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McLean CP, Cook J, Riggs DS, Peterson AL, Young-McCaughan S, Borah EV, Comtois KA, Dondanville KA, Frick E, Haddock CK, Mann J, Reynolds D, Mistretta M, Neitzer A, Brzuchalski A, Clayton SP, Conforte AM, DuMars TD, Ekundayo K, Flores A, Hein J, Jinkerson J, Keith F, Kim HJ, Link JS, Nofziger D, Pollick K, Ringdahl EN, Waggoner J, Woodworth C, Rosen CS. Barriers and Potential Solutions to Implementing Evidence-Based PTSD Treatment in Military Treatment Facilities. Mil Med 2024; 189:721-731. [PMID: 35943175 DOI: 10.1093/milmed/usac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/15/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers. MATERIALS AND METHODS As part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators, barriers, and potential solutions were summarized in a collaboratively developed implementation plan for increasing prolonged exposure therapy tailored to each site. RESULTS There was a greater than anticipated consistency in the barriers reported by the sites, despite variation in the size and type of facility. The identified barriers were grouped into four categories: time-related barriers, provider-related barriers, barriers related to patient education and matching patients to providers, and scheduling-related barriers. Potential solutions to each barrier are described. CONCLUSIONS The findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers.
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Affiliation(s)
- Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Jeffrey Cook
- Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - David S Riggs
- Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
| | - Elisa V Borah
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78712, USA
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Erin Frick
- Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | | | - Jeffrey Mann
- Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - David Reynolds
- Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Melissa Mistretta
- Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Andrea Neitzer
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
| | - Amy Brzuchalski
- William Beaumont Army Medical Center, El Paso, TX 79920, USA
- Kimbrough Ambulatory Care Center, Fort Meade, MD 20755, USA
| | - Spencer P Clayton
- 49th Medical Group, Holloman Air Force Base, Alamogordo, NM 88330, USA
- Nellis Air Force Base, NV 89191, USA
| | - Allison M Conforte
- Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA
- 3d Marine Division, UNIT 35840, Okinawa FPO AP 96602-5840, Japan
| | - Tyler D DuMars
- William Beaumont Army Medical Center, El Paso, TX 79920, USA
| | - Kendra Ekundayo
- 49th Medical Group, Holloman Air Force Base, Alamogordo, NM 88330, USA
| | - Araceli Flores
- William Beaumont Army Medical Center, El Paso, TX 79920, USA
| | - Jessica Hein
- Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA
| | - Jeremy Jinkerson
- 81st Medical Group, Keesler Air Force Base, Biloxi, MS 39534, USA
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Felicia Keith
- David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA 94533, USA
- Spangdahlem Air Base, Spangdahlem 09123, Germany
| | - Hana J Kim
- Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, FL 32214, USA
| | - Jared S Link
- 81st Medical Group, Keesler Air Force Base, Biloxi, MS 39534, USA
| | - Debra Nofziger
- Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Kirsten Pollick
- Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, FL 32214, USA
| | - Erik N Ringdahl
- David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA 94533, USA
| | - John Waggoner
- 81st Medical Group, Keesler Air Force Base, Biloxi, MS 39534, USA
| | - Craig Woodworth
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Craig S Rosen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA
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Mann J. Dietary fibre and diabetes revisited. Eur J Clin Nutr 2024. [DOI: 10.1038/sj/ejcn/1601258] [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: 11/09/2022]
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Saroya G, Hu J, Hu M, Panaretos C, Mann J, Kim S, Bush J, Kaartinen V. Periderm Fate during Palatogenesis: TGF-β and Periderm Dedifferentiation. J Dent Res 2023; 102:459-466. [PMID: 36751050 PMCID: PMC10041600 DOI: 10.1177/00220345221146454] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Failure of palatogenesis results in cleft palate, one of the most common congenital disabilities in humans. During the final phases of palatogenesis, the protective function of the peridermal cell layer must be eliminated for the medial edge epithelia to adhere properly, which is a prerequisite for the successful fusion of the secondary palate. However, a deeper understanding of the role and fate of the periderm in palatal adherence and fusion has been hampered due to a lack of appropriate periderm-specific genetic tools to examine this cell type in vivo. Here we used the cytokeratin-6A (Krt-6a) locus to develop both constitutive (Krt6ai-Cre) and inducible (Krt6ai-CreERT2) periderm-specific Cre driver mouse lines. These novel lines allowed us to achieve both the spatial and temporal control needed to dissect the periderm fate on a cellular resolution during palatogenesis. Our studies suggest that, already before the opposing palatal shelves contact each other, at least some palatal periderm cells start to gradually lose their squamous periderm-like phenotype and dedifferentiate into cuboidal cells, reminiscent of the basal epithelial cells seen in the palatal midline seam. Moreover, we show that transforming growth factor-β (TGF-β) signaling plays a critical periderm-specific role in palatogenesis. Thirty-three percent of embryos lacking a gene encoding the TGF-β type I receptor (Tgfbr1) in the periderm display a complete cleft of the secondary palate. Our subsequent experiments demonstrated that Tgfbr1-deficient periderm fails to undergo appropriate dedifferentiation. These studies define the periderm cell fate during palatogenesis and reveal a novel, critical role for TGF-β signaling in periderm dedifferentiation, which is a prerequisite for appropriate palatal epithelial adhesion and fusion.
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Affiliation(s)
- G. Saroya
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - J. Hu
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - M. Hu
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- College of Literature, Sciences, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - C. Panaretos
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - J. Mann
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - S. Kim
- Department of Cell and Tissue Biology and Program in Craniofacial Biology, University of California San Francisco, San Francisco, CA, USA
| | - J.O. Bush
- Department of Cell and Tissue Biology and Program in Craniofacial Biology, University of California San Francisco, San Francisco, CA, USA
| | - V. Kaartinen
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Hale L, Higgs C, Gray A, Mann J, Mani R, Sullivan T, Terry J, Keen D, Stokes T. The diabetes community exercise programme plus usual care versus usual care in patients with type 2 diabetes: A randomised, two-arm, parallel, open-label trial. EClinicalMedicine 2022; 46:101361. [PMID: 35360148 PMCID: PMC8961191 DOI: 10.1016/j.eclinm.2022.101361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Exercise is important in type 2 diabetes (T2D) management. Focussing on Māori and Pacific people and those from deprived circumstances, the Diabetes Community Exercise Programme (DCEP) was developed to engage people with T2D in exercise. We report the evaluation of whether being offered DCEP (plus usual care) was more effective than usual care in improving glycaemic control at 1-year. METHODS A randomised, two-arm, parallel, open-label trial with blinding of outcome assessor and data analyst. Adults (age ≥35 years) with T2D recruited from two New Zealand (NZ) communities were randomised, using opaque sealed envelopes and stratified by centre with random block lengths, to DCEP or usual care. DCEP comprises twice-weekly, two-hour sessions of exercise and education over 12-weeks, followed by a twice-weekly maintenance exercise class. The primary outcome was between-group differences in mean changes of glycated haemoglobin (HbA1c) from baseline to 1-year follow-up with intention-to treat analysis. This trial is registered with the Australian NZ Clinical Trials Registry (ANZCTR): ACTRN12617001624370p and is closed to new participants. FINDINGS From 2018 - 2019, of 294 people screened, 165 (mean age 63·8, SD16·2 years, 56% female, 78·5% European, 14% Māori, 6% Pacific, 27% most deprived) were baseline evaluated, randomised, and analysed at study end (DCEP = 83, control = 82). Multimorbidity (≥2) and polypharmacy (>5 medications) were high (82%, 69%). We found no statistically significant between-groups differences in HbA1c (mmol/mol) change at 15 months (mean 3% higher in DCEP, 95% CI 2% lower to 8% higher, p = 0·23). Twelve-week intervention adherence was good (41% attended >80% available sessions). No adverse events were reported. INTERPRETATION DCEP was not effective in improving glycaemic control, possibly due to insufficient exercise intensity. Our attendance demonstrated DCEP's cultural accessibility. DCEP might be good to engage in exercise marginalised people with high Hb1Ac levels, multimorbidity, and high polypharmacy. FUNDING Health Research Council of New Zealand.
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Affiliation(s)
- L. Hale
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
- Corresponding author.
| | - C. Higgs
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - A.R. Gray
- Biostatistics Centre, University of Otago, Dunedin, Otago, New Zealand
| | - J. Mann
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - R. Mani
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - T. Sullivan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - J. Terry
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - D. Keen
- Centre of Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, PO Box 56, Dunedin 9054, New Zealand
| | - T. Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Strickland K, Levengood A, Foroughirad V, Mann J, Krzyszczyk E, Frère CH. Correction to: A framework for the identification of long-term social avoidance in longitudinal datasets. R Soc Open Sci 2022; 9:220017. [PMID: 35116171 PMCID: PMC8767182 DOI: 10.1098/rsos.220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
[This corrects the article DOI: 10.1098/rsos.170641.][This corrects the article DOI: 10.1098/rsos.170641.].
