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Langlois AWR, Pouget JG, Knight J, Chenoweth MJ, Tyndale RF. Associating CYP2A6 structural variants with ovarian and lung cancer risk in the UK Biobank: replication and extension. Eur J Hum Genet 2024; 32:357-360. [PMID: 38097766 PMCID: PMC10923790 DOI: 10.1038/s41431-023-01518-2] [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: 07/21/2023] [Revised: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 03/10/2024] Open
Abstract
CYP2A6 is a polymorphic enzyme that inactivates nicotine; structural variants (SVs) include gene deletions and hybrids with the neighboring pseudogene CYP2A7. Two studies found that CYP2A7 deletions were associated with ovarian cancer risk. Using their methodology, we aimed to characterize CYP2A6 SVs (which may be misidentified by prediction software as CYP2A7 SVs), then assess CYP2A6 SV-associated risk for ovarian cancer, and extend analyses to lung cancer. An updated reference panel was created to impute CYP2A6 SVs from UK Biobank array data. Logistic regression models analyzed the association between CYP2A6 SVs and cancer risk, adjusting for covariates. Software-predicted CYP2A7 deletions were concordant with known CYP2A6 SVs. Deleterious CYP2A6 SVs were not associated with ovarian cancer (OR = 1.06; 95% CI: 0.80-1.37; p = 0.7) but did reduce the risk of lung cancer (OR = 0.44; 95% CI: 0.29-0.64; p < 0.0001), and a lung cancer subtype. Replication of known lung cancer associations indicates the validity of array-based SV analyses.
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Affiliation(s)
- Alec W R Langlois
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
| | - Jennie G Pouget
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Jo Knight
- Data Science Institute and Medical School, Lancaster University, Lancaster, UK
| | - Meghan J Chenoweth
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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Mountain R, Knight J, Heys K, Giorgi E, Gatheral T. Spatio-temporal modelling of referrals to outpatient respiratory clinics in the integrated care system of the Morecambe Bay area, England. BMC Health Serv Res 2024; 24:229. [PMID: 38388919 PMCID: PMC10882730 DOI: 10.1186/s12913-024-10716-7] [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] [Received: 08/30/2022] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Promoting integrated care is a key goal of the NHS Long Term Plan to improve population respiratory health, yet there is limited data-driven evidence of its effectiveness. The Morecambe Bay Respiratory Network is an integrated care initiative operating in the North-West of England since 2017. A key target area has been reducing referrals to outpatient respiratory clinics by upskilling primary care teams. This study aims to explore space-time patterns in referrals from general practice in the Morecambe Bay area to evaluate the impact of the initiative. METHODS Data on referrals to outpatient clinics and chronic respiratory disease patient counts between 2012-2020 were obtained from the Morecambe Bay Community Data Warehouse, a large store of routinely collected healthcare data. For analysis, the data is aggregated by year and small area geography. The methodology comprises of two parts. The first explores the issues that can arise when using routinely collected primary care data for space-time analysis and applies spatio-temporal conditional autoregressive modelling to adjust for data complexities. The second part models the rate of outpatient referral via a Poisson generalised linear mixed model that adjusts for changes in demographic factors and number of respiratory disease patients. RESULTS The first year of the Morecambe Bay Respiratory Network was not associated with a significant difference in referral rate. However, the second and third years saw significant reductions in areas that had received intervention, with full intervention associated with a 31.8% (95% CI 17.0-43.9) and 40.5% (95% CI 27.5-50.9) decrease in referral rate in 2018 and 2019, respectively. CONCLUSIONS Routinely collected data can be used to robustly evaluate key outcome measures of integrated care. The results demonstrate that effective integrated care has real potential to ease the burden on respiratory outpatient services by reducing the need for an onward referral. This is of great relevance given the current pressure on outpatient services globally, particularly long waiting lists following the COVID-19 pandemic and the need for more innovative models of care.
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Affiliation(s)
| | - Jo Knight
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Kelly Heys
- University Hospitals of Morecambe Bay NHS Foundation Trust, Westmorland General Hospital, Kendal, UK
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Timothy Gatheral
- Lancaster Medical School, Lancaster University, Lancaster, UK
- University Hospitals of Morecambe Bay NHS Foundation Trust, Westmorland General Hospital, Kendal, UK
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Chenoweth MJ, Kim YJ, Nollen NL, Hawk LW, Mahoney MC, Lerman C, Knight J, Tyndale RF. Genetic Prediction of Smoking Cessation Medication Side Effects: A Genome-Wide Investigation of Abnormal Dreams on Varenicline. Clin Pharmacol Ther 2024. [PMID: 38369951 DOI: 10.1002/cpt.3210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/26/2024] [Indexed: 02/20/2024]
Abstract
Varenicline, the most efficacious smoking cessation monotherapy, produces abnormal dreams. Although genetic contributions to varenicline-associated nausea and cessation have been identified, the role of genetics in abnormal dreams is unknown. We conducted a genomewide association study (GWAS) of abnormal dreams in 188 European ancestry smokers treated with varenicline (NCT01314001). Additive genetic models examined the likelihood of experiencing abnormal dreams 2 weeks following varenicline initiation. For the top locus, we tested for selectivity to varenicline, effects on cessation, replication, and generalizability to African ancestry (AA) individuals. The top GWAS variant associated with abnormal dreams was rs901886, mapping to intron 2 of ICAM5 on chromosome 19. The prevalence of abnormal dreams in those with rs901886 CC, CT, and TT genotypes was 15%, 36%, and 62%, respectively (odds ratio = 2.94 for T vs. C, 95% confidence interval = 1.92-4.55, P = 2.03e-7 ; T allele frequency = 52%). This rs901886 association was selective to varenicline (P values > 0.05 on nicotine patch and placebo). There were also positive associations for rs901886 T (vs. C allele, P = 0.03) and for abnormal dreams (P = 0.06) with varenicline-aided cessation. Neither rs901886 (P = 0.40) nor abnormal dreams (P = 0.24) were associated with adherence. A similar direction of effect of rs901886 on abnormal dreams was observed in a second varenicline trial (NCT01836276). In AA individuals (n = 137), rs901886 was not associated with abnormal dreams (P = 0.41), but there was an association for a variant located ~ 74.4 kb 5' of ICAM5 (P = 2.56e-3 ). Variation in ICAM5 may influence abnormal dreams and cessation on varenicline. These findings provide additional support for genetically optimized smoking cessation approaches.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yong Jae Kim
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nikki L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Martin C Mahoney
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jo Knight
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Data Science Institute, Lancaster University Medical School, Lancaster, UK
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Luyckx VA, Alasfar S, Bajpai D, Atwater CE, Knight J, Talbot B, Davies S, Niang A. Providing environmentally sustainable nephrology care: focus in low- and middle-income countries. Kidney Int 2024; 105:259-268. [PMID: 38008159 DOI: 10.1016/j.kint.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 11/28/2023]
Abstract
Health care on a global scale significantly contributes to carbon emissions, with high-income countries being the primary culprits. Within health care, dialysis plays a significant role as a major source of emissions. Low- and middle-income countries have a high burden of kidney disease and are facing an increasing demand for dialysis. This reality presents multiple opportunities to plan for environmentally sustainable and quality kidney care. By placing a stronger emphasis on primary and secondary prevention of kidney disease and its progression, within the framework of universal health coverage, as well as empowering patients to enhance self-care, we can significantly reduce the need for costly and environmentally detrimental kidney replacement therapy. Mandating the adoption of lean and innovative low-carbon dialysis practices while also promoting the growth of kidney transplantation would enable low- and middle-income countries to take the lead in implementing environmentally friendly nephrology practices and reducing costs, thus optimizing sustainability and the well-being of individuals living with kidney disease.
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Affiliation(s)
- V A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - S Alasfar
- Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - D Bajpai
- Department of Nephrology, Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India
| | - C E Atwater
- Department of Dialysis Capacity and Technical Operations, Bridge of Life, founded by Davita Inc., Denver, Colorado, USA
| | - J Knight
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - B Talbot
- The George Institute for Global Health, Newtown, Australia; Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - S Davies
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Abdou Niang
- Nephrology Department, Cheikh Anta Diop University & Dalal Jamm University Hospital, Dakar, Senegal
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Garner A, Lewis J, Dixon S, Preston N, Caiado CCS, Hanratty B, Jones M, Knight J, Mason SM. The impact of digital technology in care homes on unplanned secondary care usage and associated costs. Age Ageing 2024; 53:afae004. [PMID: 38346686 PMCID: PMC10861323 DOI: 10.1093/ageing/afae004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND A substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents' care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs. METHODS A retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models. FINDINGS Data from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6-15%], emergency admissions by 25% [20-39%] and length of stay by 11% [3-18%] (with an additional month-by-month decrease of 28% [24-34%]). The cost analysis found a cost reduction of £57 per resident in 2018, increasing to £113 in 2021. INTERPRETATION The introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents.
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Affiliation(s)
- Alex Garner
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Jen Lewis
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Monica Jones
- Faculty of Health and Medicine, University of Leeds, Leeds, UK
| | - Jo Knight
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Suzanne M Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Giratallah H, Chenoweth MJ, Pouget JG, El-Boraie A, Alsaafin A, Lerman C, Knight J, Tyndale RF. CYP2A6 associates with respiratory disease risk and younger age of diagnosis: a phenome-wide association Mendelian Randomization study. Hum Mol Genet 2024; 33:198-210. [PMID: 37802914 PMCID: PMC10772040 DOI: 10.1093/hmg/ddad172] [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] [Received: 02/28/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023] Open
Abstract
CYP2A6, a genetically variable enzyme, inactivates nicotine, activates carcinogens, and metabolizes many pharmaceuticals. Variation in CYP2A6 influences smoking behaviors and tobacco-related disease risk. This phenome-wide association study examined associations between a reconstructed version of our weighted genetic risk score (wGRS) for CYP2A6 activity with diseases in the UK Biobank (N = 395 887). Causal effects of phenotypic CYP2A6 activity (measured as the nicotine metabolite ratio: 3'-hydroxycotinine/cotinine) on the phenome-wide significant (PWS) signals were then estimated in two-sample Mendelian Randomization using the wGRS as the instrument. Time-to-diagnosis age was compared between faster versus slower CYP2A6 metabolizers for the PWS signals in survival analyses. In the total sample, six PWS signals were identified: two lung cancers and four obstructive respiratory diseases PheCodes, where faster CYP2A6 activity was associated with greater disease risk (Ps < 1 × 10-6). A significant CYP2A6-by-smoking status interaction was found (Psinteraction < 0.05); in current smokers, the same six PWS signals were found as identified in the total group, whereas no PWS signals were found in former or never smokers. In the total sample and current smokers, CYP2A6 activity causal estimates on the six PWS signals were significant in Mendelian Randomization (Ps < 5 × 10-5). Additionally, faster CYP2A6 metabolizer status was associated with younger age of disease diagnosis for the six PWS signals (Ps < 5 × 10-4, in current smokers). These findings support a role for faster CYP2A6 activity as a causal risk factor for lung cancers and obstructive respiratory diseases among current smokers, and a younger onset of these diseases. This research utilized the UK Biobank Resource.
