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Hopkins J, Narasimhan M, Aujla M, Silva R, Mandil A. The importance of insufficient national data on sexual and reproductive health and rights in international databases. EClinicalMedicine 2024; 70:102554. [PMID: 38533341 PMCID: PMC10963186 DOI: 10.1016/j.eclinm.2024.102554] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Looking at SRHR as an isolated set of elements, as is the current practice, does not do justice to the needs and rights of people and communities and may be one of the reasons why challenges remain in the attainment of SRHR for all. SRHR Infographic snapshots were developed for all 194 WHO Member States and included 120 indicators covering a broad range of policy, health systems and service delivery interventions. The snapshots were created using data less than 10 years old publicly available in data repositories maintained by international and global agencies. Data availability was not consistent across countries with low and lower-middle income countries having higher data availability (71%) compared to high income countries (40%). SRHR data that is easily accessible and consistently reported can improve accountability and opportunities for learning to improve people-centred approaches to accelerate the attainment of SRHR for all.
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Affiliation(s)
- Jonathan Hopkins
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Ronaldo Silva
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Ahmed Mandil
- (Retired) Department of Science, Information & Dissemination, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Narasimhan M, Hargreaves JR, Logie CH, Abdool-Karim Q, Aujla M, Hopkins J, Cover J, Sentumbwe-Mugisa O, Maleche A, Gilmore K. Self-care interventions for women's health and well-being. Nat Med 2024; 30:660-669. [PMID: 38454127 DOI: 10.1038/s41591-024-02844-8] [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: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The human right to health is universal and non-exclusionary, supporting health in full, and for all. Despite advances in health systems globally, 3.6 billion people lack access to essential health services. Women and girls are disadvantaged when it comes to benefiting from quality health services, owing to social norms, unequal power in relationships, lack of consideration beyond their reproductive roles and poverty. Self-care interventions, including medicines and diagnostics, which offer an additional option to facility-based care, can improve the autonomy and agency of women in managing their own health. However, tackling challenges such as stigma is essential to avoid scenarios in which self-care interventions provide more choice for those who already benefit from access to quality healthcare, and leave behind those with the greatest need. This Perspective explores the opportunities that self-care interventions offer to advance the health and well-being of women with an approach grounded in human rights, gender equality and equity.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - James R Hargreaves
- Center for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Jane Cover
- Sexual and Reproductive Health Program, PATH, Seattle, WA, USA
| | | | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Kate Gilmore
- Department of International Development, London School of Economics and Political Science, London, UK
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Malama K, Logie CH, Narasimhan M, Ouedraogo L, Asmani C, Elamin H, van de Merwe LLA, Hopkins J, Bukusi EA. Short Communication: Awareness of HIV Self-Care Interventions Across Global Regions: Results from a Values and Preferences Survey. AIDS Res Hum Retroviruses 2022; 38:645-648. [PMID: 35579954 PMCID: PMC9419936 DOI: 10.1089/aid.2021.0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The high burden of HIV in sub-Saharan Africa places significant demands on health care services. Interventions such as HIV self-testing, and pre- and post-exposure prophylaxis (PrEP and PEP) could empower individuals to determine their HIV status and prevent HIV acquisition. In 2018, the World Health Organization disseminated an online, anonymous, global values and preferences survey to adults 18 years of age and older. The survey aimed to inform guidance on awareness, use, and preferences around self-care interventions for sexual and reproductive health. We conducted a cross-sectional analysis using Pearson's chi-squared test to compare awareness of HIV self-testing, PrEP and PEP across five global regions. Our analysis included 814 participants from 110 countries. We noted that respondents from Africa reported higher awareness of HIV interventions than participants from Europe, Latin America and the Caribbean, North America, and Asia. Our finding highlights an opportunity to expand self-care interventions for HIV prevention and management in Africa.