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Buerke M, Galfalvy H, Keilp J, Sheftall A, Burke A, Bridge J, Mann J, Szanto K. Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study. J Affect Disord 2021; 295:123-130. [PMID: 34425314 PMCID: PMC8551053 DOI: 10.1016/j.jad.2021.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies of risk factors for suicidal behavior are typically restricted to narrow age ranges, making it difficult to determine if they have the same relevance or potency across the full adult lifespan. METHODS This study examined selected clinical and neurocognitive risk factors for suicidal behavior - borderline personality traits, aggression, depressive rumination, memory performance, and language fluency- in a multi-site sample (N = 309, ages 16-80) of depressed patients with a recent (last 5 years) suicide attempt or no history of attempt, and demographically similar non-psychiatric controls. We examined cross-sectional age and attempter/non-attempter differences on these risk factors, and whether certain risk factors were more prominent discriminators of past suicide attempt earlier or later in the lifespan. Correlations with age were computed, and logistic regression was used to classify attempter status based on each risk factor and its interaction with age. RESULTS Nearly all risk factors were negatively correlated with age. Borderline traits, aggression, memory, and category fluency each predicted attempter status (p < 0.05), but these effects were not different across ages. In contrast, the association between rumination and suicide attempt status differed across the lifespan, becoming a stronger discriminator of past suicidal behavior at older ages. LIMITATIONS The cross-sectional design limits our developmental findings. CONCLUSIONS Despite age-related changes in symptom severity or neurocognitive performance, key risk factors for suicidal behavior previously identified in studies with more restricted age-ranges are salient throughout the adult lifespan. In contrast, depressive rumination may be particularly salient in later life.
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Affiliation(s)
- M. Buerke
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - H. Galfalvy
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - J. Keilp
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - A. Sheftall
- Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - A. Burke
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - J. Bridge
- Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - J. Mann
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology, New York, NY, USA
| | - K. Szanto
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
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Mann J, Li L, Kulakov E, Bassett P, Birnie A. Home viewing of educational video improves patient understanding of Mohs Surgery. Clin Exp Dermatol 2021; 47:93-97. [PMID: 34260092 DOI: 10.1111/ced.14845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/27/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Educational videos improve patient knowledge of wound care and skin cancer. However, the effect of viewing an educational video at home prior to Mohs surgery has not been demonstrated. OBJECTIVE To evaluate the use of an educational video to improve patient understanding of MMS MATERIALS AND METHODS: Patients scheduled to undergo MMS were randomized to receive standard patient education, or standard patient education with an additional video developed by the authors. The educational material was mailed to patients along with the details of their MMS appointment. Both groups answered questionnaires to assess their knowledge of MMS, as well as their anxiety and satisfaction. RESULTS Patients that watched the educational video scored higher on the knowledge questionnaire than patients in the control group (0.8, 95% CI 0.3 to 1.4, p = 0.003), but were not statistically less anxious (-0.7, 95% CI -2.6 to 1.3, p = 0.50). Overall, patients undergoing MMS were satisfied. CONCLUSION Home viewing of an educational video prior to MMS can improve patient understanding.
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Affiliation(s)
- J Mann
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, United Kingdom
| | - L Li
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - E Kulakov
- Dermatology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Bassett
- Statsconsultancy Ltd, Amersham, United Kingdom
| | - A Birnie
- Department of Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
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Wong LH, Udugama M, Hii L, Garvie A, Garvie M, Vinod B, Chan L, Mann J, Collas P, Voon J. Abstract 2065: Mutations inhibiting KDM4B drive ALT telomere maintenance pathway in ATRX-mutated cancers. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2065] [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
Alternative Lengthening of Telomeres (ALT) is a telomere maintenance pathway utilized in 15% of cancers. ALT cancers are strongly associated with inactivating mutations in ATRX; yet ATRX knockout (KO) alone is insufficient to trigger ALT, suggesting that additional cooperating factors are involved. We identify H3.3G34R and IDH1/2 mutations as two such factors in ATRX-mutated glioblastomas. Both mutations are capable of inactivating histone demethylases, and we identify KDM4B as the key demethylase which is inactivated in ALT. Mouse ES cells inactivated for ATRX, TP53, TERT and KDM4B (KDM4B KO or H3.3G34R) show characteristic features of ALT. Conversely, KDM4B over-expression in ALT cancer cells abrogates ALT-associated features. Our data demonstrate that inactivation of KDM4B, either through H3.3G34R or IDH1/2 mutations, acts in tandem with ATRX mutations to promote ALT in cancers.
Citation Format: Lee H. Wong, Maheshi Udugama, Linda Hii, Andrew Garvie, Matthew Garvie, Benjamin Vinod, Lyn Chan, Jeffrey Mann, Philippe Collas, Joanna Voon. Mutations inhibiting KDM4B drive ALT telomere maintenance pathway in ATRX-mutated cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2065.
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Affiliation(s)
- Lee H. Wong
- 1Monash University, Clayton, Victoria, Australia
| | | | - Linda Hii
- 1Monash University, Clayton, Victoria, Australia
| | | | | | | | - Lyn Chan
- 1Monash University, Clayton, Victoria, Australia
| | - Jeffrey Mann
- 1Monash University, Clayton, Victoria, Australia
| | | | - Joanna Voon
- 1Monash University, Clayton, Victoria, Australia
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Alani A, Wernham AGH, Mann J, Veitch D, Affleck A, Ghura V. UK National Mohs Surgeon Survey 2020. Clin Exp Dermatol 2021; 46:1609-1610. [PMID: 34170560 DOI: 10.1111/ced.14817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Affiliation(s)
- A Alani
- Dermatological Surgery Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - A G H Wernham
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
| | - J Mann
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Veitch
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Affleck
- Department of Dermatology, Leicester Royal Infirmary, Leicester, UK.,Dermatological Surgery Unit, Ninewells Hospital, Tayside, Dundee, UK
| | - V Ghura
- Dermatological Surgery Unit, Salford Royal Foundation Trust, Manchester, UK
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Mann J, Doshi M, Quentin L, Eaton K, Morton-Holtham L. Cost Benefit Analysis of Two Oral health Improvement Programmes. Community Dent Health 2021; 38:26-32. [PMID: 33079498 DOI: 10.1922/cdh_001012020mann07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Oral health is frequently given a low priority when healthcare funds are allocated to new initiatives. One method to highlight the health and social benefits of new oral health initiatives is to use cost benefit analysis to show their value. AIM To demonstrate how Cost Benefit Analysis (CBA) has been applied to two recent oral health initiatives to evaluate their ability to reduce costs and improve the quality of life. METHODS CBA was applied to the Mouth Care Matters project in Kent, Surrey and Sussex, and the Senior Smiles project - improving oral health in residential homes in Australia. RESULTS Over a five-year period, the Mouth Care Matters project would generate £2.66 in cost savings, within the healthcare system, for every £1 spent. Over a three year period the Senior Smiles project would generate a cost saving for the healthcare system of $3.14 for every $1 spent. These evaluations were instrumental to enable a national rollout for Mouth Care Matters and a public endorsement of the programme for Senior Smiles. CONCLUSIONS Health economics can be a useful tool in aiding care organisations to assess the implications of decisions to spend limited resources in particular areas of healthcare over others.