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Affiliation(s)
- Haidy Giratallah
- Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College St, Toronto, ON M5T 1R8, Canada
| | - Meghan J Chenoweth
- Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College St, Toronto, ON M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Jennie G Pouget
- Campbell Family Mental Health Research Institute, CAMH, 250 College St, Toronto, ON M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Ahmed El-Boraie
- Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College St, Toronto, ON M5T 1R8, Canada
| | - Alaa Alsaafin
- Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College St, Toronto, ON M5T 1R8, Canada
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
| | - Jo Knight
- Department of Psychiatry, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Data Science Institute, Lancaster University Medical School, Lancaster LA1 4YE, United Kingdom
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College St, Toronto, ON M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
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Biggin F, Ashcroft Q, Howcroft T, Knight J, Emsley H. Discovering patterns in outpatient neurology appointments using state sequence analysis. BMC Health Serv Res 2023; 23:1208. [PMID: 37926834 PMCID: PMC10626691 DOI: 10.1186/s12913-023-10218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Outpatient services in the UK, and in particular outpatient neurology services, are under considerable pressure with an ever-increasing gap between capacity and demand. To improve services, we first need to understand the current situation. This study aims to explore the patterns of appointment type seen in outpatient neurology, in order to identify potential opportunities for change. METHODS We use State Sequence Analysis (SSA) on routinely collected data from a single neurology outpatient clinic. SSA is an exploratory methodology which allows patterns within sequences of appointments to be discovered. We analyse sequences of appointments for the 18 months following a new appointment. Using SSA we create groups of similar appointment sequence patterns, and then analyse these clusters to determine if there are particular sequences common to different diagnostic categories. RESULTS Of 1315 patients 887 patients had only one appointment. Among the 428 patients who had more than one appointment a 6 monthly cycle of appointments was apparent. SSA revealed that there were 11 distinct clusters of appointment sequence patterns. Further analysis showed that there are 3 diagnosis categories which have significant influence over which cluster a patient falls into: seizure/epilepsy, movement disorders, and headache. CONCLUSIONS Neurology outpatient appointment sequences show great diversity, but there are some patterns which are common to specific diagnostic categories. Information about these common patterns could be used to inform the structure of future outpatient appointments.
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Affiliation(s)
- Fran Biggin
- Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK.
| | - Quinta Ashcroft
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, PR2 9HT, UK
| | - Timothy Howcroft
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, PR2 9HT, UK
| | - Jo Knight
- Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
| | - Hedley Emsley
- Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, LA1 4YG, UK
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, PR2 9HT, UK
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Biggin F, Knight J, Dayanandan R, Marson A, Wilson M, Nitkunan A, Rog D, Kipps C, Mummery C, Williams A, Emsley HCA. Outpatient neurology diagnostic coding: a proposed scheme for standardised implementation. Pract Neurol 2023; 23:317-322. [PMID: 36808078 PMCID: PMC10423506 DOI: 10.1136/pn-2021-003286] [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] [Accepted: 01/15/2023] [Indexed: 02/22/2023]
Abstract
Clinical coding uses a classification system to assign standard codes to clinical terms and so facilitates good clinical practice through audit, service design and research. However, despite clinical coding being mandatory for inpatient activity, this is often not so for outpatient services, where most neurological care is delivered. Recent reports by the UK National Neurosciences Advisory Group and NHS England's 'Getting It Right First Time' initiative recommend implementing outpatient coding. The UK currently has no standardised system for outpatient neurology diagnostic coding. However, most new attendances at general neurology clinics appear to be classifiable with a limited number of diagnostic terms. We present the rationale for diagnostic coding and its benefits, and the need for clinical engagement to develop a system that is pragmatic, quick and easy to use. We outline a scheme developed in the UK that could be used elsewhere.
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Affiliation(s)
- Fran Biggin
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Jo Knight
- Lancaster Medical School, Lancaster University, Lancaster, UK
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rejith Dayanandan
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Anthony Marson
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Martin Wilson
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher Kipps
- Neurology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Catherine Mummery
- Dementia Research Centre, University College Hospitals NHS Foundation Trust, London, UK
| | - Adrian Williams
- Division of Neurosciences, University of Birmingham, Birmingham, UK
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University, Lancaster, UK
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Chenoweth MJ, Lerman C, Knight J, Tyndale RF. Influence of CYP2A6 Genetic Variation, Nicotine Dependence Severity, and Treatment on Smoking Cessation Success. Nicotine Tob Res 2023; 25:1207-1211. [PMID: 36789481 PMCID: PMC10202625 DOI: 10.1093/ntr/ntac268] [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: 04/25/2022] [Revised: 09/07/2022] [Accepted: 11/21/2022] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Genetic variation in Cytochrome P450 2A6 (CYP2A6), the major nicotine metabolizing enzyme, is associated with nicotine dependence and smoking cessation. Nicotine dependence severity also predicts smoking cessation. Our goals were to determine how CYP2A6 variation and nicotine dependence alter smoking cessation, and whether dependence could refine CYP2A6-based treatment recommendations. AIMS AND METHODS Adult smokers treated for 12 weeks with placebo, nicotine patch, or varenicline (NCT01314001) were grouped as CYP2A6 normal (n = 567) or slow (n = 432) nicotine metabolizers based on a CYP2A6 weighted genetic risk score. Fagerström test for nicotine dependence scores were measured at baseline and biochemically verified smoking cessation was assessed at end of treatment. RESULTS Dependence neither mediated nor moderated an association between CYP2A6 variation and smoking cessation overall, within any treatment arm, or after stratifying by ancestry (n = 591 European, n = 408 African ancestry) or sex (n = 444 women, n = 555 men). In within-treatment analyses, the mediation effect odds ratio (OR) ranged from 0.95 to 1.00 and the bias-corrected 95% confidence interval contained 1. Moderation (i.e. interaction) effect ORs ranged from 0.88 to 1.61 (p = .397-.828). For CYP2A6 normal metabolizers, quit rates on varenicline were similar for those with high (41.1%) and low (43.4%) dependence, while quit rates were lower for those with high versus low dependence on both patch (16.5 vs. 29.7%) and placebo (8.9 vs. 18.5%). CYP2A6 slow metabolizers with high versus low dependence had lower quit rates in all three treatment arms. CONCLUSIONS Although nicotine dependence severity neither mediated nor moderated CYP2A6 associations with smoking cessation, incorporating information on dependence may optimize the choice of smoking cessation treatment aid in CYP2A6 normal and slow metabolizers. IMPLICATIONS Variation in CYP2A6 and nicotine dependence severity alter smoking cessation success. Our findings suggest that while nicotine dependence severity is unlikely to mediate or moderate CYP2A6 associations with cessation, incorporating patient information on both CYP2A6 and nicotine dependence severity may lead to improved smoking cessation strategies.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Caryn Lerman
- Department of Psychiatry and USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jo Knight
- Data Science Institute, Lancaster University Medical School, Lancaster, UK
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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10
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Langlois AWR, El-Boraie A, Pouget JG, Cox LS, Ahluwalia JS, Fukunaga K, Mushiroda T, Knight J, Chenoweth MJ, Tyndale RF. Genotyping, characterization, and imputation of known and novel CYP2A6 structural variants using SNP array data. J Hum Genet 2023:10.1038/s10038-023-01148-y. [PMID: 37059825 DOI: 10.1038/s10038-023-01148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
CYP2A6 metabolically inactivates nicotine. Faster CYP2A6 activity is associated with heavier smoking and higher lung cancer risk. The CYP2A6 gene is polymorphic, including functional structural variants (SV) such as gene deletions (CYP2A6*4), duplications (CYP2A6*1 × 2), and hybrids with the CYP2A7 pseudogene (CYP2A6*12, CYP2A6*34). SVs are challenging to genotype due to their complex genetic architecture. Our aims were to develop a reliable protocol for SV genotyping, functionally phenotype known and novel SVs, and investigate the feasibility of CYP2A6 SV imputation from SNP array data in two ancestry populations. European- (EUR; n = 935) and African- (AFR; n = 964) ancestry individuals from smoking cessation trials were genotyped for SNPs using an Illumina array and for CYP2A6 SVs using Taqman copy number (CN) assays. SV-specific PCR amplification and Sanger sequencing was used to characterize a novel SV. Individuals with SVs were phenotyped using the nicotine metabolite ratio, a biomarker of CYP2A6 activity. SV diplotype and SNP array data were integrated and phased to generate ancestry-specific SV reference panels. Leave-one-out cross-validation was used to investigate the feasibility of CYP2A6 SV imputation. A minimal protocol requiring three Taqman CN assays for CYP2A6 SV genotyping was developed and known SV associations with activity were replicated. The first domain swap CYP2A6-CYP2A7 hybrid SV, CYP2A6*53, was identified, sequenced, and associated with lower CYP2A6 activity. In both EURs and AFRs, most SV alleles were identified using imputation (>70% and >60%, respectively); importantly, false positive rates were <1%. These results confirm that CYP2A6 SV imputation can identify most SV alleles, including a novel SV.
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Affiliation(s)
- Alec W R Langlois
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
| | - Ahmed El-Boraie
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
| | - Jennie G Pouget
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, 66160, USA
| | - Jasjit S Ahluwalia
- Departments of Behavioral and Social Sciences and Medicine, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Koya Fukunaga
- Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - Taisei Mushiroda
- Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - Jo Knight
- Data Science Institute and Medical School, Lancaster University, Lancaster, UK
| | - Meghan J Chenoweth
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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Garner A, Knight J, Preston N, Dixon S, Watchorn S, Caiado C, McShane C, King G, Mason S. 1583 Impact of digital technology in care homes on Emergency Department attendances. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-rcem2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims, Objectives and BackgroundHealthCall is a digital health initiative that aims to reduce emergency department attendances by upskilling care home staff to use app-based technology whereby residents with new clinical presentations’ observations are recorded electronically using a structured SBAR approach. Information is fed to a Single Point of Access where clinical staff triage the referrals. This study evaluated the effectiveness of the HealthCall technology across the North East of England to safely reduce ED referrals and attendance.Method and DesignThe study included 122 care homes covering the study period 2018–2021. Routinely collected secondary care data from County Durham and Darlington NHS Foundation Trust was linked with clinical data from HealthCall. We describe the change in ED attendances over the period before, during and after the introduction of the technology to the care homes. We fitted Poisson generalised linear mixture models to monthly counts of emergency attendances. Covariates were included to adjust for seasonality and external factors such as COVID-19, and hierarchical random intercepts were included to account for both individual and care home variability. The impact of HealthCall technology usage on residents’ expected number of attendances is tested as a ‘step’ change at intervention and a ‘slope’ change post intervention.Results and ConclusionWe identified 8,702 care home residents through linkage between the secondary care and HealthCall datasets. Preliminary results suggest the use of HealthCall reduces expected monthly ED attendances for care home residents by 16% (95%CI 5 to 25, p-value<0.001). No significant change was observed in the impact of HealthCall during the post-intervention period.This study finds that the implementation of the HealthCall technology reduces the expected number of monthly emergency department attendances for residents. The technology allows for ongoing monitoring of resident health alongside providing more convenient and timely access to clinical advice that promotes more appropriate and resident-focussed decision leading to fewer unnecessary ED attendances.