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Affiliation(s)
- Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Address correspondence to: Kalonde Malama, MPH, PhD, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto M5S 1V4, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, Includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction—HRP, Geneva, Switzerland, World Health Organization, Geneva, Switzerland
| | - Léopold Ouedraogo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Chilanga Asmani
- Reproductive, Maternal Health and Ageing Team, Intercountry Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Hafya Elamin
- Reproductive, Maternal Health and Ageing Team, Intercountry Support Team for East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | - L. Leigh-Ann van de Merwe
- Social Health Empowerment, Feminist Collective of Transgender Women of Africa, East London, South Africa
| | | | - Elizabeth Anne Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Department of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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Abstract
Jon Hopkins and Manjulaa Narasimhan examine the barriers to self-care for people experiencing homelessness and how to overcome them
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Affiliation(s)
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/Unicef/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Carney T, Hopkins J, Laubscher R, Siegfried N. Factors associated with current substance use among a sample of homeless individuals in Cape Town, South Africa: a secondary data analysis. J Ethn Subst Abuse 2021; 22:741-754. [PMID: 34890300 DOI: 10.1080/15332640.2021.2011817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Homelessness is a global issue that is often associated with substance use. Research on this relationship in low- to middle-income countries (LMIC) is limited. We aimed to explore which factors are associated with substance use through secondary data analysis of a sample of 472 adults who attended services for homeless individuals in Cape Town, South Africa. Logistic regression was utilized to investigate if length of homelessness was associated with current alcohol and drug use respectively, after accounting for other factors. Current drug use (44.9%) was higher than current alcohol use (22.7%) and the most prevalent lifetime drug was methamphetamine (32.6%). After adjusting for lifetime substance use, and source of income, length of homelessness was not significantly associated with current alcohol use (less than on year: OR = 2.60; 95% CI: 0.78-8.66; one or more years: OR = 0.90; 95% CI: 0.32-2.57) or current drug use (less than one year: OR = 0.78; 95% CI: 0.41-1.47; one year or more: OR = 1.04; 95% CI: 0.56-1.93). These results highlight the need to further investigate other factors that may influence current alcohol or drug use among populations at risk of being homeless, and to utilize validated measures of substance and other mental health conditions.
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Affiliation(s)
- Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | | | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Nandi Siegfried
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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Swain C, Rogers J, Gane D, Quinn M, Hopkins J, Pullyblank AM. SP3.1.3 Use of a Care Bundle to reduce Surgical Site Infection after Emergency Laparotomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.056] [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]
Abstract
Abstract
Aim
Surgical Site Infection (SSI) is common after abdominal surgery. A care bundle was introduced to sustainably reduce SSI after elective colorectal surgery. This study aimed to implement an expanded care bundle after emergency laparotomy.
Methods
Quality improvement methodology was used. SSI was measured by direct assessment of the wound in patients in hospital at 30 days. For discharged patients, the PHE SSI surveillance questionnaire was used to measure patient-reported SSI 30 days post-operatively. The care bundle included: 2% chlorhexidine skin preparation; dual ring wound protectors; triclosan-coated sutures for wound closure; second dose of antibiotics >4 hours, betadine to the wound and glove change before closure. Bundle compliance was measured and fed back to surgical teams.
Results
Baseline SSI was 13.5% (178 patients) which reduced to 8.5% (118 patients) following bundle introduction. Response rate was 60%. Compliance with antibacterial sutures was measured for patients whose wounds were closed; 10% received negative pressure dressings. Mortality within 30 days was 9%. Length of stay reduced from mean 22.6 to 12.45, median 13.5 to 9 days.
Conclusion
The care bundle reduced SSI after emergency laparotomy. Measuring SSI is more difficult after emergency surgery due to higher death rate, longer length of stay and use of laparostomy. Other challenges include difficulty using wound protectors for some procedures e.g. adhesiolysis and changing practice from use of skin clips.
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Affiliation(s)
- C Swain
- Somerset Foundation Trust
- Institute of Naval Medicine
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Le X, Marcelo K, Coleman N, Hopkins J, Balsara B, Leoni M, Spelman A, Hong D, Albacker L, Gillison M. 893P Clinico-genetic profiling of HRAS mutant head and neck squamous cell carcinoma (HNSCC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1303] [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: 10/20/2022] Open
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Salamat MKF, Gossner A, Bradford B, Hunter N, Hopkins J, Houston F. Scrapie infection and endogenous retroviral expression in sheep lymphoid tissues. Vet Immunol Immunopathol 2021; 233:110194. [PMID: 33530020 DOI: 10.1016/j.vetimm.2021.110194] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 01/09/2023]
Abstract
Transmissible spongiform encephalopathies, or prion diseases, are fatal neurodegenerative diseases affecting humans and animals. Although many host tissues express PrPC (essential for prion replication), relatively few cell types accumulate significant levels of infectivity, including neurons and other cell types in the nervous system, and follicular dendritic cells in secondary lymphoid organs. This suggests that tissue or cell-specific receptors or cofactors could play a role in controlling differential susceptibility to infection. Endogenous retroviruses (ERV), the remnants of ancient retroviral integration into the host germline, may represent one such cofactor. We examined the effect of scrapie infection on expression of three ovine ERV families (enJSRV/β1-OERV, γ1-OERV, γ2-OERV) in secondary lymphoid tissues of sheep at different time points following subcutaneous inoculation, using RT-qPCR. These OERVs were constitutively expressed in the prescapular lymph node and spleen of uninfected sheep. However, we were unable to find convincing evidence of specific differential expression of OERV in the same tissues following scrapie infection, in contrast to previous studies of ERV expression in brains of prion-infected mice and macaques. This study is the first to quantify the expression of potentially functional OERV transcripts in sheep lymphoid tissues, opening up interesting questions about the consequences for host immune function.