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Affiliation(s)
- J Mann
- Special Care Dentistry, University Hospitals Bristol and West Trust, Bristol Dental Hospital
| | - M Doshi
- Surrey and Sussex Healthcare Trust
| | - L Quentin
- Kent Surrey Sussex Academic Health Science Network
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Roberts EJ, Mann J, Ravenscroft JC. What is the demand for out-of-hours dermatology? A UK-based region-wide survey of dermatology demand and provision during the evenings and at weekends. Clin Exp Dermatol 2021; 46:861-866. [PMID: 33438243 DOI: 10.1111/ced.14555] [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] [Received: 08/31/2020] [Revised: 12/07/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the demand for out-of-hours (OOH) dermatology in the UK, and this can make commissioning of acute services difficult. The East Midlands region has a population of 4.5 million people, with variable access to OOH dermatology services. AIM We sought to investigate the provision of, and demand for, OOH dermatology services across the region with a view to informing commissioning decisions for the future. METHODS We contacted all dermatology departments in the East Midlands region to establish what level of service was commissioned at evenings and weekends. At the sites providing any form of OOH service, we recorded all requests for advice received after 17.00 h on weekdays, or at any time during weekends and bank holidays over a 3-month period from October to December 2019. RESULTS The OOH services provided ranged from 24 h/day cover 7 days/week at one site, to no formal provision across much of the rest of the region. In total, 125 calls were received during the study period, averaging 1 call per day on weekday evenings, and 2 calls per day at weekends and on bank holidays. Of these 125 calls, 11 patients (9%) were prioritized and seen by the on-call dermatologist on the day of referral, and 9 of these had potentially life-threatening skin conditions. A further 39 (31%) were deemed to need review within 24 h and 22 (18%) within 48 h. The remaining 42% were given appointments within 7 days or dealt with by telephone advice. CONCLUSION The demand for OOH dermatology across the East Midlands is low, but access to timely dermatology advice is essential in some situations. Commissioning of a regional dermatology OOH service incorporating digital technology may help to improve the equity of access for all patients across the region.
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Affiliation(s)
- E J Roberts
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Mann
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Dermatology, University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - J C Ravenscroft
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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12
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Martir J, Flanagan T, Mann J, Fotaki N. Impact of Food and Drink Administration Vehicles on Paediatric Formulation Performance Part 2: Dissolution of Montelukast Sodium and Mesalazine Formulations. AAPS PharmSciTech 2020; 21:287. [PMID: 33063245 PMCID: PMC7561592 DOI: 10.1208/s12249-020-01815-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
Paediatric medicines are not always age-appropriate, causing problems with dosing, acceptability and adherence. The use of food and drinks as vehicles for medicine co-administration is common practice, yet the impact on drug bioavailability, safety and efficacy remains unaddressed. The aim of this study was to use in vitro dissolution testing, under infant simulating conditions, to evaluate the effect of co-administration with vehicles on the dissolution performance of two poorly soluble paediatric drugs. Dissolution studies of mesalazine and montelukast formulations were conducted with mini-paddle apparatus on a two-stage approach: simulated gastric fluid followed by addition of simulated intestinal fluid. The testing scenarios were designed to reflect daily administration practices: direct administration of formulation; formulation co-administered with food and drinks, both immediately after mixing and 4 h after mixing. Drug dissolution was significantly affected by medicine co-administration with vehicles, compared to the direct administration of formulation. Furthermore, differences were observed on drug dissolution when the formulations were mixed with different vehicles of the same subtype. The time between preparation and testing of the drug-vehicle mixture also impacted dissolution behaviour. Drug dissolution was shown to be significantly affected by the physicochemical properties and composition of the vehicles, drug solubility in each vehicle and drug/formulation characteristics. Ultimately, in this study, we show the potential of age-appropriate in vitro dissolution testing as a useful biopharmaceutical tool for estimating drug dissolution in conditions relevant to the paediatric population. The setup developed has potential to evaluate the impact of medicine co-administration with vehicles on paediatric formulation performance.
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13
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Martir J, Flanagan T, Mann J, Fotaki N. In Vivo Predictive Dissolution Testing of Montelukast Sodium Formulations Administered with Drinks and Soft Foods to Infants. AAPS PharmSciTech 2020; 21:282. [PMID: 33051713 PMCID: PMC7554011 DOI: 10.1208/s12249-020-01825-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022] Open
Abstract
In vitro dissolution testing conditions that reflect and predict in vivo drug product performance are advantageous, especially for the development of paediatric medicines, as clinical testing in this population is hindered by ethical and technical considerations. The aim of this study was to develop an in vivo predictive dissolution test in order to investigate the impact of medicine co-administration with soft food and drinks on the dissolution performance of a poorly soluble compound. Relevant in vitro dissolution conditions simulating the in vivo gastrointestinal environment of infants were used to establish in vitro-in vivo relationships with corresponding in vivo data. Dissolution studies of montelukast formulations were conducted with mini-paddle apparatus on a two-stage approach: infant fasted-state simulated gastric fluid (Pi-FaSSGF; for 1 h) followed by either infant fasted-state or infant fed-state simulated intestinal fluid (FaSSIF-V2 or Pi-FeSSIF, respectively; for 3 h). The dosing scenarios tested reflected in vivo paediatric administration practices: (i.) direct administration of formulation; (ii.) formulation co-administered with vehicles (formula, milk or applesauce). Drug dissolution was significantly affected by co-administration of the formulation with vehicles compared with after direct administration of the formulation. Montelukast dissolution from the granules was significantly higher under fed-state simulated intestinal conditions in comparison with the fasted state and was predictive of the in vivo performance when the granules are co-administered with milk. This study supports the potential utility of the in vitro biorelevant dissolution approach proposed to predict in vivo formulation performance after co-administration with vehicles, in the paediatric population.
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Mathews K, Perlman S, Conway K, Ciafaloni E, Thomas S, Mann J, Romitti P. DMD & BMD – CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.053] [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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15
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Ciafaloni E, Fapo O, Conway K, Street N, Romitti P, Westfield C, Fox D, Matthews K, Mann J, Thomas S, Soim A, STARnet MD. DMD & BMD – CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Martir J, Flanagan T, Mann J, Fotaki N. BCS-based biowaivers: Extension to paediatrics. Eur J Pharm Sci 2020; 155:105549. [PMID: 32941998 DOI: 10.1016/j.ejps.2020.105549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 12/25/2022]
Abstract
A BCS-based biowaiver allows extrapolation of drug product bioequivalence (when applicable) based on the BCS class of the drug and in vitro dissolution testing. Drug permeability and solubility considerations for adult BCS might not apply directly to paediatric subpopulations and bridging of adult and paediatric formulations should be undertaken with caution. The aims of this study were to: (i.) identify compounds which would change drug solubility classification in the paediatric population, and (ii.) to assess the risk of extending BCS-based biowaiver criteria into paediatric products of these compounds. Amoxicillin, prednisolone, and amlodipine were selected as the model compounds. Dissolution studies of IR formulations of these compounds were conducted with USP II (paddle) and mini-paddle apparatus, in media of three pHs (pH 1.2, 4.5 and 6.8). Three dissolution setups were tested: (1) 'typical' BCS-based biowaiver conditions, (2) "BE" setup derived from BE study protocols (volume: 250 mL), and (3) "paediatric" setup based on representative volume for the paediatric population (50 mL). Results revealed that extension of regulated BCS-based biowaiver criteria for paediatric application is not as simple as scaling down volumes. It was further shown that BCS-based biowaiver criteria should not be applied when there is the risk of change of the drug solubility class, from the adult to paediatric populations. A deeper knowledge of the paediatric gastrointestinal environment is still lacking and would assist in refining the biopharmaceutical tools needed to appropriately evaluate formulation performance across age groups. This would potentially reduce the number of clinical studies required and speed up formulation development.
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Affiliation(s)
- J Martir
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Oral Product Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, UK; Currently at UCB Pharma, Chemin du Foriest, B - 1420 Braine-l'Alleud, Belgium
| | - J Mann
- Oral Product Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Macclesfield, UK
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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17
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Haag G, Stocker G, Lorenzen S, Ettrich T, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Mann J, Lordick F. 1447P S-1 maintenance therapy in non-Asian patients with advanced, Her-2 negative esophagogastric adenocarcinoma – First results of the international MATEO trial initiated by the AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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18
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Zarmpi P, Flanagan T, Meehan E, Mann J, Østergaard J, Fotaki N. Biopharmaceutical implications of excipient variability on drug dissolution from immediate release products. Eur J Pharm Biopharm 2020; 154:195-209. [PMID: 32681966 DOI: 10.1016/j.ejpb.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Elucidating the impact of excipient variability on oral product performance in a biopharmaceutical perspective would be beneficial and allow excipient implementation on Quality by Design (QbD) approaches. The current study investigated the impact of varying viscosity of binders (hypromellose (HPMC)) and superdisintegrants (sodium starch glycolate (SSG)) and particle size distribution of lubricants (magnesium stearate (MgSt)) on the in vitro dissolution of a highly and a poorly soluble drug from immediate release formulations. Compendial (pharmacopoeia buffers) and biorelevant (media simulating the gastrointestinal fluids) media and the USP 2 and USP 4 apparatuses were used to assess the exerted excipient effects on drug dissolution. Real-time dissolution UV imaging provided mechanistic insights into disintegration and dissolution of the immediate release formulations. Varying the viscosity type of HPMC or SSG did not significantly affect drug dissolution irrespective of the compound used. Faster drug dissolution was observed when decreasing the particle size of MgSt for the highly soluble drug. The use of real-time dissolution UV Imaging revealed the influential role of excipient variability on tablet disintegration, as for the highly soluble drug, tablets containing high viscosity HPMC or low particle size MgSt disintegrated faster as compared to the control tablets while for the poorly soluble drug, slower tablet disintegration was observed when increasing the viscosity of the HPMC as compared to the control tablets. Changes in drug dissolution when varying excipients may be anticipated if the excipient change has previously affected drug solubility. The use of multivariate data analysis revealed the influential biopharmaceutical factors such as critical excipient types/properties, drug aqueous solubility, medium/hydrodynamic characteristics affecting the impact of excipient variability on in vitro drug dissolution.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom; Currently at UCB Pharma, Chemin du Foriest, B - 1420 Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Østergaard
- Department of Pharmacy, Faculty of Health and Medicinal Sciences, University of Copenhagen, Denmark
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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19
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Martir J, Flanagan T, Mann J, Fotaki N. Impact of Food and Drink Administration Vehicles on Paediatric Formulation Performance: Part 1-Effects on Solubility of Poorly Soluble Drugs. AAPS PharmSciTech 2020; 21:177. [PMID: 32592045 PMCID: PMC7373161 DOI: 10.1208/s12249-020-01722-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
Food and drinks are commonly used to facilitate administration of
paediatric medicines to improve palatability and enhance patient compliance.