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Knight J, Bernard M, St Clair W, Kudrimoti M, Pokhrel D. Two Novel Irradiation Methods for Angiosarcoma of Total Scalp Irradiation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2284] [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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Isba R, Brennan L, Davies N, Knight J. Measles, mumps, and rubella vaccination coverage in children younger than 5 years attending a paediatric emergency department in Manchester, UK: a cross-sectional observational study. Lancet 2022; 400 Suppl 1:S51. [PMID: 36929997 DOI: 10.1016/s0140-6736(22)02261-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2019, the UK lost its WHO measles-free status, due to circulating measles virus and suboptimal coverage with the measles, mumps, and rubella (MMR) vaccine. The National Health Service (NHS) schedule recommends MMR vaccines at age 12 and 40 months. In England in 2020-21, MMR coverage did not meet the 95% target for herd immunity. This work is part of a project to develop a vaccination intervention delivered in the paediatric emergency department (PED). The aim of this study was to quantify unmet MMR-related vaccination need among PED attendees. METHODS This cross-sectional, single-centre observational study collected data on children (aged 1-5 years) attending a large district general PED in Greater Manchester, UK, from Oct 1 to Oct 31, 2021, with data collected on a single occasion. Ethics approval was for an opt-out approach. Vaccination data were extracted from individual electronic summary care records, as part of the primary care record visible within secondary care. Coverage in the study population was compared with data for the northwest of England from the Cover of Vaccination Evaluated Rapidly surveillance scheme for the period April 1, 2020 to March 31, 2021. χ2 tests were used to examine differences in proportions vaccinated. FINDINGS 1059 children aged 1-5 years attended the PED in October, 2021, and data for 977 children were included in this study. Among all children, 638 (65·3%) had at least one dose of MMR recorded in their summary care record. The most similar regional comparator was first-dose MMR by the age of 5 years, which was administered in 86 678 (95·2%) of 91 023 children in 2020-21 (p<0·0001). In our cohort, among eligible children older than 40 months (n=339), only 66 (19·5%) had received both MMR doses, compared with regional coverage (by age 5 years) in 79 535 (87·4%) of 91 023 children (p<0·0001). A power calculation showed 577 participants were needed to detect a 5% difference in second-dose MMR. INTERPRETATION Children younger than 5 years attending the PED had low rates of age-appropriate MMR vaccination coverage, suggesting considerable unmet need in these PED attendees. Other work within this project looks at tetanus coverage and sources of vaccination data. FUNDING None.
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Affiliation(s)
- Rachel Isba
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, UK; North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Louise Brennan
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, UK
| | - Nigel Davies
- School of Computing and Communication, Lancaster University, Lancaster, UK
| | - Jo Knight
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, UK
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, Low Z, May C, Musto L, Nagi S, Nur S, Salau E, Shabbir S, Thomas MC, Uthayanan L, Vig S, Zaheer M, Zeng G, Ashcroft-Quinn S, Brown R, Hayes J, McConville R, French R, Gilliam A, Sheetal S, Shehzad MU, Bani W, Christie I, Franklyn J, Khan M, Russell J, Smolarek S, Varadarassou R, Ahmed SK, Narayanaswamy S, Sealy J, Shah M, Dodhia V, Manukyan A, O'Hare R, Orbell J, Chung I, Forenc K, Gupta A, Agarwal A, Al Dabbagh A, Bennewith R, Bottomley J, Chu TSM, Chu YYA, Doherty W, Evans B, Hainsworth P, Hosfield T, Li CH, McCullagh I, Mehta A, Thaker A, Thompson B, Virdi A, Walker H, Wilkins E, Dixon C, Hassan MR, Lotca N, Tong KS, Batchelor-Parry H, Chaudhari S, Harris T, Hooper J, Johnson C, Mulvihill C, Nayler J, Olutobi O, Piramanayagam B, Stones K, Sussman M, Weaver C, Alam F, Al Rawi M, Andrew F, Arrayeh A, Azizan N, Hassan A, Iqbal Z, John I, Jones M, Kalake O, Keast M, Nicholas J, Patil A, Powell K, Roberts P, Sabri A, Segue AK, Shah A, Shaik Mohamed SA, Shehadeh A, Shenoy S, Tong A, Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, Vijay Sukhnani M, Brown L, Desai B, Elzanati H, Godhaniya J, Kavanagh E, Kent J, Kishor A, Liu A, Norwood M, Shaari N, Wood C, Wood M, Brown A, Chellapuri A, Ferriman A, Ghosh I, Kulkarni N, Noton T, Pinto A, Rajesh S, Varghese B, Wenban C, Aly R, Barciela C, Brookes T, Corrin E, Goldsworthy M, Mohamed Azhar MS, Moore J, Nakhuda S, Ng D, Pillay S, Port S, Abdullah M, Akinyemi J, Islam S, Kale A, Lewis A, Manjunath T, McCabe H, Misra S, Stubley T, Tam JP, Waraich N, Chaora T, Ford C, Osinkolu I, Pong G, Rai J, Risquet R, Ainsworth J, Ayandokun P, Barham E, Barrett G, Barry J, Bisson E, Bridges I, Burke D, Cann J, Cloney M, Coates S, Cripps P, Davies C, Francis N, Green S, Handley G, Hathaway D, Hurt L, Jenkins S, Johnston C, Khadka A, McGee U, Morris D, Murray R, Norbury C, Pierrepont Z, Richards C, Ross O, Ruddy A, Salmon C, Shield M, Soanes K, Spencer N, Taverner S, Williams C, Wills-Wood W, Woodward S, Chow J, Fan J, Guest O, Hunter I, Moon WY, Arthur-Quarm S, Edwards P, Hamlyn V, McEneaney L, N D G, Pranoy S, Ting M, Abada S, Alawattegama LH, Ashok A, Carey C, Gogna A, Haglund C, Hurley P, Leelo N, Liu B, Mannan F, Paramjothy K, Ramlogan K, Raymond-Hayling O, Shanmugarajah A, Solichan D, Wilkinson B, Ahmad NA, Allan D, Amin A, Bakina C, Burns F, Cameron F, Campbell A, Cavanagh S, Chan SMZ, Chapman S, Chong V, Edelsten E, Ekpete O, El Sheikh M, Ghose R, Hassane A, Henderson C, Hilton-Christie S, Husain M, Hussain H, Javid Z, Johnson-Ogbuneke J, Johnston A, Khalil M, Leung TCC, Makin I, Muralidharan V, Naeem M, Patil P, Ravichandran S, Saraeva D, Shankey-Smith W, Sharma N, Swan R, Waudby-West R, Wilkinson A, Wright K, Balasubramanian A, Bhatti S, Chalkley M, Chou WK, Dixon M, Evans L, Fisher K, Gandhi P, Ho S, Lau YB, Lowe S, Meechan C, Murali N, Musonda C, Njoku P, Ochieng L, Pervez MU, Seebah K, Shaikh I, Sikder MA, Vanker R, Alom J, Bajaj V, Coleman O, Finch G, Goss J, Jenkins C, Kontothanassis A, Liew MS, Ng K, Outram M, Shakeel MM, Tawn J, Zuhairy S, Chapple K, Cinnamond A, Coleman S, George HA, Goulder L, Hare N, Hawksley J, Kret A, Luesley A, Mecia L, Porter H, Puddy E, Richardson G, Sohail B, Srikaran V, Tadross D, Tobin J, Tokidis E, Young L, Ashdown T, Bratsos S, Koomson A, Kufuor A, Lim MQ, Shah S, Thorne EPC, Warusavitarne J, Xu S, Abigail S, Ahmed A, Ahmed J, Akmal A, Al-Khafaji M, Amini B, Arshad M, Bogie E, Brazkiewicz M, Carroll M, Chandegra A, Cirelli C, Deng A, Fairclough S, Fung YJ, Gornell C, Green RL, Green SV, Gulamhussein AHM, Isaac AG, Jan R, Jegatheeswaran L, Knee M, Kotecha J, Kotecha S, Maxwell-Armstrong C, McIntyre C, Mendis N, Naing TKP, Oberman J, Ong ZX, Ramalingam A, Saeed Adam A, Tan LL, Towell S, Yadav J, Anandampillai R, Chung S, Hounat A, Ibrahim B, Jeyakumar G, Khalil A, Khan UA, Nair G, Owusu-Ayim M, Wilson M, Kanani A, Kilkelly B, Ogunmwonyi I, Ong L, Samra B, Schomerus L, Shea J, Turner O, Yang Y, Amin M, Blott N, Clark A, Feather A, Forrest M, Hague S, Hamilton K, Higginbotham G, Hope E, Karimian S, Loveday K, Malik H, McKenna O, Noor A, Onsiong C, Patel B, Radcliffe N, Shah P, Tye L, Verma K, Walford R, Yusufi U, Zachariah M, Casey A, Doré C, Fludder V, Fortescue L, Kalapu SS, Karel E, Khera G, Smith C, Appleton B, Ashaye A, Boggon E, Evans A, Faris Mahmood H, Hinchcliffe Z, Marei O, Silva I, Spooner C, Thomas G, Timlin M, Wellington J, Yao SL, Abdelrazek M, Abdelrazik Y, Bee F, Joseph A, Mounce A, Parry G, Vignarajah N, Biddles D, Creissen A, Kolhe S, K T, Lea A, Ledda V, O'Loughlin P, Scanlon J, Shetty N, Weller C, Abdalla M, Adeoye A, Bhatti M, Chadda KR, Chu J, Elhakim H, Foster-Davies H, Rabie M, Tailor B, Webb S, Abdelrahim ASA, Choo SY, Jiwa A, Mangam S, Murray S, Shandramohan A, Aghanenu O, Budd W, Hayre J, Khanom S, Liew ZY, McKinney R, Moody N, Muhammad-Kamal H, Odogwu J, Patel D, Roy C, Sattar Z, Shahrokhi N, Sinha I, Thomson E, Wonga L, Bain J, Khan J, Ricardo D, Bevis R, Cherry C, Darkwa S, Drew W, Griffiths E, Konda N, Madani D, Mak JKC, Meda B, Odunukwe U, Preest G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Chenoweth MJ, Peng AR, Zhu AZX, Cox LS, Nollen NL, Ahluwalia JS, Benowitz NL, Knight J, Swardfager W, Tyndale RF. Does sex alter the relationship between CYP2B6 variation, hydroxybupropion concentration and bupropion-aided smoking cessation in African Americans? A moderated mediation analysis. Addiction 2022; 117:1715-1724. [PMID: 34791718 DOI: 10.1111/add.15742] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/28/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS CYP2B6, a genetically variable enzyme, converts bupropion to its active metabolite hydroxybupropion. CYP2B6 activity and bupropion-aided cessation differ between women and men. The aim of this study was to determine whether genetically normal (versus reduced) CYP2B6 activity increases bupropion-aided cessation in African American smokers via higher hydroxybupropion concentration, and whether this differs by sex. DESIGN AND SETTING Secondary analysis of a smoking cessation clinical trial (NCT00666978). PARTICIPANTS/CASES African American light smokers (≤ 10 cigarettes/day). INTERVENTIONS Participants were treated with bupropion for 7 weeks. MEASUREMENTS Participants with detectable bupropion and/or hydroxybupropion concentrations were divided into normal (n = 64) and reduced (n = 109) CYP2B6 activity groups based on the presence of decreased-function CYP2B6*6 and CYP2B6*18 alleles. Biochemically verified smoking cessation was assessed at week 3, end of treatment (7 weeks) and follow-up (26 weeks). FINDINGS Normal (versus reduced) CYP2B6 activity was associated with increased cessation at week 7, which was mediated by higher hydroxybupropion concentration [odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.03, 1.78]; this mediation effect persisted at week 26 (OR = 1.23, 95% CI = 1.02, 1.70). The mediation effect was similar in women (n = 116; OR = 1.33, 95% CI = 1.01, 2.30) and men (n = 57; OR = 1.33, 95% CI = 0.92, 3.87). Moreover, sex did not appear to moderate the mediation effect, although this should be tested in a larger sample. CONCLUSIONS In African American light smokers with verified early bupropion use, genetically normal CYP2B6 activity appears to be indirectly associated with greater smoking cessation success in a relationship mediated by higher hydroxybupropion concentration. The mediating effect of higher hydroxybupropion concentration on smoking cessation persists beyond the active treatment phase and does not appear to differ by sex.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Annie R Peng
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Andy Z X Zhu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nikki L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jasjit S Ahluwalia
- Departments of Behavioral and Social Sciences and Medicine, Brown University, Providence, RI, USA
| | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jo Knight
- Data Science Institute, Lancaster University Medical School, Lancaster, UK.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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16
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Langlois AW, El-Boraie A, Fukunaga K, Mushiroda T, Kubo M, Lerman C, Knight J, Scherer SE, Chenoweth MJ, Tyndale RF. Accuracy and applications of sequencing and genotyping approaches for CYP2A6 and homologous genes. Pharmacogenet Genomics 2022; 32:159-172. [PMID: 35190513 PMCID: PMC9081136 DOI: 10.1097/fpc.0000000000000466] [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: 11/27/2022]
Abstract
OBJECTIVES We evaluated multiple genotyping/sequencing approaches in a homologous region of chromosome 19, and investigated associations of two common 3'-UTR CYP2A6 variants with activity in vivo. METHODS Individuals (n = 1704) of European and African ancestry were phenotyped for the nicotine metabolite ratio (NMR), an index of CYP2A6 activity, and genotyped/sequenced using deep amplicon exon sequencing, SNP array, genotype imputation and targeted capture sequencing. Amplicon exon sequencing was the gold standard to which other methods were compared within-individual for CYP2A6, CYP2A7, CYP2A13, and CYP2B6 exons to identify highly discordant positions. Linear regression models evaluated the association of CYP2A6*1B and rs8192733 genotypes (coded additively) with logNMR. RESULTS All approaches were ≤2.6% discordant with the gold standard; discordant calls were concentrated at few positions. Fifteen positions were discordant in >10% of individuals, with 12 appearing in regions of high identity between homologous genes (e.g. CYP2A6 and CYP2A7). For six, allele frequencies in our study and online databases were discrepant, suggesting errors in online sources. In the European-ancestry group (n = 935), CYP2A6*1B and rs8192733 were associated with logNMR (P < 0.001). A combined model found main effects of both variants on increasing logNMR. Similar trends were found in those of African ancestry (n = 506). CONCLUSION Multiple genotyping/sequencing approaches used in this chromosome 19 region contain genotyping/sequencing errors, as do online databases. Gene-specific primers and SNP array probes must consider gene homology; short-read sequencing of related genes in a single reaction should be avoided. Using improved sequencing approaches, we characterized two gain-of-function 3'-UTR variants, including the relatively understudied rs8192733.
