interact genetically suggesting a functional relationship. Genetic and biochemical data together favor the view that MBD3 is a key component of the Mi-2/NuRD corepressor complex, whereas MBD2 may be one of several factors that can recruit this complex to DNA.
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MESH Headings
- Age Factors
- Animals
- Blotting, Northern
- Blotting, Southern
- Blotting, Western
- Brain/metabolism
- Cell Line
- Cell Nucleus/metabolism
- CpG Islands
- DNA Methylation
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- DNA-Binding Proteins/physiology
- Embryo, Mammalian/metabolism
- Expressed Sequence Tags
- Gene Deletion
- Gene Expression Regulation, Developmental
- Genomic Imprinting
- Genotype
- Liver/metabolism
- Mice
- Mice, Inbred C57BL
- Mice, Mutant Strains
- Models, Biological
- Models, Genetic
- Plasmids/metabolism
- Promoter Regions, Genetic
- Protein Binding
- Protein Structure, Tertiary
- Spleen/metabolism
- Stem Cells/cytology
- Transcription Factors
- Transcription, Genetic
- Transfection
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Affiliation(s)
- B Hendrich
- Wellcome Trust Centre for Cell Biology, Institute of Cell and Molecular Biology, The University of Edinburgh, Michael Swann Building, The King's Buildings, Edinburgh EH9 3JR, Scotland.
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45
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Abstract
Rett syndrome (RTT) is an inherited neurodevelopmental disorder of females that occurs once in 10,000-15,000 births. Affected females develop normally for 6-18 months, but then lose voluntary movements, including speech and hand skills. Most RTT patients are heterozygous for mutations in the X-linked gene MECP2 (refs. 3-12), encoding a protein that binds to methylated sites in genomic DNA and facilitates gene silencing. Previous work with Mecp2-null embryonic stem cells indicated that MeCP2 is essential for mouse embryogenesis. Here we generate mice lacking Mecp2 using Cre-loxP technology. Both Mecp2-null mice and mice in which Mecp2 was deleted in brain showed severe neurological symptoms at approximately six weeks of age. Compensation for absence of MeCP2 in other tissues by MeCP1 (refs. 19,20) was not apparent in genetic or biochemical tests. After several months, heterozygous female mice also showed behavioral symptoms. The overlapping delay before symptom onset in humans and mice, despite their profoundly different rates of development, raises the possibility that stability of brain function, not brain development per se, is compromised by the absence of MeCP2.
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Affiliation(s)
- J Guy
- Wellcome Centre for Cell Biology, Institute of Cell and Molecular Biology, University of Edinburgh, The King's Buildings, Edinburgh, UK
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46
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Abstract
Experimental models of human diseases have affected the design and direction of both basic and clinical research into understanding the pathogenesis and treatments of demyelinating disease, stroke, and hereditary disorders of the central nervous system. However, in spite of major advances in molecular research that have linked Leber Hereditary Optic Neuropathy to mutations in mitochondrial DNA, there has been relatively little focus in applying basic scientific methodologies to optic neuropathies other than glaucoma. The relative absence of detailed scientific knowledge about the basic mechanisms involved in the pathogenesis of optic nerve injury has contributed to the use of empiric therapies for neuro-ophthalmic optic neuropathies. Over the past decade major clinical trials, such as the Optic Neuritis Treatment Trial and Ischemic Optic Neuropathy Decompression Trial, have proven that currently available treatment options for demyelinating and ischemic optic neuropathies are ineffective and can even be harmful. Although the pathogenesis of visual failure in demyelinating, ischemic, and hereditary optic neuropathies appears diverse, a final common pathway for irreparable optic nerve injury may exist. This article reviews several models of experimental optic neuropathies that may aid in the development of novel treatments for neuro-ophthalmic disorders of the optic nerve during the 21st century.
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Affiliation(s)
- J Guy
- University of Florida College of Medicine, Box 100284 Gainesville 32610-0284, Florida, USA.
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Owen R IV, Lewin AP, Peel A, Wang J, Guy J, Hauswirth WW, Stacpoole PW, Flotte TR. Recombinant adeno-associated virus vector-based gene transfer for defects in oxidative metabolism. Hum Gene Ther 2000; 11:2067-78. [PMID: 11044909 DOI: 10.1089/104303400750001381] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Defects in oxidative metabolism may be caused by mutations either in nuclear genes or in mitochondrial DNA (mtDNA). We tested the hypothesis that recombinant adeno-associated virus (rAAV) could be used to complement mtDNA mutations. AAV vector constructs were designed to express the reporter gene encoding green fluorescent protein (GFP), fused to a targeting presequence that directed GFP to be translocated into mitochondria. These vectors mediated expression of mitochondrial-localized GFP, as indicated by fluorescence microscopy and electron microscopy, in respiring human embryonic kidney 293 cells and nonrespiring mtDNA-deficient (rho 0) cells. However, when sequences encoding hydrophobic segments of proteins normally encoded by mtDNA were inserted between the presequence and GFP, mitochondrial import failed to occur. In similar experiments, a fusion was created between pyruvate dehydrogenase (PDH) E1 alpha subunit, a nuclear-encoded mitochondrial gene with its own targeting presequence, and GFP. With this construct, expression of GFP was observed in mitochondria in vitro and in vivo. We conclude that the hydrophobicity of mtDNA-encoded proteins limits their ability to be transported from the cytoplasm. However, rAAV-based gene therapy may hold promise for gene therapy of PDH deficiency, the most common biochemically proven cause of congenital lactic acidosis.