However, the impact of this practice on drug solubility and on oral drug
bioavailability is not usually studied. Based on recommended strategies for oral
administration of paediatric medicines with food and drink vehicles, the aims of
this study were (i) to measure the physicochemical properties of (soft) food and
drink vehicles, commonly mixed with paediatric medicines prior to administration,
and (ii) to assess the impact of the co-administered vehicles on the solubility of
two poorly soluble paediatric drugs. Montelukast (sodium) and mesalazine were
selected as the model compounds. Distinct differences were observed between the
physicochemical properties (i.e. pH, surface
tension, osmolality, viscosity and buffer capacity) and macronutrient composition
(i.e. fat, sugar and protein content) of the
different soft foods and drinks, not only among vehicle type but also within
vehicles of the same subtype. Solubility studies of the two model compounds in
selected drinks and soft foods resulted in considerably different drug solubility
values in each vehicle. The solubility of the drugs was significantly affected by
the vehicle physicochemical properties and macronutrient composition, with the
solubility of montelukast being driven by the pH, fat and protein content of the
vehicles and the solubility of mesalazine by vehicle osmolality, viscosity and sugar
content. This vehicle-dependent impact on drug solubility could compromise its
bioavailability, and ultimately affect the safety and/or efficacy of the drug and
should be taken into consideration during paediatric product development.
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20
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Mann J, Wernham A, Kulkarni K, Varma S. An unexpected lesion on the scalp. Clin Exp Dermatol 2020; 45:922-924. [PMID: 32449175 DOI: 10.1111/ced.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Mann
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Wernham
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Kulkarni
- Department of Histopathology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Varma
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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21
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Impact of Magnesium Stearate Presence and Variability on Drug Apparent Solubility Based on Drug Physicochemical Properties. AAPS J 2020; 22:75. [PMID: 32440810 PMCID: PMC7242257 DOI: 10.1208/s12248-020-00449-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/27/2019] [Accepted: 03/20/2020] [Indexed: 11/30/2022]
Abstract
Excipients are major components of oral solid dosage forms, and changes in their critical material attributes (excipient variability) and/or amount (excipient variation) in pharmaceutical formulations may present a challenge for product performance. Understanding the biopharmaceutical factors affecting excipient performance is recommended for the successful implementation of excipient variability on Quality by Design (QbD) approaches. The current study investigated the impact of magnesium stearate (MgSt) variability on the apparent solubility of drugs with a wide range of physicochemical properties (drug ionization, drug lipophilicity, drug aqueous solubility). Compendial and biorelevant media were used to assess the role of gastrointestinal (GI) conditions on the excipient effects on drug apparent solubility. The lipophilic nature of MgSt decreased the apparent solubility of most compounds. The reduction in drug apparent solubility was more pronounced for highly soluble and/or highly ionized drugs and in presence of more highly crystalline or smaller particle size MgSt. The use of multivariate data analysis revealed the critical physicochemical and biopharmaceutical factors and the complex nature of excipient variability on the reduction in drug apparent solubility. The construction of a roadmap combining drug, excipient and medium characteristics allowed the identification of the cases where the presence of excipient or excipient variability may present risks for oral drug performance.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK.,UCB Pharma, Chemin du Foriest, B-1420, Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - Nikoletta Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
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22
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Biopharmaceutical Understanding of Excipient Variability on Drug Apparent Solubility Based on Drug Physicochemical Properties: Case Study-Hypromellose (HPMC). AAPS J 2020; 22:49. [PMID: 32072317 PMCID: PMC7028811 DOI: 10.1208/s12248-019-0411-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/27/2019] [Accepted: 12/21/2019] [Indexed: 02/07/2023]
Abstract
Identification of the biopharmaceutical risks of excipients and excipient variability on oral drug performance can be beneficial for the development of robust oral drug formulations. The current study investigated the impact of Hypromellose (HPMC) presence and varying viscosity type, when used as a binder in immediate release formulations, on the apparent solubility of drugs with wide range of physicochemical properties (drug ionization, drug lipophilicity, drug aqueous solubility). The role of physiological conditions on the impact of excipients on drug apparent solubility was assessed with the use of pharmacopoeia (compendial) and biorelevant media. Presence of HPMC affected drug solubility according to the physicochemical properties of studied compounds. The possible combined effects of polymer adsorption (drug shielding effect) or the formation of a polymeric viscous layer around drug particles may have retarded drug dissolution leading to reduced apparent solubility of highly soluble and/or highly ionized compounds and were pronounced mainly at early time points. Increase in the apparent solubility of poorly soluble low ionized drugs containing a neutral amine group was observed which may relate to enhanced drug solubilization or reduced drug precipitation. The use of multivariate data analysis confirmed the importance of drug physicochemical properties on the impact of excipients on drug apparent solubility and revealed that changes in HPMC material properties or amount may not be critical for oral drug performance when HPMC is used as a binder. The construction of a roadmap combining drug, excipient, and medium characteristics allowed the identification of the cases where HPMC presence may present risks in oral drug performance and bioavailability.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK.,UCB Pharma, Chemin du Foriest, 1420, Braine-l'Alleud, Belgium
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, UK
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Surface dissolution UV imaging for characterization of superdisintegrants and their impact on drug dissolution. Int J Pharm 2020; 577:119080. [PMID: 31988030 DOI: 10.1016/j.ijpharm.2020.119080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/15/2022]
Abstract
Superdisintegrants are a key excipient used in immediate release formulations to promote fast tablet disintegration, therefore understanding the impact of superdisintegrant variability on product performance is important. The current study examined the impact of superdisintegrant critical material attributes (viscosity for sodium starch glycolate (SSG), particle size distribution (PSD) for croscarmellose sodium (CCS)) on their performance (swelling) and on drug dissolution using surface dissolution UV imaging. Acidic and basic pharmacopoeia (compendial) media were used to assess the role of varying pH on superdisintegrant performance and its effect on drug dissolution. A highly soluble (paracetamol) and a poorly soluble (carbamazepine) drug were used as model compounds and drug compacts and drug-excipient compacts were prepared for the dissolution experiments. The presence of a swelled SSG or CCS layer on the compact surface, due to the fast excipient hydration capacity, upon contact with dissolution medium was visualized. The swelling behaviour of superdisintegrants depended on excipient critical material attributes and the pH of the medium. Drug dissolution was faster in presence compared to superdisintegrant absence due to improved compact wetting or compact disintegration. The improvement in drug dissolution was less pronounced with increasing SSG viscosity or CCS particle size. Drug dissolution was slightly more complete in basic compared to acidic conditions in presence of the studied superdisintegrants for the highly soluble drug attributed to the increased excipient hydration capacity and the fast drug release through the swelled excipient structure. The opposite was observed for the poorly soluble drug as potentially the improvement in drug dissolution was compromised by drug release from the highly swelled structure. The use of multivariate data analysis revealed the influential role of excipient and drug properties on the impact of excipient variability on drug dissolution.