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Affiliation(s)
- Alec W.R. Langlois
- Department of Pharmacology & Toxicology, University of Toronto; 1 King’s College Circle, Toronto, ON, M5S 1A8, Canada. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
| | - Ahmed El-Boraie
- Department of Pharmacology & Toxicology, University of Toronto; 1 King’s College Circle, Toronto, ON, M5S 1A8, Canada. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
| | - Koya Fukunaga
- Center for Integrative Medical Sciences, RIKEN; 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - Taisei Mushiroda
- Center for Integrative Medical Sciences, RIKEN; 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - Michiaki Kubo
- Center for Integrative Medical Sciences, RIKEN; 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - Caryn Lerman
- Department of Psychiatry and USC Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Cancer Center, Los Angeles, CA, 90089, United States
| | - Jo Knight
- Data Science Institute and Lancaster University Medical School, Lancaster, UK
- Department of Psychiatry, University of Toronto; 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Steven E. Scherer
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Meghan J. Chenoweth
- Department of Pharmacology & Toxicology, University of Toronto; 1 King’s College Circle, Toronto, ON, M5S 1A8, Canada. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
| | - Rachel F. Tyndale
- Department of Pharmacology & Toxicology, University of Toronto; 1 King’s College Circle, Toronto, ON, M5S 1A8, Canada. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto; 250 College Street, Toronto, ON, M5T 1R8, Canada
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Chighizola C, Pregnolato F, Andrade D, Tektonidou M, Sciascia S, Pengo V, Ugarte A, Belmont HM, Gerosa M, Fortin P, Lopez-Pedrera C, Zhang Z, Atsumi T, De Jesùs G, Kello N, Branch DW, Andreoli L, Wahl D, Petri MA, Rodríguez Almaraz E, Cervera R, Pons Estel G, Knight J, Willis R, Barber M, Artim Esen B, Efthymiou M, Erkan D, Bertolaccini ML. POS0462 HYDROXYCHLOROQUINE REDUCES THE TITERS OF ANTI-DOMAIN 1 ANTIBODIES OVER TIME IN PATIENTS WITH PERSISTENTLY POSITIVE ANTIPHOSPHOLIPID ANTIBODIES: RESULTS FROM THE APS ACTION CLINICAL DATABASE AND REPOSITORY (“REGISTRY”). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundData on fluctuation of antibodies directed against domain 1 (anti-D1) of β2-glycoprotein I (β2GPI) are scarce. Patients with antiphospholipid syndrome (APS) and all three criteria tests for antiphospholipid antibodies (aPL) display higher titers of anti-D1, which correlate with anti-β2GPI levels.ObjectivesThis project aims at evaluating predictors of the variation of anti-D1 titers over time in a large international cohort of persistently aPL positive patients.MethodsAntiPhospholipid Syndrome Alliance For Clinical Trials and InternatiOnal Networking (APS ACTION) Registry was created to study the course of persistently aPL-positive patients with or without autoimmune disorders over at least 10 years. Inclusion criteria are positive aPL by Updated Sapporo Criteria tested within one year prior to enrolment. Patients are followed every 12±3 months with clinical data and blood collection. Patients with available blood samples from at least three time points were included in this analysis. Anti-β2GPI and anti-D1 IgG were tested by chemiluminescence (BioFlash, Werfen) at APS ACTION core laboratories. Positive results were defined as >20 CU, according to the manufacturer. Clinical data were retrieved from APS ACTION online database. Anti-D1 titers within the same subject were compared by Friedman’s test. A mixed linear model was built to identify predictors of the fluctuation of anti-D1 antibody titers over time.ResultsIn this longitudinal study, 230 patients with anti-D1 tested at 4 time points were included (Table 1). Patients with thrombotic APS had anti-D1 titers significantly higher than those without thrombosis (p=0.022). Among 135 patients with at least one anti-D1 positive result, anti-D1 titers varied significantly over time (Friedman statistics: 508.5, p<0.0001; anti-D1 geometric mean at baseline 189.0; T1 132.3 [-15%]; T2 113.8 [-17%]; T3 109.2 [-6% versus T2, -38% versus T1]). Anti-D1 titers were significantly higher at baseline compared to T3 (p=0.029). In the 4 years of follow-up, 18 new thrombotic events occurred. Patients with double/triple aPL positivity displayed 12.5 fold increase [95%CI 7.4-20.0] in baseline anti-D1 titers. After adjustment for age, gender and number of positive aPL tests, the fluctuation of anti-D1 titers was associated with treatment with hydroxychloroquine (HCQ) at each time-point. In particular, treatment with HCQ, but not those with conventional immunosuppressors, was associated with a 1.3-fold decrease in anti-D1 titers [95%CI 1.1-1.5]. In the same multivariable model, incident vascular events were associated with a 1.5 fold increase of anti-D1 titers. A concomitant diagnosis of systemic lupus erythematosus did not affect the fluctuation of anti-D1 titers.Table 1.Demographic and Clinical Characteristics of 230 APS ACTION Registry Patients with anti-D1 tested ≥3 time points during the follow-upAnti-D1 pos samplesAnti-D1 neg samplesp-valueOverall sample(n=135)(n=95)(n=230)Age [years] mean (SD)42.3 (11.8)48.8 (13.0)0.000145.0 (12.7)%Female (n)71.9 (97)65.3 (62)0.35869.1 (159)Associated systemic autoimmune disease39.3 (53)44.2 (42)0.53941.3 (95)aPL without APS19.3 (26)34.7 (33)0.01025.7 (59)Thrombotic APS54.1 (73)53.7 (51)53.9 (124)Obstetric APS11.9 (16)5.3 (5)9.1 (21)Thrombotic/+obstetric APS14.8 (20)6.3 (6)11.3 (26)aCL IgG89.5 (119/133)25.5 (24/94)<0.000163.0 (143/227)aCL, IgM36.1 (48/133)27.7 (26/94)0.23432.6 (74/227)Anti-2GPI, IgG93.2 (124/133)39.4 (37/94)<0.000170.9 (161/227)Anti-2GPI, IgM34.6 (46/133)21.3 (20/94)0.04329.1 (66/227)LA82.8 (82/99)59.5 (44/74)0.00172.8 (126/173)ConclusionTreatment with HCQ and vascular events during follow-up were identified as significant predictors of the fluctuation of anti-D1 antibody titers over time.Disclosure of InterestsNone declared.
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Wall J, Knight J, Emsley H. Late-onset epilepsy predicts future stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Late-onset epilepsy (LOE) is closely associated with cerebrovascular disease. LOE also appears to be a harbinger of dementia. We performed a systematic review of observational studies, clinical studies and radiological studies relating to LOE. We conducted a meta-analysis of 5 observational studies and have found that patients presenting with LOE experience an increased risk of subsequent stroke, weighted OR 3.88 (95% CI 2.76 - 5.46). Above the age of fifty, incidence of new onset epilepsy is approximately 400/100,000 person years. Of these, 9.8–11.9% will have a stroke in the decade following epilepsy onset, translating to an incidence of «pre-stroke epilepsy» of 25–55/100,000 person years. The additional studies demonstrated clinical and radiological evidence to support the premise that LOE is likely to reflect underly- ing cerebrovascular disease. Cerebrovascular risk factors convey increased risk of LOE, and LOE can act as a «harbinger» for stroke and dementia, with various proposed pathophysiological mechanisms. The onset of LOE may represent a potential point for intervention, with the aim of stroke prevention. Current data supports the need for prospective research in order to better understand the natural history of LOE, disease mechanisms and opportunities for intervention to reduce the apparent sequelae of stroke and dementia.jasminewall@googlemail.com
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Biggin F, Knight J, Emsley H. 184 Right data, right care. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There is considerable current interest in neurology ‘intelligence’. For example, NHS RightCare uses nation- ally collected data to identify and address variations in care, and the clinically led NHS improvement programme Getting It Right First Time seeks to improve quality of care by reducing variation. Despite this, current neurology ‘intelligence’ strategies lack data on clinic activity because outpatient coding is not routinely done.In order to determine what insights can be gained from routine data, we have analysed data collected at a neurology outpatient clinic (5902 appointments for 3100 patients) offered by one neurologist (HE) over three years.We found clear patterns in variables such as age distributions, interval from referral to appointment by conditions, and geographical source of referral. The data can be presented in a format useful for clini- cians and service managers, allowing identification of opportunities for change such as optimal utilisation of alternative pathways for management of primary headache disorders.In order to be most useful, this type of analysis should be available across all Neurology outpatient services. However various barriers including workforce, non-standardised approaches to outpatient coding, and variation in IT systems hamper implementation. Our ongoing collaborative project seeks to meet these challenges.f.biggin@lancaster.ac.uk
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Smith DM, Eade R, Andrews MB, Ayres H, Clark A, Chripko S, Deser C, Dunstone NJ, García-Serrano J, Gastineau G, Graff LS, Hardiman SC, He B, Hermanson L, Jung T, Knight J, Levine X, Magnusdottir G, Manzini E, Matei D, Mori M, Msadek R, Ortega P, Peings Y, Scaife AA, Screen JA, Seabrook M, Semmler T, Sigmond M, Streffing J, Sun L, Walsh A. Robust but weak winter atmospheric circulation response to future Arctic sea ice loss. Nat Commun 2022; 13:727. [PMID: 35132058 PMCID: PMC8821642 DOI: 10.1038/s41467-022-28283-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe possibility that Arctic sea ice loss weakens mid-latitude westerlies, promoting more severe cold winters, has sparked more than a decade of scientific debate, with apparent support from observations but inconclusive modelling evidence. Here we show that sixteen models contributing to the Polar Amplification Model Intercomparison Project simulate a weakening of mid-latitude westerlies in response to projected Arctic sea ice loss. We develop an emergent constraint based on eddy feedback, which is 1.2 to 3 times too weak in the models, suggesting that the real-world weakening lies towards the higher end of the model simulations. Still, the modelled response to Arctic sea ice loss is weak: the North Atlantic Oscillation response is similar in magnitude and offsets the projected response to increased greenhouse gases, but would only account for around 10% of variations in individual years. We further find that relationships between Arctic sea ice and atmospheric circulation have weakened recently in observations and are no longer inconsistent with those in models.