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Affiliation(s)
- I V Owen R
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
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48
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Guy J, Spalluto C, McMurray A, Hearn T, Crosier M, Viggiano L, Miolla V, Archidiacono N, Rocchi M, Scott C, Lee PA, Sulston J, Rogers J, Bentley D, Jackson MS. Genomic sequence and transcriptional profile of the boundary between pericentromeric satellites and genes on human chromosome arm 10q. Hum Mol Genet 2000; 9:2029-42. [PMID: 10942432 DOI: 10.1093/hmg/9.13.2029] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The organization of centromeric heterochromatin has been established in a number of eucaryotes but remains poorly defined in human. Here we present 1025 kb of contiguous human genomic sequence which links pericentromeric satellites to the RET proto-oncogene in 10q11.2 and is presumed to span the transition from centric heterochromatin to euchromatin on this chromosome arm. Two distinct domains can be defined within the sequence. The proximal approximately 240 kb consists of arrays of satellites and other tandem repeats separated by tracts of complex sequence which have evolved by pericentromeric-directed duplication. Analysis of 32 human paralogues of these sequences indicates that most terminate at or within repeat arrays, implicating these repeats in the interchromosomal duplication process. Corroborative PCR-based analyses establish a genome-wide correlation between the distribution of these paralogues and the distribution of satellite families present in 10q11. In contrast, the distal approximately 780 kb contains few tandem repeats and is largely chromosome specific. However, a minimum of three independent intrachromosomal duplication events have resulted in >370 kb of this sequence sharing >90% identity with sequences on 10p. Using computer-based analyses and RT-PCR we confirm the presence of three genes within the sequence, ZNF11/33B, KIAA0187 and RET, in addition to five transcripts of unknown structure. All of these transcribed sequences map distal to the satellite arrays. The boundary between satellite-rich interchromosomally duplicated DNA and chromosome-specific DNA therefore appears to define a transition from pericentromeric heterochromatin to euchromatin on the long arm of this chromosome.
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MESH Headings
- Centromere/genetics
- Centromere/metabolism
- Chromosomes, Artificial, Yeast
- Chromosomes, Human, Pair 10/genetics
- DNA, Satellite/genetics
- DNA, Satellite/metabolism
- Drosophila Proteins
- Electrophoresis, Gel, Pulsed-Field
- Heterochromatin/genetics
- Heterochromatin/metabolism
- Humans
- Hybrid Cells
- Molecular Sequence Data
- Proto-Oncogene Mas
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins c-ret
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor Protein-Tyrosine Kinases/metabolism
- Restriction Mapping
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Analysis, DNA
- Transcription, Genetic
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Affiliation(s)
- J Guy
- Human Genetics Unit, School of Biochemistry and Genetics, University of Newcastle upon Tyne, UK
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Abstract
OBJECTIVE To determine if adenoviral-mediated transfer of the gene for catalase (CAT), the reactive oxygen species scavenger, suppresses experimental optic neuritis. CLINICAL RELEVANCE Gene therapy with CAT delivered by an adeno-associated viral vector was previously shown to suppress experimental optic neuritis. Because the transduction of protein expression with recombinant adeno-associated viral vector is relatively slow, taking weeks to reach full levels, we studied the effects of replication-deficient adenovirus containing CAT in suppressing experimental optic neuritis. Transduction with adenovirus occurs within days of inoculation, thus, it may be more applicable for the treatment of patients with acute optic neuritis. MATERIALS AND METHODS Replication-deficient adenovirus containing CAT was injected above the right optic nerve heads of SJL/J mice that were simultaneously sensitized for experimental allergic encephalomyelitis. For controls, the left eyes were injected with the replication-deficient adenovirus without CAT or no virus. The histological effects of CAT on the lesions of experimental allergic encephalomyelitis were measured by computerized analysis of the myelin sheath area (for demyelination), optic disc area (for optic nerve head swelling), the extent of the cellular infiltrate, extravasated serum albumin labeled with immunogold (for disruption of the blood-brain barrier), and the in vivo hydrogen peroxide reaction product. RESULTS After 1 month, cell-specific catalase activity, evaluated by the quantitation of catalase immunogold, was increased about 2-fold each in endothelia, oligodendroglia, astrocytes, and axons of the CAT-inoculated right optic nerves compared with the control left optic nerves. The increased cellular levels of catalase reduced demyelination by 30%, optic nerve head swelling by 25%, cellular infiltration by 26%, disruption of the blood-brain barrier by 61%, and in vivo levels of hydrogen peroxide by 81%. CONCLUSIONS Adenoviral-mediated gene transfer increased catalase levels in all optic nerve cell types, and it persisted for 1 month after inoculation. The increased cellular levels of catalase suppressed demyelination and blood-brain barrier disruption at the foci in the optic nerve where prior magnetic resonance imaging and histopathologic studies have demonstrated the demyelinating inflammation of experimental and human optic neuritis. Together, they suggest that gene therapy with CAT may be helpful in the treatment of patients with optic neuritis.
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Affiliation(s)
- J Guy
- Department of Ophthalmology, University of Florida, College of Medicine, Gainesville, USA
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Cronk M, Reed B, Hone C, Hobbs L, Warren C, Guy J, Lord C, Sims C, Weston R. Helping women through crises in their labour. Interview by Jo Hartley. Pract Midwife 1999; 2:12-3. [PMID: 10481685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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