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Affiliation(s)
- P Zarmpi
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - T Flanagan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - E Meehan
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - J Mann
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - N Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
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Salchow J, Mann J, Koch B, von Grundherr J, Jensen W, Elmers S, Straub LA, Vettorazzi E, Escherich G, Rutkowski S, Dwinger S, Bergelt C, Sokalska-Duhme M, Bielack S, Calaminus G, Baust K, Classen CF, Rössig C, Faber J, Faller H, Hilgendorf I, Gebauer J, Langer T, Metzler M, Schuster S, Niemeyer C, Puzik A, Reinhardt D, Dirksen U, Sander A, Köhler M, Habermann JK, Bokemeyer C, Stein A. Comprehensive assessments and related interventions to enhance the long-term outcomes of child, adolescent and young adult cancer survivors - presentation of the CARE for CAYA-Program study protocol and associated literature review. BMC Cancer 2020; 20:16. [PMID: 31906955 PMCID: PMC6945396 DOI: 10.1186/s12885-019-6492-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 03/25/2019] [Accepted: 12/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potential future problems, to offer need-based preventative interventions and thus to improve long-term outcomes in this particularly vulnerable population. Methods The trial is designed as an adaptive trial with an annual comprehensive assessment followed by needs stratified, modular interventions, currently including physical activity, nutrition and psycho-oncology, all aimed at improving the lifestyle and/or the psychosocial situation of the patients. Patients, aged 15–39 years old, with a prior cancer diagnosis, who have completed tumour therapy and are in follow-up care, and who are tumour free, will be included. At baseline (and subsequently on an annual basis) the current medical and psychosocial situation and lifestyle of the participants will be assessed using a survey compiled of various validated questionnaires (e.g. EORTC QLQ C30, NCCN distress thermometer, PHQ-4, BSA, nutrition protocol) and objective parameters (e.g. BMI, WHR, co-morbidities like hyperlipidaemia, hypertension, diabetes), followed by basic care (psychological and lifestyle consultation). Depending on their needs, CAYAs will be allocated to preventative interventions in the above-mentioned modules over a 12-month period. After 1 year, the assessment will be repeated, and further interventions may be applied as needed. During the initial trial phase, the efficacy of this approach will be compared to standard care (waiting list with intervention in the following year) in a randomized study. During this phase, 530 CAYAs will be included and 320 eligible CAYAs who are willing to participate in the interventions will be randomly allocated to an intervention. Overall, 1500 CAYAs will be included and assessed. The programme is financed by the innovation fund of the German Federal Joint Committee and will be conducted at 14 German sites. Recruitment began in January 2018. Discussion CAYAs are at high risk for long-term sequelae. Providing structured interventions to improve lifestyle and psychological situation may counteract against these risk factors. The programme serves to establish uniform regular comprehensive assessments and need-based interventions to improve long-term outcome in CAYA survivors. Trial registration Registered at the German Clinical Trial Register (ID: DRKS00012504, registration date: 19th January 2018).
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Affiliation(s)
- J Salchow
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - J Mann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Koch
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J von Grundherr
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Jensen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Elmers
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L A Straub
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Vettorazzi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Escherich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Rutkowski
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Dwinger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bergelt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - S Bielack
- Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - K Baust
- University Hospital Bonn, Bonn, Germany
| | - C F Classen
- University Hospital Rostock, Rostock, Germany
| | - C Rössig
- University Children's Hospital Münster, Münster, Germany
| | - J Faber
- Mainz University Medical Center, Mainz, Germany
| | - H Faller
- University Hospital Würzburg, Würzburg, Germany
| | | | - J Gebauer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - M Metzler
- University Hospital Erlangen, Erlangen, Germany
| | - S Schuster
- University Hospital Erlangen, Erlangen, Germany
| | - C Niemeyer
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Puzik
- Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Reinhardt
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - U Dirksen
- University Hospital Essen, Essen, Germany.,German Cancer Consortium, Essen, Germany
| | - A Sander
- Hannover Medical School, Hannover, Germany
| | - M Köhler
- Medical Faculty University Hospital Magdeburg, Magdeburg, Germany
| | | | - C Bokemeyer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stein
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Verma S, Bain S, Honoré J, Mann J, Nauck M, Pratley R, Rasmussen S, Sejersten Ripa M, Zinman B, Buse J. IMPACT OF MICROVASCULAR DISEASE ON CARDIORENAL OUTCOMES IN TYPE 2 DIABETES: AN ANALYSIS FROM THE LEADER AND SUSTAIN 6 CLINICAL TRIALS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.568] [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: 10/25/2022] Open
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Baiyegunhi O, Mann J, Nkosi T, Pansegrou J, Dong K, Ndungu T, Walker B, Ndhlovu Z. High HIV viral burden persists in CXCR3+TFH despite very early cART initiation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31059-1] [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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Mann J. Dental equipment: Hands-free heaven. Br Dent J 2018; 225:994. [DOI: 10.1038/sj.bdj.2018.1089] [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: 11/09/2022]
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Biegalski S, Kane N, Mann J, Tipping T, Dayman K. Neutron activation of NIST surrogate post-detonation urban debris (SPUD) candidate SRMs. J Radioanal Nucl Chem 2018. [DOI: 10.1007/s10967-018-6023-x] [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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Dagar V, Hutchison W, Muscat A, Krishnan A, Hoke D, Buckle A, Siswara P, Amor DJ, Mann J, Pinner J, Colley A, Wilson M, Sachdev R, McGillivray G, Edwards M, Kirk E, Collins F, Jones K, Taylor J, Hayes I, Thompson E, Barnett C, Haan E, Freckmann ML, Turner A, White S, Kamien B, Ma A, Mackenzie F, Baynam G, Kiraly-Borri C, Field M, Dudding-Byth T, Algar EM. Genetic variation affecting DNA methylation and the human imprinting disorder, Beckwith-Wiedemann syndrome. Clin Epigenetics 2018; 10:114. [PMID: 30165906 PMCID: PMC6117921 DOI: 10.1186/s13148-018-0546-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/17/2018] [Indexed: 11/24/2022] Open
Abstract
Background Beckwith-Wiedemann syndrome (BWS) is an imprinting disorder with a population frequency of approximately 1 in 10,000. The most common epigenetic defect in BWS is a loss of methylation (LOM) at the 11p15.5 imprinting centre, KCNQ1OT1 TSS-DMR, and affects 50% of cases. We hypothesised that genetic factors linked to folate metabolism may play a role in BWS predisposition via effects on methylation maintenance at KCNQ1OT1 TSS-DMR. Results Single nucleotide variants (SNVs) in the folate pathway affecting methylenetetrahydrofolate reductase (MTHFR), methionine synthase reductase (MTRR), 5-methyltetrahydrofolate-homocysteine S-methyltransferase (MTR), cystathionine beta-synthase (CBS) and methionine adenosyltransferase (MAT1A) were examined in 55 BWS patients with KCNQ1OT1 TSS-DMR LOM and in 100 unaffected cases. MTHFR rs1801133: C>T was more prevalent in BWS with KCNQ1OT1 TSS-DMR LOM (p < 0.017); however, the relationship was not significant when the Bonferroni correction for multiple testing was applied (significance, p = 0.0036). None of the remaining 13 SNVs were significantly different in the two populations tested. The DNMT1 locus was screened in 53 BWS cases, and three rare missense variants were identified in each of three patients: rs138841970: C>T, rs150331990: A>G and rs757460628: G>A encoding NP_001124295 p.Arg136Cys, p.His1118Arg and p.Arg1223His, respectively. These variants have population frequencies of less than 1 in 1000 and were absent from 100 control cases. Functional characterization using a hemimethylated DNA trapping assay revealed a reduced methyltransferase activity relative to wild-type DNMT1 for each variant ranging from 40 to 70% reduction in activity. Conclusions This study is the first to examine folate pathway genetics in BWS and to identify rare DNMT1 missense variants in affected individuals. Our data suggests that reduced DNMT1 activity could affect maintenance of methylation at KCNQ1OT1 TSS-DMR in some cases of BWS, possibly via a maternal effect in the early embryo. Larger cohort studies are warranted to further interrogate the relationship between impaired MTHFR enzymatic activity attributable to MTHFR rs1801133: C>T, dietary folate intake and BWS. Electronic supplementary material The online version of this article (10.1186/s13148-018-0546-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vinod Dagar
- Department of Paediatrics, University of Melbourne, Parkville, 3052, Australia
| | | | - Andrea Muscat