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TALBOT B, Martin J, Burman J, Kaur N, Garvey V, Knight J. POS-713 PROOF OF CONCEPT FOR A POINT OF CARE AFFORDABLE DIALYSIS SYSTEM. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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22
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Isba R, Davies N, Knight J. Are child health information services a viable source of accurate vaccination data for clinicians working in paediatric emergency departments in England? BMJ Health Care Inform 2021; 28:bmjhci-2021-100486. [PMID: 34949586 PMCID: PMC8704959 DOI: 10.1136/bmjhci-2021-100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/11/2021] [Indexed: 11/09/2022] Open
Abstract
Vaccination is a global success story, yet UK coverage remains undertarget for a number of diseases. The paediatric emergency department (PED) offers the potential for opportunistic vaccination interventions. OBJECTIVES To map the Greater Manchester (GM) Child Health Information System network to see if it was a viable source of vaccination data for clinicians working in the PED as a case study. METHODS Postprimary care vaccination management systems for GM were visualised using a systems mapping approach, with data obtained from the Office for National Statistics and commissioners in the GM Health and Social Care Partnership. RESULTS Once vaccination data left primary care, it passed through 1 of 10 local child health information services (CHISs), using an assortment of different information technology systems, after which it shed individual identifiers and was aggregated within national systems. None of the existing GM CHISs were accessible to PED practitioners. CONCLUSION More work needs to be done to explore possible alternative sources of accurate vaccination data during a PED consultation.
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Affiliation(s)
- Rachel Isba
- Lancaster Medical School, Lancaster University, Lancaster, UK
- Emergency Department, North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nigel Davies
- School of Computing and Communication, Lancaster University, Lancaster, UK
| | - Jo Knight
- Lancaster Medical School, Lancaster University, Lancaster, UK
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Chenoweth MJ, Cox LS, Nollen NL, Ahluwalia JS, Benowitz NL, Lerman C, Knight J, Tyndale RF. Analyses of nicotine metabolism biomarker genetics stratified by sex in African and European Americans. Sci Rep 2021; 11:19572. [PMID: 34599228 PMCID: PMC8486765 DOI: 10.1038/s41598-021-98883-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/08/2021] [Indexed: 12/01/2022] Open
Abstract
Nicotine is inactivated by the polymorphic CYP2A6 enzyme to cotinine and then to 3′hydroxycotinine. The Nicotine Metabolite Ratio (NMR; 3′hydroxycotinine/cotinine) is a heritable nicotine metabolism biomarker, varies with sex and ancestry, and influences smoking cessation and disease risk. We conducted sex-stratified genome-wide association studies of the NMR in European American (EA) and African American (AA) smokers (NCT01314001, NCT00666978). In EA females (n = 389) and males (n = 541), one significant (P < 5e−8) chromosome 19 locus was found (top variant: rs56113850, CYP2A6 (intronic), for C vs. T: females: beta = 0.67, P = 7.5e−22, 21.8% variation explained; males: beta = 0.75, P = 1.2e−37, 26.1% variation explained). In AA females (n = 503) and males (n = 352), the top variant was found on chromosome 19 but differed by sex (females: rs11878604, CYP2A6 (~ 16 kb 3′), for C vs. T: beta = − 0.71, P = 6.6e−26, 16.2% variation explained; males: rs3865454, CYP2A6 (~ 7 kb 3′), for G vs. T: beta = 0.64, P = 1.9e−19, 18.9% variation explained). In AA females, a significant region was found on chromosome 12 (top variant: rs12425845: P = 5.0e−9, TMEM132C (~ 1 Mb 5′), 6.1% variation explained) which was not significant in AA males. In AA males, significant regions were found on chromosomes 6 (top variant: rs9379805: P = 4.8e−9, SLC17A2 (~ 8 kb 5′), 8.0% variation explained) and 16 (top variant: rs77368288: P = 3.5e−8, ZNF469 (~ 92 kb 5′), 7.1% variation explained) which were not significant in AA females. Further investigation of these associations outside of chromosome 19 is required, as they did not replicate. Understanding how sex and ancestry influence nicotine metabolism genetics may improve personalized approaches for smoking cessation and risk prediction for tobacco-related diseases.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nikki L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jasjit S Ahluwalia
- Departments of Behavioral and Social Sciences and Medicine, Brown University, Providence, Rhode Island, USA
| | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jo Knight
- Data Science Institute and Lancaster University Medical School, Lancaster, UK.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Department of Pharmacology and Toxicology, University of Toronto, Medical Sciences Building Room 4326, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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Chenoweth MJ, Lerman C, Knight J, Tyndale RF. A Genome-Wide Association Study of Nausea Incidence in Varenicline-Treated Cigarette Smokers. Nicotine Tob Res 2021; 23:1805-1809. [PMID: 33713409 DOI: 10.1093/ntr/ntab044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/11/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Varenicline is the most efficacious smoking cessation treatment; however, long-term cessation rates tend to be <25%. Nausea, the most common side effect of varenicline, observed in ~28% of individuals treated, peaks early following treatment initiation and reduces cessation success. Genetic variation influences treatment response, however genetic contributors to individual differences in side effects are less understood. METHODS We conducted a genome-wide association study of nausea incidence at 1 week following the initiation of varenicline treatment (corresponding to the target quit date) in 189 cigarette smokers of European ancestry (NCT01314001). Additive genetic models examining the likelihood of experiencing any versus no nausea controlled for population substructure, age, and sex. Variants with minor allele frequencies (MAF)≥10% were considered. RESULTS Fifty-seven (30.2%) out of 189 participants reported nausea. The top variant associated with nausea was rs1568209 (odds ratio [OR] = 2.61 for A vs. G allele; 95% confidence interval [CI] = 1.65,4.15; p = 2.1e-7; MAF = 48.7%), mapping to the SLCO3A1 drug transporter gene on chromosome 15. In the same trial, rs1568209 was not associated with nausea in either the nicotine patch (p = .56; n = 181) or placebo (p = .59; n = 174) arms. In varenicline-treated smokers, the incidence of nausea was higher in females (44.6%; n = 74) versus males (20.9%; n = 115) (p = .001), however there was no evidence of a difference in the influence of rs1568209 on nausea between the sexes (p for sex*genotype interaction = .36). Future studies in larger samples are required to test the robustness of this finding. CONCLUSIONS Variation in SLCO3A1 may influence the risk for developing nausea in varenicline-treated smokers, which may alter adherence and cessation. IMPLICATIONS Varenicline-associated nausea reduces adherence and limits cessation success. Previous candidate gene association studies showed genetic factors influence nausea on varenicline. This pilot genome-wide investigation of nausea, the most common side effect associated with varenicline treatment and an important cause of treatment discontinuation, suggests the potential involvement of common variation in the SLCO3A1 drug transporter gene.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jo Knight
- Data Science Institute and Lancaster University Medical School, Lancaster, UK.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Knight J, Day M, Lee ACK, Morling JR. COVID-19: transferring learning from the pandemic response to non-communicable disease control. Public Health 2021; 197:A1-A2. [PMID: 34535216 PMCID: PMC8437800 DOI: 10.1016/j.puhe.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - M Day
- Public Health England, UK
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Biggin F, Howcroft T, Davies Q, Knight J, Emsley HCA. Variation in waiting times by diagnostic category: an observational study of 1,951 referrals to a neurology outpatient clinic. BMJ Neurol Open 2021; 3:e000133. [PMID: 34151270 PMCID: PMC8183200 DOI: 10.1136/bmjno-2021-000133] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate the frequency of diagnoses seen among new referrals to neurology outpatient services; to understand how these services are used through exploratory analysis of diagnostic tests and follow-up appointments; and to examine the waiting times between referral and appointment. METHODS Routine data from new National Health Service appointments at a single consultant-delivered clinic between September 2016 and January 2019 were collected. These clinical data were then linked to hospital administrative data. The combined data were assigned diagnostic categories based on working diagnoses to allow further analysis using descriptive statistics. RESULTS Five diagnostic categories accounted for 62% of all patients seen within the study period, the most common of which was headache disorders. Following a first appointment, 50% of all patients were offered at least one diagnostic test, and 35% were offered a follow-up appointment, with variation in both measures by diagnostic category. Waiting times from referral to appointment also varied by diagnostic category. 65% of patients with a seizure/epilepsy disorder were seen within the 18-week referral to treatment target, compared with 38% of patients with a movement disorder. CONCLUSIONS A small number of diagnostic categories account for a large proportion of new patients. This information could be used in policy decision-making to describe a minimum subset of categories for diagnostic coding. We found significant differences in waiting times by diagnostic category, as well as tests ordered, and follow-up offered; further investigation could address causes of variation.
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Affiliation(s)
- Fran Biggin
- Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Timothy Howcroft
- Health Informatics, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Quinta Davies
- Health Informatics, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jo Knight
- Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Kemp M, Biggin F, Dayanandan R, Knight J, Emsley HCA. COVID-19 exposes the urgent need for coding of outpatient neurology episodes. BMJ Neurol Open 2021; 2:e000080. [PMID: 33681802 PMCID: PMC7903171 DOI: 10.1136/bmjno-2020-000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mike Kemp
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Fran Biggin
- Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
| | - Rejith Dayanandan
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Jo Knight
- Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
| | - Hedley C A Emsley
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.,Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
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Wall J, Knight J, Emsley HCA. Late-onset epilepsy predicts stroke: Systematic review and meta-analysis. Epilepsy Behav 2021; 115:107634. [PMID: 33334717 DOI: 10.1016/j.yebeh.2020.107634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Late-onset epilepsy (LOE) is closely associated with cerebrovascular disease, acting as both a marker of cerebrovascular disease (CVD) and occurring as a direct consequence. Despite this, our understanding of LOE as a cerebrovascular phenomenon is in its infancy. LOE also appears to be a harbinger of dementia. METHODS A systematic review was performed to identify publications relating to LOE and identified observational studies, clinical studies, and radiological studies. RESULTS A meta-analysis of observational studies demonstrated that patients presenting with LOE experience an increased risk of subsequent stroke (weighted OR 3.88 (95% CI 2.76-5.46)). The additional studies demonstrated clinical and radiological evidence to support the premise that LOE is likely to reflect underlying cerebrovascular disease. SIGNIFICANCE Cerebrovascular disease risk factors convey increased risk of LOE and LOE can precede stroke and dementia, acting as an early marker for cerebrovascular risk. This may represent a potential point for intervention. There are a number of suggested mechanisms relating LOE to stroke; however, there is limited understanding of the natural history of LOE. Current data support the need for prospective research in order to understand the natural history of LOE and modify disease, in order to reduce the apparent sequelae of stroke and dementia.
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Affiliation(s)
- Jasmine Wall
- Lancaster Medical School, Lancaster University, Lancaster, UK; Department of Neurology, Royal Preston Hospital, Preston, UK.
| | - Jo Knight
- Lancaster Medical School, Lancaster University, Lancaster, UK; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University, Lancaster, UK; Department of Neurology, Royal Preston Hospital, Preston, UK
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Johnson O, Gatheral T, Knight J, Giorgi E. A modelling framework for developing early warning systems of COPD emergency admissions. Spat Spatiotemporal Epidemiol 2021; 36:100392. [PMID: 33509425 DOI: 10.1016/j.sste.2020.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality worldwide and is a major contributor to the number of emergency admissions in the UK. We introduce a modelling framework for the development of early warning systems for COPD emergency admissions. We analyse the number of COPD emergency admissions using a Poisson generalised linear mixed model. We group risk factors into three main groups, namely pollution, weather and deprivation. We then carry out variable selection within each of the three domains of COPD risk. Based on a threshold of incidence rate, we then identify the model giving the highest sensitivity and specificity through the use of exceedance probabilities. The developed modelling framework provides a principled likelihood-based approach for detecting the exceedance of thresholds in COPD emergency admissions. Our results indicate that socio-economic risk factors are key to enhance the predictive power of the model.
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Affiliation(s)
- Olatunji Johnson
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK.
| | - Tim Gatheral
- Respiratory Medicine, Royal Lancaster Infirmary, Lancaster, UK
| | - Jo Knight
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Emanuele Giorgi
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
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El-Boraie A, Chenoweth MJ, Pouget JG, Benowitz NL, Fukunaga K, Mushiroda T, Kubo M, Nollen NL, Sanderson Cox L, Lerman C, Knight J, Tyndale RF. Transferability of Ancestry-Specific and Cross-Ancestry CYP2A6 Activity Genetic Risk Scores in African and European Populations. Clin Pharmacol Ther 2020; 110:975-985. [PMID: 33300144 DOI: 10.1002/cpt.2135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
The Nicotine Metabolite Ratio (NMR; 3-hydroxycotinine/cotinine), a highly heritable index of nicotine metabolic inactivation by the CYP2A6 enzyme, is associated with numerous smoking behaviors and diseases, as well as unique cessation outcomes. However, the NMR cannot be measured in nonsmokers, former smokers, or intermittent smokers, for example, in evaluating tobacco-related disease risk. Traditional pharmacogenetic groupings based on CYP2A6 * alleles capture a modest portion of NMR variation. We previously created a CYP2A6 weighted genetic risk score (wGRS) for European (EUR)-ancestry populations by incorporating independent signals from genome-wide association studies to capture a larger proportion of NMR variation. However, CYP2A6 genetic architecture is unique to ancestral populations. In this study, we developed and replicated an African-ancestry (AFR) wGRS, which captured 30-35% of the variation in NMR. We demonstrated model robustness against known environmental sources of NMR variation. Furthermore, despite the vast diversity within AFR populations, we showed that the AFR wGRS was consistent between different US geographical regions and unaltered by fine AFR population substructure. The AFR and EUR wGRSs can distinguish slow from normal metabolizers in their respective populations, and were able to reflect unique smoking cessation pharmacotherapy outcomes previously observed for the NMR. Additionally, we evaluated the utility of a cross-ancestry wGRS, and the capacity of EUR, AFR, and cross-ancestry wGRSs to predict the NMR within stratified or admixed AFR-EUR populations. Overall, our findings establish the clinical benefit of applying ancestry-specific wGRSs, demonstrating superiority of the AFR wGRS in AFRs.
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Affiliation(s)
- Ahmed El-Boraie
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Toronto, Ontario, Canada
| | - Meghan J Chenoweth
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Toronto, Ontario, Canada
| | - Jennie G Pouget
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Koya Fukunaga
- Center for Integrative Medical Sciences, RIKEN, Kanagawa, Japan
| | | | - Michiaki Kubo
- Center for Integrative Medical Sciences, RIKEN, Kanagawa, Japan
| | - Nicole L Nollen
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Lisa Sanderson Cox
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Caryn Lerman
- Department of Psychiatry and USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Jo Knight
- Data Science Institute and Medical School, Lancaster University, Lancaster, UK
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND This review focuses on neurology research which uses routinely collected data. The number of such studies is growing alongside the expansion of data collection. We aim to gain a broad picture of the scope of how routine healthcare data have been utilised. METHODS This study follows a systematic mapping review approach which does not make a judgement on the quality of the papers included in the review, thereby enabling a complete overview of the field. RESULTS Of 4481 publications retrieved, 386 met the eligibility criteria for this study. These publications covered a wide range of conditions, but the majority were based on one or only a small number of neurological conditions. In particular, publications concerned with three discrete areas of neurological practice - multiple sclerosis (MS), epilepsy/seizure and Parkinson's disease - accounted for 60% of the total. MS was the focus of the highest proportion of eligible studies (35%), yet in the recent Global Burden of Neurological Disease study it ranks only 14th out of 15 neurological disorders for DALY rates. In contrast, migraine is the neurological disorder with the highest ranking of DALYs globally (after stroke) and yet it was represented by only 4% of eligible studies. CONCLUSION This review shows that there is a disproportionately large body of literature pertaining to relatively rare disorders, and a correspondingly small body of literature describing more common conditions. Therefore, there is potential for future research to redress this balance.
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Affiliation(s)
- Fran Biggin
- Lancaster University Faculty of Health and Medicine, Furness College, Lancaster University, Bailrigg, Lancaster, LA1 4YG England
| | - Hedley C. A. Emsley
- Lancaster University Faculty of Health and Medicine, Furness College, Lancaster University, Bailrigg, Lancaster, LA1 4YG England
- Lancashire Hospitals NHS Foundation Trust, Department of Neurology, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, PR2 9HT England
| | - Jo Knight
- Lancaster University Faculty of Health and Medicine, Furness College, Lancaster University, Bailrigg, Lancaster, LA1 4YG England
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AlHilli M, Maggiotto A, Tullio K, Ricci S, Mahdi H, Knight J, DeBernardo R, Michener C, Rose P. Decrease in time to treatment in gynecologic cancers through quality improvement. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.526] [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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Room HJ, Ji C, Kohli S, Choh C, Robinson P, Knight J, Dennis S. Core surgical field camps: a new deanery-based model for enhancing advanced skills in core surgical trainees through simulation. Br J Hosp Med (Lond) 2020; 81:1-6. [PMID: 32990069 DOI: 10.12968/hmed.2020.0333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.
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Affiliation(s)
- H J Room
- Department of Upper Gastrointestinal Surgery, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - C Ji
- Department of Upper Gastrointestinal Surgery, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - S Kohli
- Department of Trauma and Orthopaedic Surgery, Salisbury District Hospital Foundation Trust, Salisbury, UK
| | - Ctp Choh
- Department of Upper Gastrointestinal Surgery, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Bournemouth, UK
| | - P Robinson
- Department of Colorectal Surgery, University Hospitals Southampton, Southampton, UK
| | - J Knight
- Department of Upper Gastrointestinal Surgery, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - S Dennis
- Department of Otolaryngology, Salisbury District Hospital Foundation Trust, Salisbury, UK
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Pouget JG, Han B, Wu Y, Mignot E, Ollila HM, Barker J, Spain S, Dand N, Trembath R, Martin J, Mayes MD, Bossini-Castillo L, López-Isac E, Jin Y, Santorico SA, Spritz RA, Hakonarson H, Polychronakos C, Raychaudhuri S, Knight J. Cross-disorder analysis of schizophrenia and 19 immune-mediated diseases identifies shared genetic risk. Hum Mol Genet 2020; 28:3498-3513. [PMID: 31211845 PMCID: PMC6891073 DOI: 10.1093/hmg/ddz145] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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: 03/02/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 01/01/2023] Open
Abstract
Many immune diseases occur at different rates among people with schizophrenia compared to the general population. Here, we evaluated whether this phenomenon might be explained by shared genetic risk factors. We used data from large genome-wide association studies to compare the genetic architecture of schizophrenia to 19 immune diseases. First, we evaluated the association with schizophrenia of 581 variants previously reported to be associated with immune diseases at genome-wide significance. We identified five variants with potentially pleiotropic effects. While colocalization analyses were inconclusive, functional characterization of these variants provided the strongest evidence for a model in which genetic variation at rs1734907 modulates risk of schizophrenia and Crohn’s disease via altered methylation and expression of EPHB4—a gene whose protein product guides the migration of neuronal axons in the brain and the migration of lymphocytes towards infected cells in the immune system. Next, we investigated genome-wide sharing of common variants between schizophrenia and immune diseases using cross-trait LD score regression. Of the 11 immune diseases with available genome-wide summary statistics, we observed genetic correlation between six immune diseases and schizophrenia: inflammatory bowel disease (rg = 0.12 ± 0.03, P = 2.49 × 10−4), Crohn’s disease (rg = 0.097 ± 0.06, P = 3.27 × 10−3), ulcerative colitis (rg = 0.11 ± 0.04, P = 4.05 × 10–3), primary biliary cirrhosis (rg = 0.13 ± 0.05, P = 3.98 × 10−3), psoriasis (rg = 0.18 ± 0.07, P = 7.78 × 10–3) and systemic lupus erythematosus (rg = 0.13 ± 0.05, P = 3.76 × 10–3). With the exception of ulcerative colitis, the degree and direction of these genetic correlations were consistent with the expected phenotypic correlation based on epidemiological data. Our findings suggest shared genetic risk factors contribute to the epidemiological association of certain immune diseases and schizophrenia.
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Affiliation(s)
- Jennie G Pouget
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Buhm Han
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yang Wu
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Hanna M Ollila
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA, USA.,Finnish Institute for Molecular Medicine, Helsinki, Finland.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA and Broad Institute, Cambridge, MA, USA
| | - Jonathan Barker
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,St. John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sarah Spain
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Nick Dand
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard Trembath
- School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - Javier Martin
- Institute of Parasitology and Biomedicine López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Granada, Spain
| | - Maureen D Mayes
- The University of Texas Health Science Center-Houston, Houston, USA
| | - Lara Bossini-Castillo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Elena López-Isac
- Institute of Parasitology and Biomedicine López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Granada, Spain
| | - Ying Jin
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora 80045, CO, USA
| | - Stephanie A Santorico
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Richard A Spritz
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora 80045, CO, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Constantin Polychronakos
- Endocrine Genetics Laboratory, Department of Pediatrics and the Child Health Program of the Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Soumya Raychaudhuri
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Partners HealthCare Center for Personalized Genetic Medicine, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Jo Knight
- Lancaster Medical School and Data Science Institute, Lancaster University, Lancaster, UK
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Bassi A, John MD O, Joshi R, Kotwal S, Angell B, Jan S, Gallagher M, Knight J, Jha V. SUN-180 SOCIO-DEMOGRAPHIC CHARACTERISTICS AND OUTCOMES AT 18 MONTHS OF A COHORT OF ESKD PATIENTS STARTING HEMODIALYSIS IN INDIA. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.713] [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: 11/28/2022] Open
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36
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TALBOT B, Sood A, Smyth B, Leishman G, Garvey V, Kaur N, Knight J. SAT-273 EARLY DETECTION OF PERITONITIS - A NOVEL APPROACH TO PERITONEAL EFFLUENT TURBIDITY. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.290] [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: 10/24/2022] Open
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37
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Asghari S, Boyd S, Knight J, Blackmore J, Hurley O, Allison J, Gilbert L, Dowden J, Lundrigan P. Developing a comprehensive database with sensitive health information: A profile of people living with HIV in Newfoundland and Labrador, Canada. Int J Popul Data Sci 2020; 5:1144. [PMID: 32935052 PMCID: PMC7473269 DOI: 10.23889/ijpds.v5i1.1144] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction Developing a comprehensive cohort of people living with HIV (PLHIV) to help improve healthcare has long been the vision of researchers, clinicians and decision makers. The development of this kind of database is challenging and requires strict adherence to privacy and confidentiality policies. We explored procedures, activities and events in database development. Objectives To understand processes of developing a database with sensitive health information in Newfoundland and Labrador (NL), and to investigate procedures and activities to develop the database within its environmental context. Methods A narrative case study was used to explain the challenges and procedures involved in developing a database for our population. The development of the PLHIV cohort in NL is provided as an example to demonstrate the complexity of the process. We linked three datasets that included patient-level data for PLHIV: 1. laboratory data; 2. HIV clinic data; 3. health administrative data, which allowed for the creation of a large database containing many variables describing the PLHIV cohort in the province. Results We developed a de-identified cohort of 251 PLHIV that contained 178 variables. Our case study showed database development is an iterative process. The main challenges were ensuring patient privacy and data confidentiality are not compromised and working with multi-custodian data. These challenges were addressed by establishing a data governance team. Conclusions It is important that policy be implemented to merge siloed data sources in order to provide researchers with accurate and complete data that is required to conduct sound and precise research with maximum benefits for treatment and policy-making to improve health outcomes.