- School of Medicine, Deakin University, Geelong, 3216, Australia
| | - Anita Krishnan
- Victorian Comprehensive Cancer Centre, Parkville, 3052, Australia
| | - David Hoke
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, 3800, Australia
| | - Ashley Buckle
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, 3800, Australia
| | | | - David J Amor
- Department of Paediatrics, University of Melbourne, Parkville, 3052, Australia.,Murdoch Children's Research Institute, Parkville, 3052, Australia
| | - Jeffrey Mann
- Department of Anatomy and Developmental Biology, Monash University, Clayton, 3800, Australia
| | - Jason Pinner
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, 2050, Australia
| | - Alison Colley
- Clinical Genetics, Liverpool Hospital, Liverpool, 2170, Australia
| | - Meredith Wilson
- Clinical Genetics, Children's Hospital at Westmead, Westmead, 2145, Australia
| | - Rani Sachdev
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, 2031, Australia
| | | | - Matthew Edwards
- School of Medicine, University of Western Sydney, Penrith, 2751, Australia
| | - Edwin Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, 2031, Australia
| | - Felicity Collins
- Clinical Genetics, Children's Hospital at Westmead, Westmead, 2145, Australia
| | - Kristi Jones
- Clinical Genetics, Children's Hospital at Westmead, Westmead, 2145, Australia.,School of Medicine, University of Sydney, Camperdown, 2006, Australia
| | - Juliet Taylor
- Auckland District Health Board, Auckland, 1023, New Zealand
| | - Ian Hayes
- Auckland District Health Board, Auckland, 1023, New Zealand
| | - Elizabeth Thompson
- South Australian (SA) Clinical Genetics Service, SA Pathology, Women's and Children's Hospital, Adelaide, 5000, Australia.,School of Medicine, University of Adelaide, Adelaide, 5000, Australia
| | - Christopher Barnett
- South Australian (SA) Clinical Genetics Service, SA Pathology, Women's and Children's Hospital, Adelaide, 5000, Australia
| | - Eric Haan
- South Australian (SA) Clinical Genetics Service, SA Pathology, Women's and Children's Hospital, Adelaide, 5000, Australia
| | - Mary-Louise Freckmann
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, 2065, Australia
| | - Anne Turner
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, 2031, Australia.,School of Women's and Children's Health, University of NSW, Kensington, 2052, Australia
| | - Susan White
- Murdoch Children's Research Institute, Parkville, 3052, Australia
| | - Ben Kamien
- Hunter Genetics, Hunter New England Local Health District, New Lambton, 2305, Australia
| | - Alan Ma
- Clinical Genetics, Children's Hospital at Westmead, Westmead, 2145, Australia
| | - Fiona Mackenzie
- Genetics Services of Western Australia, Crawley, 6009, Australia
| | - Gareth Baynam
- Genetics Services of Western Australia, Crawley, 6009, Australia
| | | | - Michael Field
- Hunter Genetics, Hunter New England Local Health District, New Lambton, 2305, Australia
| | - Tracey Dudding-Byth
- Hunter Genetics, Hunter New England Local Health District, New Lambton, 2305, Australia.,University of Newcastle GrowUpWell Priority Research Centre, Callaghan, 2308, Australia
| | - Elizabeth M Algar
- Department of Paediatrics, University of Melbourne, Parkville, 3052, Australia. .,Pathology, Monash Health, Clayton, 3168, Australia. .,Hudson Institute of Medical Research, Clayton, 3168, Australia. .,Department of Translational Medicine, Monash University, Clayton, 3168, Australia.
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Wan Muhammad Hatta SF, Kandaswamy L, Gherman-Ciolac C, Mann J, Buch HN. An unusual case of shortness of breath. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180074. [PMID: 30087779 PMCID: PMC6063989 DOI: 10.1530/edm-18-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 11/08/2022] Open
Abstract
Myopathy is a well-known complication of hypercortisolism and commonly involves proximal lower-limb girdle. We report a rare case of Cushing’s syndrome in a 60-year-old female presenting with significant respiratory muscle weakness and respiratory failure. She had history of rheumatoid arthritis, primary biliary cirrhosis and primary hypothyroidism and presented with weight gain and increasing shortness of breath. Investigations confirmed a restrictive defect with impaired gas transfer but with no significant parenchymatous pulmonary disease. Respiratory muscle test confirmed weakness of respiratory muscles and diaphragm. Biochemical and radiological investigations confirmed hypercortisolaemia secondary to a left adrenal tumour. Following adrenalectomy her respiratory symptoms improved along with an objective improvement in the respiratory muscle strength, diaphragmatic movement and pulmonary function test.
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Affiliation(s)
- S F Wan Muhammad Hatta
- 1New Cross Hospital, Wolverhampton, UK
- 2Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia
| | | | | | - J Mann
- 1New Cross Hospital, Wolverhampton, UK
| | - H N Buch
- 1New Cross Hospital, Wolverhampton, UK
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Renault O, Martinez E, Zborowski C, Mann J, Inoue R, Newman J, Watanabe K. Analysis of buried interfaces in multilayer device structures with hard XPS (HAXPES) using a CrKα source. SURF INTERFACE ANAL 2018. [DOI: 10.1002/sia.6451] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- O. Renault
- Université Grenoble Alpes; CEA, LETI; 38000 Grenoble France
| | - E. Martinez
- Université Grenoble Alpes; CEA, LETI; 38000 Grenoble France
| | - C. Zborowski
- Université Grenoble Alpes; CEA, LETI; 38000 Grenoble France
- Department of Physics, Chemistry and Pharmacy; University of Southern Denmark; Odense M Denmark
| | - J. Mann
- Physical Electronics; 18725 Lake Drive Chanhassen MN 55317 USA
| | - R. Inoue
- ULVAC-PHI, Inc; 2500 Hagisono Chigasaki Kanagawa 253-8522 Japan
| | - J. Newman
- Physical Electronics; 18725 Lake Drive Chanhassen MN 55317 USA
| | - K. Watanabe
- ULVAC-PHI, Inc; 2500 Hagisono Chigasaki Kanagawa 253-8522 Japan
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Mann J, Fonseca V, Mosenzon O, Raz I, Frimer-Larsen H, Scholten BJ, Idorn T, Poulter N, Lüdemann J. Sicherheit von Liraglutid vs. Placebo bei Patienten mit T2D und CKD in der LEADER Studie. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Mann
- KfH Nierenzentrum, München, Germany
| | - V Fonseca
- Tulane University Health Sciences Center, New Orleans, United States
| | - O Mosenzon
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - I Raz
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | | | - T Idorn
- Novo Nordisk A/S, Søborg, Denmark
| | - N Poulter
- Imperial College London, London, United Kingdom
| | - J Lüdemann
- Schwerpunktpraxis für Diabetes, Gefäß- & Ernährungsmedizin, Falkensee, Germany
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Poulter N, Mann J, Fonseca V, Mosenzon O, Raz I, Frimer-Larsen H, Scholten BJ, Idorn T, Nauck M. Liraglutid reduzierte MACE (Major Cardiovascular Events, schwere unerwünschte kardiovaskuläre Ereignisse) bei Patienten mit chronischer Nierenerkrankung: Ergebnisse aus der LEADER Studie. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- N Poulter
- Imperial College London, London, United Kingdom
| | - J Mann
- KfH Nierenzentrum, München, Germany
| | - V Fonseca
- Tulane University Health Sciences Center, New Orleans, United States
| | - O Mosenzon
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - I Raz
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | | | - T Idorn
- Novo Nordisk A/S, Søborg, Denmark
| | - M Nauck
- Universitätsklinikum St. Josef-Hospital, Bochum, Germany
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Miketa M, Patterson E, Krzyszczyk E, Foroughirad V, Mann J. Calf age and sex affect maternal diving behaviour in Shark Bay bottlenose dolphins. Anim Behav 2018. [DOI: 10.1016/j.anbehav.2017.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abreu LN, Oquendo MA, Galfavy H, Burke A, Grunebaum MF, Sher L, Sullivan GM, Sublette ME, Mann J, Lafer B. Are comorbid anxiety disorders a risk factor for suicide attempts in patients with mood disorders? A two-year prospective study. Eur Psychiatry 2017; 47:19-24. [PMID: 29096128 DOI: 10.1016/j.eurpsy.2017.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/05/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Comorbid anxiety disorders have been considered a risk factor for suicidal behavior in patients with mood disorders, although results are controversial. The aim of this two-year prospective study was to determine if lifetime and current comorbid anxiety disorders at baseline were risk factors for suicide attempts during the two-year follow-up. METHODS We evaluated 667 patients with mood disorders (504 with major depression and 167 with bipolar disorder) divided in two groups: those with lifetime comorbid anxiety disorders (n=229) and those without (n=438). Assessments were performed at baseline and at 3, 12, and 24 months. Kaplan-Meier survival analysis and log-rank test were used to evaluate the relationship between anxiety disorders and suicide attempts. Cox proportional hazard regression was performed to investigate clinical and demographic variables that were associated with suicide attempts during follow-up. RESULTS Of the initial sample of 667 patients, 480 had all three follow-up interviews. During the follow-up, 63 patients (13.1%) attempted suicide at least once. There was no significant difference in survival curves for patients with and without comorbid anxiety disorders (log-rank test=0.269; P=0.604). Female gender (HR=3.66, P=0.001), previous suicide attempts (HR=3.27, P=0.001) and higher scores in the Buss-Durkee Hostility Inventory (HR=1.05, P≤0.001) were associated with future suicide attempts. CONCLUSIONS Our results suggest that comorbid anxiety disorders were not risk factors for suicide attempts. Further studies were needed to determine the role of anxiety disorders as risk factors for suicide attempts.