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Affiliation(s)
- S Asghari
- Memorial University of Newfoundland Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine St. John's, Newfoundland and Labrador, Canada A1B 3V6
| | - S Boyd
- Memorial University of Newfoundland Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine St. John's, Newfoundland and Labrador, Canada A1B 3V6
| | - J Knight
- Memorial University of Newfoundland Primary Healthcare Research Unit, Discipline of Family Medicine, Faculty of Medicine St. John's, Newfoundland and Labrador, Canada A1B 3V6
| | - J Blackmore
- Memorial University of Newfoundland Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine St. John's, Newfoundland and Labrador, Canada A1B 3V6
| | - O Hurley
- Memorial University of Newfoundland Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine St. John's, Newfoundland and Labrador, Canada A1B 3V6
| | - J Allison
- Memorial University of Newfoundland Division of Community Health and Humanities St. John's, Newfoundland and Labrador, Canada
| | - L Gilbert
- Eastern Health Newfoundland and Labrador Public Health Microbiology Laboratory St. John's, Newfoundland and Labrador, Canada A1A 3Z9
| | - J Dowden
- Eastern Health Provincial Cancer Care Program St. John's, Newfoundland and Labrador, Canada A1B 3V6
| | - P Lundrigan
- University of Ottawa Bruyere Research Institute Ottawa, Ontario, Canada K1R 6M1
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Youde J, Rawlings J, Knight J. 41 Using Patient Centred Care to Redesign Integrated Discharge Services in Derby. Age Ageing 2020. [DOI: 10.1093/ageing/afz185.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Discharge to Assess as outlined by the Department of Health was adopted in Derby in 2016. Previously the discharge pathways to community settings from the acute trust were complex. Challenges included: Operating from a traditional residential care home.No integration of community health staff and social care teams leading to delays in treatment and decision making as well as multiple referrals and hand-overs and no joint communication which was confusing for patients.Stakeholder anticipation of 6 weeks length of stay.Limited responsiveness to capacity demand within planned and unplanned community physiotherapy.Changing the culture and mind-set of staff.Different health and social care processes and procedures, IT systems, working patterns, contracts and pay scales.
Methods
A new service model, joint processes and standard operating procedures was developed with the patient at the centre of the design. Trusted assessment and information sharing reduce multiple assessments and hand overs, ensuring a smoother and improved patient experience.
Outcomes
Triage of patients from the Integrated Discharge Hub to the appropriate pathway, early discharge planning, board rounds and MDT's and timely assessments combined with an enablement ethos have increased the flow of patients through the service, decreased care package hours and increased capacity through reducing both length of stay and delayed transfers of care. The health and social care teams are now delivering fully integrated care and undertaking joint training. This has led to a reduction in treatment times from 20 days to 12 days, reductions in DTOC to average of 8 days per month and improved access to community based routine therapy from 85% of referrals being seen by 6 weeks 2017-18 to 99% in 2018-19.
Conclusions
The integrated service delivers more for less resulting in significant savings in the healthcare and social care system while maintaining quality standards and outcomes.
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Affiliation(s)
- J Youde
- University Hospitals of Derby and Burton
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Winterburn JL, Voineskos AN, Devenyi GA, Plitman E, de la Fuente-Sandoval C, Bhagwat N, Graff-Guerrero A, Knight J, Chakravarty MM. Can we accurately classify schizophrenia patients from healthy controls using magnetic resonance imaging and machine learning? A multi-method and multi-dataset study. Schizophr Res 2019; 214:3-10. [PMID: 29274736 DOI: 10.1016/j.schres.2017.11.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 02/02/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Machine learning is a powerful tool that has previously been used to classify schizophrenia (SZ) patients from healthy controls (HC) using magnetic resonance images. Each study, however, uses different datasets, classification algorithms, and validation techniques. Here, we perform a critical appraisal of the accuracy of machine learning methodologies used in SZ/HC classifications studies by comparing three machine learning algorithms (logistic regression [LR], support vector machines [SVMs], and linear discriminant analysis [LDA]) on three independent datasets (435 subjects total) using two tissue density estimates and cortical thickness (CT). Performance is assessed using 10-fold cross-validation, as well as a held-out validation set. Classification using CT outperformed tissue densities, but there was no clear effect of dataset. LR, SVMs, and LDA each yielded the highest accuracies for a different feature set and validation paradigm, but most accuracies were between 55 and 70%, well below previously reported values. The highest accuracy achieved was 73.5% using CT data and an SVM. Taken together, these results illustrate some of the obstacles to constructing effective disease classifiers, and suggest that tissue densities and CT may not be sufficiently sensitive for SZ/HC classification given current available methodologies and sample sizes.
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Affiliation(s)
- Julie L Winterburn
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Aristotle N Voineskos
- Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel A Devenyi
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Eric Plitman
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Nikhil Bhagwat
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jo Knight
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Data Science Institute and Medical School, Lancaster University, Bailrigg, United Kingdom
| | - M Mallar Chakravarty
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada.
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40
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Mirza SS, Saeed U, Knight J, Ramirez J, Stuss DT, Keith J, Nestor SM, Yu D, Swardfager W, Rogaeva E, St George Hyslop P, Black SE, Masellis M. APOE ε4, white matter hyperintensities, and cognition in Alzheimer and Lewy body dementia. Neurology 2019; 93:e1807-e1819. [PMID: 31575706 PMCID: PMC6946485 DOI: 10.1212/wnl.0000000000008377] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 10/17/2018] [Accepted: 06/13/2019] [Indexed: 01/07/2023] Open
Abstract
Objective To determine if APOE ε4 influences the association between white matter hyperintensities (WMH) and cognitive impairment in Alzheimer disease (AD) and dementia with Lewy bodies (DLB). Methods A total of 289 patients (AD = 239; DLB = 50) underwent volumetric MRI, neuropsychological testing, and APOE ε4 genotyping. Total WMH volumes were quantified. Neuropsychological test scores were included in a confirmatory factor analysis to identify cognitive domains encompassing attention/executive functions, learning/memory, and language, and factor scores for each domain were calculated per participant. After testing interactions between WMH and APOE ε4 in the full sample, we tested associations of WMH with factor scores using linear regression models in APOE ε4 carriers (n = 167) and noncarriers (n = 122). We hypothesized that greater WMH volume would relate to worse cognition more strongly in APOE ε4 carriers. Findings were replicated in 198 patients with AD from the Alzheimer's Disease Neuroimaging Initiative (ADNI-I), and estimates from both samples were meta-analyzed. Results A significant interaction was observed between WMH and APOE ε4 for language, but not for memory or executive functions. Separate analyses in APOE ε4 carriers and noncarriers showed that greater WMH volume was associated with worse attention/executive functions, learning/memory, and language in APOE ε4 carriers only. In ADNI-I, greater WMH burden was associated with worse attention/executive functions and language in APOE ε4 carriers only. No significant associations were observed in noncarriers. Meta-analyses showed that greater WMH volume was associated with worse performance on all cognitive domains in APOE ε4 carriers only. Conclusion APOE ε4 may influence the association between WMH and cognitive performance in AD and DLB.
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Affiliation(s)
- Saira Saeed Mirza
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK.
| | - Usman Saeed
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Jo Knight
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Joel Ramirez
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Donald T Stuss
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Julia Keith
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Sean M Nestor
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Di Yu
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Walter Swardfager
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Ekaterina Rogaeva
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Peter St George Hyslop
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Sandra E Black
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Mario Masellis
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
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Lopez Hernandez D, Knight J, Litvin P, Rugh-Fraser R, Bueno A, Cervantes R, Mangassarian S, Fatoorechi S, Rico M, Arzuyan AMcElwee C, Hardy D, Carranza E, Vespa P, Plurad D, Hovda D, Woo E, Fuster J, Budding D, Wright M. B-66 The Effect of Bilingualism on Boston Naming Test Performance in Traumatic Brain Injury Survivors and Healthy Adults. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The Boston Naming Test (BNT) is a lexical-retrieval task. It has been documented that those with a history of traumatic brain injury (TBI) have reduced performance on the BNT. Bilingualism is also known to impact BNT performances. We examined the relationship of TBI and bilingualism/monolingualism on BNT performances.
Method
The sample (N = 95) consisted of 36 healthy controls (19 bilingual; 17 monolingual), 32 acute TBI participants (12 bilingual; 20 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. All participants passed performance validity testing. A 3X2 ANOVA was conducted to determine the effect of TBI and bilingualism/monolingualism on BNT performance.
Results
A main effect was found for group (i.e., control, 6 month TBI, and 12 month TBI), p < .001, ηp² = .21. Pairwise comparisons revealed that acute TBI participants performed worse than the control and chronic TBI groups. A main effect for bilingualism/ monolingualism was found, p < .001, ηp² = .14; monolinguals performed better on the BNT. No interactions were found between TBI and bilingualism/monolingualism.
Conclusions
BNT performance improves overtime in TBI and the pattern of improvement post-TBI is not statistically different between bilingual/monolingual groups. Relative to monolinguals, bilingual participants demonstrated worse BNT performance.
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Bueno A, Lopez Hernandez W, Litvin P, Knight J, McElwee C, Cervantes R, Rugh-Fraser R, Arzuyan A, Bichlmeier A, Fatoorechi SMangassarian S, Hardy D, Vespa P, Plurad D, Hovda D, Woo E, Fuster J, Budding D, Wright M. B-71 The Effect of Bilingualism on Verbal and Design Fluency Performance in Traumatic Brain Injury Survivors and Healthy Adults. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Traumatic brain injury (TBI) impacts neurocognitive function. Language is also known to influence test performances. We examined the relationship between TBI and monolingualism/bilingualism on verbal and design fluency tests.
Method
The sample (N = 74) consisted of 33 healthy controls (18 bilingual; 15 monolingual), 15 acute TBI participants (6 bilingual; 9 monolingual), and 26 chronic TBI participants (15 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. The Delis-Kaplan Executive Function System Letter Fluency (DKEFS-LF), Category Fluency (DKEFS-CF), Category Switching Fluency (DKEFS-CSF), and global verbal fluency composite (DKEFS-GVF) scores assessed verbal fluency; DKEFS fill-dots (DKEFS-FD), empty dots (DFEFS-ED), dot switching (DKEFS-DS), and global design fluency composite (DKEFS-GDF) scores assessed design fluency; and global verbal and non-verbal fluency composite (DKEFS-GF) assessed overall fluency. 3X2 ANOVAs were conducted to evaluate the effect of monolingualism/bilingualism on fluency performance in TBI and controls.
Results
The groups (control and TBI groups) differed for DKEFS-LF, p = .048, ηp² = .09, DKEFS-CF, p = .000, ηp² = .21, DKEFS-GVF, p = .004, ηp² = .15, DKEFS-ED, p = .008, ηp² = .13, DKEFS-GF, p = .001, ηp² = .20, with controls outperforming TBI groups on the DKEFS-CF, DKEFS-GVF, and DKEFS-GF. Furthermore, controls outperformed acute TBI participants on the DKEFS-LF and DKEFS-ED. Main effects were found for bilingualism/monolingualism on DKEFS-CF, p = .035, ηp² = .06, with bilinguals outperforming monolinguals. No interactions were found.