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Affiliation(s)
- L N Abreu
- Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - M A Oquendo
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - H Galfavy
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - A Burke
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - M F Grunebaum
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - L Sher
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, USA
| | - G M Sullivan
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - M E Sublette
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - J Mann
- New York State Psychiatry Institute and Molecular Imaging and Neuropathology Division (MIND), Columbia University, New York, USA
| | - B Lafer
- Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Bak N, Mann J, Fagerlund B, Glenthøj BY, Jepsen JRM, Oranje B. Testing a decades' old assumption: Are individuals with lower sensory gating indeed more easily distracted? Psychiatry Res 2017; 255:387-393. [PMID: 28666245 DOI: 10.1016/j.psychres.2017.05.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/05/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022]
Abstract
The sensory gating deficits in schizophrenia have been theorized to associate with increased distractibility. We explore the potential associations between sensory and sensorimotor gating and subjective and objective indices of distraction in healthy subjects. Forty healthy males were assessed with the P50 suppression and pre-pulse inhibition of the startle reflex (PPI) paradigms. Additionally, a neurocognitive test battery was administered in a cross-over design: with/without auditory distraction. Significant effects of distraction were found in response inhibition, and verbal working memory and attention. Parameters from the PPI and P50 suppression paradigms were significantly associated with the distractor effects on strategy formation, cognitive inhibition and flexibility, visual short-term memory, and the level of subjective distraction. Subjectively reported distraction was significantly associated with verbal working memory and attention as well as executive and supervisory processes. Sensory and sensorimotor gating efficiency do not reflect the effect of distraction across executive and attention functions i.e. we did not observe a generalized distractor effect. Gating only related to the effect of distraction on strategy formation, cognitive inhibition and flexibility, as well as visual short term memory. Future studies should investigate if gating deficits affect the distractibility of the same specific cognitive functions in patients with schizophrenia.
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Affiliation(s)
- N Bak
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark.
| | - J Mann
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark
| | - B Fagerlund
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark
| | - B Y Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark
| | - J R M Jepsen
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - B Oranje
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Services Glostrup, The Capital Region, Copenhagen, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, The Capital Region, Copenhagen, Denmark; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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Abstract
Background The loss of dentures for inpatients can have a detrimental effect on their well-being. Self-respect and dignity become compromised along with their ability to eat meals and communicate clearly, and long-term recovery.Aim This investigation aimed to identify the reported number of dentures lost in hospitals and the financial reimbursements given by trusts to replace them.Method Information on reported denture loss and reimbursement was collected in 12 trusts throughout Kent, Surrey and Sussex.Results Eleven out of 12 trusts returned data about how many dentures were lost in their hospitals, between them 695 dentures were reported lost over five years (2011-16). Seven trusts reported financial reimbursements for dentures losses; results showed £357,672 was reimbursed over six years (2010-16), the highest amount reimbursed for a single denture was £2,200.Conclusion The results indicate that denture loss is a problem in hospitals that contributes to the financial burden for the NHS. Consideration needs to be given by hospitals to find ways to reduce the number of dentures lost every year.
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Affiliation(s)
- J Mann
- Special Care and Dental Public Health Trainee, East Surrey Hospital Canada Avenue, Redhill, RH1 5RH
| | - M Doshi
- Consultant in Special Care Dentistry, East Surrey Hospital Canada Avenue, Redhill, RH1 5RH
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Mann J, Doshi M. 19MOUTH CARE MATTERS (MCM) IS A HEALTH EDUCATION ENGLAND TRAINING INITIATIVE FOCUSSED ON IMPROVING THE ORAL HEALTH OF OLDER PEOPLE. THE HOSPITAL ARM OF THE PROGRAMME WAS DEVELOPED AND PILOTED AT EAST SURREY HOSPITAL AND IS CURRENTLY BEING ROLLED OUT ACROSS ALL ACUTE TRUSTS IN KENT, SURREY AND SUSSEX. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.19] [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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Djuric Z, Segar M, Orizondo C, Mann J, Faison M, Peddireddy N, Paletta M, Locke A. Delivery of Health Coaching by Medical Assistants in Primary Care. J Am Board Fam Med 2017; 30:362-370. [PMID: 28484068 PMCID: PMC5634140 DOI: 10.3122/jabfm.2017.03.160321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/23/2017] [Accepted: 02/06/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Health coaching is potentially a practical method to assist patients in achieving and maintaining healthy lifestyles. In health coaching, the coach partners with the patient, helping patients discover their own strengths, challenges, and solutions. METHODS Two medical assistants were provided with brief training. The 12-week program consisted of telephone coaching with in-person visits at the beginning and end of the program. Coaching targeted improvements in diet, physical activity, and/or sleep habits using a self-care planning form. RESULTS A total of 82 subjects enrolled in the program, 72% completed 8 weeks and 49% completed 12 weeks. Subjects who completed assessments at 12 weeks had significant weight loss despite the fact that weight loss was not a study goal. There also were improvements in diet and physical activity. Subject who completed the study were highly satisfied with the program and felt that health coaching should be available in all family medicine clinics. The main barrier providers voiced was remembering to refer patients. The medical providers indicated high satisfaction with the study and valued having coaching available for their patients. CONCLUSIONS Medical assistants can be trained to assist patients with lifestyle changes that are associated with improved health and weight control.
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Affiliation(s)
- Zora Djuric
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL).
| | - Michelle Segar
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL)
| | - Carissa Orizondo
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL)
| | - Jeffrey Mann
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL)
| | - Maya Faison
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL)
| | - Nithin Peddireddy
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL)
| | - Matthew Paletta
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL)
| | - Amy Locke
- From the Department of Family Medicine, University of Michigan, Ann Arbor (ZD, CO, JM, MF, NP, MP); Sport, Health, and Activity Research and Policy Center, University of Michigan, Ann Arbor (MS); and the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (AL)
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Mann J, Angelou N, Arnqvist J, Callies D, Cantero E, Arroyo RC, Courtney M, Cuxart J, Dellwik E, Gottschall J, Ivanell S, Kühn P, Lea G, Matos JC, Palma JMLM, Pauscher L, Peña A, Rodrigo JS, Söderberg S, Vasiljevic N, Rodrigues CV. Complex terrain experiments in the New European Wind Atlas. Philos Trans A Math Phys Eng Sci 2017; 375:rsta.2016.0101. [PMID: 28265025 PMCID: PMC5346220 DOI: 10.1098/rsta.2016.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 05/31/2023]
Abstract
The New European Wind Atlas project will create a freely accessible wind atlas covering Europe and Turkey, develop the model chain to create the atlas and perform a series of experiments on flow in many different kinds of complex terrain to validate the models. This paper describes the experiments of which some are nearly completed while others are in the planning stage. All experiments focus on the flow properties that are relevant for wind turbines, so the main focus is the mean flow and the turbulence at heights between 40 and 300 m. Also extreme winds, wind shear and veer, and diurnal and seasonal variations of the wind are of interest. Common to all the experiments is the use of Doppler lidar systems to supplement and in some cases replace completely meteorological towers. Many of the lidars will be equipped with scan heads that will allow for arbitrary scan patterns by several synchronized systems. Two pilot experiments, one in Portugal and one in Germany, show the value of using multiple synchronized, scanning lidar, both in terms of the accuracy of the measurements and the atmospheric physical processes that can be studied. The experimental data will be used for validation of atmospheric flow models and will by the end of the project be freely available.This article is part of the themed issue 'Wind energy in complex terrains'.