Conclusion
The TBI group had poor verbal and design fluency in contrast controls. Unexpectedly, bilinguals outperformed monolinguals on a task of verbal category fluency. Revealing that in the present study bilinguals have better semantic verbal fluency abilities.
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Carranza E, Abe J, Abueno A, Cervantes R, Fernandez A, Hardy D, Jauregui G, Knight J, Lopez W, Wright M. A-01 Age of Immigration and Test Performance for Immigrant Spanish-speakers on Córdoba Naming Test. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
This study examines the correlation between age of immigration for Spanish speakers in the USA and their performance on the Córdoba Naming Test (CNT), a confrontation naming test designed to be multicultural. We predicted that those who immigrated at a later age, whom we expect to have more years of education in their native language, will perform better on the CNT.
Method
The study used the CNT with a sample of 44 Spanish-speakers from the United States. We worked with participants with no prior history of medical complications, such as damage to the central nervous system, drug use, or excessive alcohol use. 21 male and 23 female participants were recruited. The age of participants ranged from 20 to 89 years old and education ranged from 0 to 22 years of schooling (either in the United States or in their native country). The variables of focus are the age of immigration into the United States (when participants migrated into the US) and their test performance on the CNT (total score of correct responses).
Results
Our results indicate a statistically significant positive correlation between age of immigration and performance on the CNT, (r(44)) = .357, p = .019). Conclusions: The overall trend of the data suggested that older age at immigration was indeed associated with better performance on the CNT, thus highlighting the importance of language and acculturation issues when being assessed with neuropsychological or cognitive testing.
Conclusions
The overall trend of the data suggested that older age at immigration was indeed associated with better performance on the CNT, thus highlighting the importance of language and acculturation issues when being assessed with neuropsychological or cognitive testing.
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Rugh-Fraser R, Litvin P, Lopez Hernandez W, Knight J, Arzuyan A, Cervantes R, Bueno A, Fatoorechi S, Mangassarian S, Hardy DVespa P, Plurad D, Hovda D, Woo E, Fuster J, Budding D, Wright M. B-69 The Effect of Bilingualism on Symbol Digit Modalities Test Performance in Traumatic Brain Injury Survivors and Healthy Adults. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Traumatic brain injury (TBI) survivors exhibit cognitive deficits. Language factors can also influence neurocognitive performance. We examined the effects of TBI and bilingualism/monolingualism on a test of attention and cognitive speed (i.e., Symbol Digit Modalities Test; SDMT).
Method
The sample (N = 98) consisted of 37 controls (19 bilingual; 18 monolingual), 34 acute TBI participants (12 bilingual; 22 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury; chronic TBI participants were tested 12 months or more post-injury. All participants passed performance validity testing. 3X2 ANOVAs were conducted to determine the effect of TBI and language on SDMT written and oral performance.
Results
A main effect was found between groups (control and TBI groups) on SDMT written, p < .001, ηp² = .19 and SDMT oral p < .001, ηp² = .16. Pairwise comparisons revealed a difference between the control group and TBI groups, with TBI groups performing worse. A main effect for bilingualism/monolingualism was not found; interaction effects emerged between TBI and bilingualism/monolingualism on SDMT written, p < .05, ηp² = .07 and SDMT oral p < .05, ηp² = .07.
Conclusion
TBI groups performed worse than controls on the SDMT. Relative to monolinguals with TBI, our findings suggest better cognitive recovery of verbal attention and cognitive speed in bilingual TBI participants.
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Knight J, Arzuyan A, Lopez-Hernandez W, Litvin P, Cervante R, Rugh-Fraser R, Torres E, Magassarian S, Fatoorechi S, Bichlmeier ABueno A, Hardy D, Vespa P, Plurad D, Hovda D, Woo E, Fuster J, Budding D, Wright M. B-68 The Effect of Bilingualism on Stroop Performance in Traumatic Brain Injury Survivors and Healthy Adults. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Traumatic brain injury (TBI) affects neurocognition. Speaking multiple languages can also influence cognitive test performances. We examined the relationship between TBI and monolingualism/bilingualism on a task of attention and response inhibition (Stroop Color Word Test; SCWT).
Method
The sample (N = 96) consisted of 37 healthy controls (19 bilingual; 18 monolingual), 32 acute TBI participants (12 bilingual; 20 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. The SCWT included the word (SCWT-W), color (SCWT-C), and color-word interference (SCWT-I) conditions. All participants passed performance validity testing. 3X2 ANOVAs were conducted to examine the relationship between TBI and monolingualism/bilingualism on SCWT performances.
Results
Group effects (control and TBI groups) were found for all Stroop measures. We found main effects of TBI on SCWT-W, p = .013, ηp² = .09, SCWT-C, p = .001, ηp² = .14, and SCWT-I, p = .022, ηp² = .08, with the controls outperforming acute TBI survivors on SCWT-I, chronic TBI survivors on SCWT-W, and both TBI groups on SCWT-C. We also observed main effects of language for SCWT-C, p = .012, ηp² = .07, and SCWT-I, p = .003, ηp² = .09, with the monolinguals outperforming bilinguals on SCWT-C and SCWT-I. However, no significant interactions between TBI and language were found.
Conclusion
As expected, the control group outperformed TBI survivors on the SCWT. Monolinguals outperformed bilinguals on all Stroop measures except SCWT-W condition. Our findings seem to suggest that monolingual speakers may have better attention and response inhibition abilities that resulted in better SCWT performance.
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Cervantes R, Lopez Hernandez W, Knight J, Litvin P, Bueno A, Rugh-Fraser R, McElwee C, Bichlmeier A, Arzuyan A, Hardy DMangassarian S, Torres E, Fatoorechi S, Vespa P, Plurad D, Hovda D, Woo E, Fuster J, Budding D, Wright M. B-67 The Effect of Bilingualism on Executive Functioning Performance in Traumatic Brain Injury Survivors and Healthy Adults. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Traumatic brain injury (TBI) survivors often exhibit problems with executive function (EF). Language use can also impact EF test performances. We examined the effects of TBI and bilingualism/monolingualism on several EF tests.
Method
The sample (N = 94) consisted of 37 healthy controls (19 bilingual; 18 monolingual), 30 acute TBI participants (10 bilingual; 20 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. Stroop Color-Word (SCW), Delis-Kaplan Executive Function System Letter Fluency (DKEFS-LF), Trail Making Test part B (TMT-B) and a EF global composite (EF-GC) were used to assess EF. All participants passed performance validity testing. 3X2 ANOVAs were conducted to determine the effect of TBI and bilingualism/monolingualism on EF performances.
Results
Main effects were found between groups (control and TBI groups) on SCW, p = .046, ηp² = .07, TMT-B, p = .042, ηp² = .07, and EF-GC, p = .005, ηp² = .13; the 6-month TBI group performed worse than controls on TMT-B and EF-GC. Main effects were found for bilingualism/ monolingualism on SCW, p = .012, ηp² = .07, and TMT-B, p = .034, ηp² = .05; monolingual participants performed better than bilingual participants. No significant interactions between TBI and language were found.
Conclusion
The TBI group underperformed on SCW, TMT-B, and EF-GC compared to controls; relative to monolinguals, bilinguals underperformed on the SCW and TMT-B only. In conclusion, our findings seem to suggest that monolinguals have better cognitive flexibility compared to bilinguals that result in better EF performances.
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Litvin P, Rugh-Fraser R, Lopez-Hernandez W, Knight J, Cervantes R, Bueno A, Arzuyan A, Rico M, Fatoorechi S, Mangassarian SHardy D, Vespa P, Plurad D, Hovda D, Woo E, Fuster J, Budding D, Wright M. B-70 The Effect of Bilingualism on Trail Making Test Performance in Traumatic Brain Injury Survivors and Healthy Adults. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Traumatic brain injury (TBI) is associated with a number of cognitive deficits. Language factors also impact neurocognitive performance. We examined the effects of TBI and bilingualism/monolingualism on a test of attention and executive functioning (Trail Making Test; TMT).
Method
The sample (N = 96) consisted of 36 healthy controls (19 bilingual; 17 monolingual), 34 acute TBI participants (12 bilingual; 21 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. 3X2 ANOVAs were conducted to determine the effect of TBI and bilingualism/monolingualism on TMT part A and B.
Results
Main effects were found between groups (i.e., control and TBI groups) on TMT A, p < .001, ηp² = .17 and TMT B, p < .05, ηp² = .09. Pairwise comparisons revealed a difference only between the control group and the 6-month TBI group, with the latter performing worse. Main effects were found for bilingualism/monolingualism on TMT A, p < .05, ηp² = .04 and TMT B, p < .05, ηp² = .05; monolingual participants performed better than bilingual participants. No interactions emerged.
Conclusion
Relative to monolinguals, bilingual participants demonstrated worse attention and executive functioning performances 6 months post-TBI; however, 12 months post-TBI, the difference was negligible.
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Wen JJ, Huang H, Lee SJ, Jang H, Knight J, Lee YS, Fujita M, Suzuki KM, Asano S, Kivelson SA, Kao CC, Lee JS. Observation of two types of charge-density-wave orders in superconducting La 2-xSr xCuO 4. Nat Commun 2019; 10:3269. [PMID: 31332190 PMCID: PMC6646325 DOI: 10.1038/s41467-019-11167-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/27/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022] Open
Abstract
The discovery of charge- and spin-density-wave (CDW/SDW) orders in superconducting cuprates has altered our perspective on the nature of high-temperature superconductivity (SC). However, it has proven difficult to fully elucidate the relationship between the density wave orders and SC. Here, using resonant soft X-ray scattering, we study the archetypal cuprate La2-xSrxCuO4 (LSCO) over a broad doping range. We reveal the existence of two types of CDW orders in LSCO, namely CDW stripe order and CDW short-range order (SRO). While the CDW-SRO is suppressed by SC, it is partially transformed into the CDW stripe order with developing SDW stripe order near the superconducting Tc. These findings indicate that the stripe orders and SC are inhomogeneously distributed in the superconducting CuO2 planes of LSCO. This further suggests a new perspective on the putative pair-density-wave order that coexists with SC, SDW, and CDW orders. To fully elucidate the relationship between density wave orders and superconductivity in high-Tc cuprates remains difficult. Here, the authors reveal two types of charge-density-wave orders and their intertwined relationship with spin-density-wave order and superconductivity in La2-xSrxCuO4.
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Affiliation(s)
- J-J Wen
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA
| | - H Huang
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA
| | - S-J Lee
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA
| | - H Jang
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA.,PAL-XFEL, Pohang Accelerator Laboratory, Gyeongbuk, 37673, South Korea
| | - J Knight
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA
| | - Y S Lee
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA.,Department of Applied Physics, Stanford University, Stanford, CA, 94305, USA
| | - M Fujita
- Institute for Materials Research, Tohoku University, Sendai, 980-8577, Japan
| | - K M Suzuki
- Institute for Materials Research, Tohoku University, Sendai, 980-8577, Japan
| | - S Asano
- Institute for Materials Research, Tohoku University, Sendai, 980-8577, Japan
| | - S A Kivelson
- Departments of Physics, Stanford University, Stanford, CA, 94305, USA
| | - C-C Kao
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA
| | - J-S Lee
- SLAC National Accelerator Laboratory, Menlo Park, California, 94025, USA.
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Agar J, Barraclough K, Sypek M, Knight J. SAT-339 Understanding the Environmental Footprints of Nephrology and Dialysis. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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50
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Barraclough K, Knight J, Sypek M, Agar J. SAT-343 PROGRESS TOWARDS ENVIRONMENTALLY SUSTAINABLE RENAL CARE IN AUSTRALIA AND NEW ZEALAND. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.391] [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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