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Affiliation(s)
- J Mann
- Technical University of Denmark, Roskilde, Denmark
| | - N Angelou
- Technical University of Denmark, Roskilde, Denmark
| | | | - D Callies
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | - E Cantero
- National Renewable Energy Centre (CENER), Sarriguren, Spain
| | | | - M Courtney
- Technical University of Denmark, Roskilde, Denmark
| | - J Cuxart
- Universitat de les Illes Balears, Mallorca, Spain
| | - E Dellwik
- Technical University of Denmark, Roskilde, Denmark
| | - J Gottschall
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | | | - P Kühn
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | - G Lea
- Technical University of Denmark, Roskilde, Denmark
| | - J C Matos
- Instituto de Ciência e Inovação em Engenharia Mecânica e Gestão Industrial (INEGI), Porto, Portugal
| | - J M L M Palma
- Faculdade de Engenharia da Universidade do Porto (FEUP), Porto, Portugal
| | - L Pauscher
- Fraunhofer Institute for Wind Energy and Energy System Technology IWES, Germany
| | - A Peña
- Technical University of Denmark, Roskilde, Denmark
| | - J Sanz Rodrigo
- National Renewable Energy Centre (CENER), Sarriguren, Spain
| | | | - N Vasiljevic
- Technical University of Denmark, Roskilde, Denmark
| | - C Veiga Rodrigues
- Faculdade de Engenharia da Universidade do Porto (FEUP), Porto, Portugal
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Zarmpi P, Flanagan T, Meehan E, Mann J, Fotaki N. Biopharmaceutical aspects and implications of excipient variability in drug product performance. Eur J Pharm Biopharm 2017; 111:1-15. [DOI: 10.1016/j.ejpb.2016.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 12/29/2022]
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Mersel A, Baruch N, Tayeb I, Mann J, Zini A. [Dentist's satisfaction of continuing education: survey among dentists in Jerusalem]. Refuat Hapeh Vehashinayim (1993) 2017; 34:53-75. [PMID: 30699496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Continuing professional development (CpD or Continuing education is defined as a career-long process required by dentist to maintain, update and broaden their attitudes, knowledge and skills in a way that will bring the greatest benefit to their patients and improve patient care. This research is a survey among 295 dentists, members of the IDA in Jerusalem. The study was conducted, in order to examine their satisfaction of CPD programs offered by IDA Jerusalem. Results indicate that in most variables )lecturer, knowledge and comfort)the satisfaction degree was at a high level. Differences in the level of satisfaction were found between general dental practitioners and dental specialists, and between dentist who graduated in Israel as compared to dentists who graduated abroad. There is a great need to further investigate this issue, in order to develop, promote and improve CE studies and arrive at practical conclusions to support the development of high-quality continuing dental education programs designed to upgrade high-quality dental care, similar to other countries that have CE programs.
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Rodrigues CV, Palma JMLM, Vasiljević N, Courtney M, Mann J. Coupled simulations and comparison with multi-lidar measurements of the wind flow over a double-ridge. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1742-6596/753/3/032025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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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Robinson SM, Mann DA, Manas DM, Oakley F, Mann J, White SA. Response to 'Comment on 'The potential contribution of tumour-related factors to the development of FOLFOX-induced sinusoidal obstruction syndrome'’. Br J Cancer 2016; 115:e8. [PMID: 27632370 PMCID: PMC5061903 DOI: 10.1038/bjc.2016.268] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Mann H, London AJ, Mann J. Equipoise in the Enhanced Supression of the Platelet IIb/IIIa Receptor with Integrilin Trial (ESPRIT): a critical appraisal. Clin Trials 2016; 2:233-41; discussion 242-3. [PMID: 16279146 DOI: 10.1191/1740774505cn086oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Enhanced Supression of the Platelet IIb/IIIa Receptor with Integrilin Trial (ESPRIT) was a multicenter randomized controlled clinical trial in which participants were randomized between eptifibatide and placebo. A “clinical hold” was initially placed on the trial by the US Food and Drug Administration (FDA), which was concerned about the placebo-only control arm. The hold was lifted after additional information concerning the use of platelet glycoprotein IIb/IIIa inhibitors in clinical practice, derived from a survey of interventional cardiologists, was provided. The trial's principal investigator and colleagues have described how these issues were resolved, and advance a claim of equipoise for the trial. In this critical appraisal we examine the information and arguments proffered in support of the trial design and conclude that they evidence a misunderstanding of equipoise. We believe that a placebo-only control arm was not justified by the information provided by the trialists.
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Affiliation(s)
- Howard Mann
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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Borthwick LA, Suwara MI, Carnell SC, Green NJ, Mahida R, Dixon D, Gillespie CS, Cartwright TN, Horabin J, Walker A, Olin E, Rangar M, Gardner A, Mann J, Corris PA, Mann DA, Fisher AJ. Pseudomonas aeruginosa Induced Airway Epithelial Injury Drives Fibroblast Activation: A Mechanism in Chronic Lung Allograft Dysfunction. Am J Transplant 2016; 16:1751-65. [PMID: 26714197 PMCID: PMC4879508 DOI: 10.1111/ajt.13690] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 12/03/2015] [Accepted: 12/06/2015] [Indexed: 01/25/2023]
Abstract
Bacterial infections after lung transplantation cause airway epithelial injury and are associated with an increased risk of developing bronchiolitis obliterans syndrome. The damaged epithelium is a source of alarmins that activate the innate immune system, yet their ability to activate fibroblasts in the development of bronchiolitis obliterans syndrome has not been evaluated. Two epithelial alarmins were measured longitudinally in bronchoalveolar lavages from lung transplant recipients who developed bronchiolitis obliterans syndrome and were compared to stable controls. In addition, conditioned media from human airway epithelial cells infected with Pseudomonas aeruginosa was applied to lung fibroblasts and inflammatory responses were determined. Interleukin-1 alpha (IL-1α) was increased in bronchoalveolar lavage of lung transplant recipients growing P. aeruginosa (11.5 [5.4-21.8] vs. 2.8 [0.9-9.4] pg/mL, p < 0.01) and was significantly elevated within 3 months of developing bronchiolitis obliterans syndrome (8.3 [1.4-25.1] vs. 3.6 [0.6-17.1] pg/mL, p < 0.01), whereas high mobility group protein B1 remained unchanged. IL-1α positively correlated with elevated bronchoalveolar lavage IL-8 levels (r(2) = 0.6095, p < 0.0001) and neutrophil percentage (r(2) = 0.25, p = 0.01). Conditioned media from P. aeruginosa infected epithelial cells induced a potent pro-inflammatory phenotype in fibroblasts via an IL-1α/IL-1R-dependent signaling pathway. In conclusion, we propose that IL-1α may be a novel therapeutic target to limit Pseudomonas associated allograft injury after lung transplantation.
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Affiliation(s)
- L. A. Borthwick
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. I. Suwara
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - S. C. Carnell
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - N. J. Green
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - R. Mahida
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - D. Dixon
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - C. S. Gillespie
- School of Mathematics and StatisticsNewcastle UniversityNewcastle upon TyneUK
| | - T. N. Cartwright
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - J. Horabin
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - A. Walker
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - E. Olin
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. Rangar
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
| | - A. Gardner
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - J. Mann
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - P. A. Corris
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
| | - D. A. Mann
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - A. J. Fisher
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
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Affiliation(s)
- J. Mann
- Dermatological Surgery and Laser Unit St John's Institute of Dermatology London U.K
- Friends Dermatology Centre East Kent University Hospitals NHS Foundation Trust Canterbury U.K
| | - F. Al‐Niaimi
- Dermatological Surgery and Laser Unit St John's Institute of Dermatology London U.K
| | - A. Cooper
- Friends Dermatology Centre East Kent University Hospitals NHS Foundation Trust Canterbury U.K
| | - V. Ghura
- Mohs unit, Department of Dermatology Salford Royal Foundation Trust Manchester U.K
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Gao J, Mann J, Abou-Alfa K, Duarte Williamson E, Calonje E. Proliferating subcutaneous nodules in a 12-year-old girl. Clin Exp Dermatol 2015; 41:451-3. [PMID: 26644195 DOI: 10.1111/ced.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J Gao
- Department of Dermatology, Kent and Canterbury Hospital, Canterbury, UK
| | - J Mann
- St John's Institute of Dermatology, London, UK
| | - K Abou-Alfa
- Department of Dermatology, Kent and Canterbury Hospital, Canterbury, UK
| | | | - E Calonje
- St John's Institute of Dermatology, London, UK
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Smalley C, Mann J. Jean Elizabeth Clark. Assoc Med J 2015. [DOI: 10.1136/bmj.h2453] [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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Affiliation(s)
- J Mann
- Department of Human Nutrition and Edgar Diabetes and Obesity Research Centre, University of Otago, Dunedin, New Zealand
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