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Affiliation(s)
- M K F Salamat
- Division of Infection and Immunity, The Roslin Institute, R(D)SVS, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
| | - A Gossner
- Division of Infection and Immunity, The Roslin Institute, R(D)SVS, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
| | - B Bradford
- Division of Infection and Immunity, The Roslin Institute, R(D)SVS, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
| | - N Hunter
- Division of Infection and Immunity, The Roslin Institute, R(D)SVS, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
| | - J Hopkins
- Division of Infection and Immunity, The Roslin Institute, R(D)SVS, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
| | - F Houston
- Division of Infection and Immunity, The Roslin Institute, R(D)SVS, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK.
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Narasimhan M, Logie CH, Moody K, Hopkins J, Montoya O, Hardon A. The role of self-care interventions on men's health-seeking behaviours to advance their sexual and reproductive health and rights. Health Res Policy Syst 2021; 19:23. [PMID: 33596921 PMCID: PMC7888093 DOI: 10.1186/s12961-020-00655-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Self-care interventions are influencing people's access to, expectation and understanding of healthcare beyond formal health delivery systems. In doing so, self-care interventions could potentially improve health-seeking behaviours. While many men proactively engage in maintaining and promoting their health, the focus on men's health comes from the recognition, at least partially, that male socialization and social norms can induce men and boys to have a lower engagement in institutionalized public health entities and systems around their sexual and reproductive health and rights, that could impact negatively on themselves, their partners and children. MAIN TEXT A research agenda could consider the ways that public health messaging and information on self care practices for sexual and reproductive health and rights could be tailored to reflect men's lived realities and experiences. Three examples of evidence-based self-care interventions related to sexual and reproductive health and rights that men can, and many do, engage in are briefly discussed: condom use, HIV self-testing and use of telemedicine and digital platforms for sexual health. We apply four core elements that contribute to health, including men's health (people-centred approaches, quality health systems, a safe and supportive enabling environment, and behaviour-change communication) to each intervention where further research can inform normative guidance. CONCLUSION Engaging men and boys and facilitating their participation in self care can be an important policy intervention to advance global sexual and reproductive health and rights goals. The longstanding model of men neglecting or even sabotaging their wellbeing needs to be replaced by healthier lifestyles, which requires understanding how factors related to social support, social norms, power, academic performance or employability conditions, among others, influence men's engagement with health services and with their own self care practices.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | | | | | - Oswaldo Montoya
- MenEngage Alliance Global Secretariat, 1875 Connecticut Avenue. Floor 10, Washington, D.C., 20009, United States of America
| | - Anita Hardon
- Institute for Advanced Studies and Anthropology Department, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
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Mathew TA, Hopkins J, Kamerer D, Ali SN, Ortiz D, Johnson P, Chittick P, Carpenter CF. 458. Molecular SARS-CoV-2 Testing During the COVID-19 Outbreak: Experiences of a Hospital in Southeast Michigan, USA. Open Forum Infect Dis 2020. [PMCID: PMC7777634 DOI: 10.1093/ofid/ofaa439.651] [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: 12/04/2022] Open
Abstract
Background The novel Coronavirus SARS CoV-2 (COVID-19) outbreak was complicated by the lack of diagnostic testing kits. In early March 2020, leadership at Beaumont Hospital, Royal Oak Michigan (Beaumont) identified the need to develop high capacity testing modalities with appropriate sensitivity and specificity and rapid turnaround time. We describe the molecular diagnostic testing experience since initial rollout on March 16, 2020 at Beaumont, and results of repeat testing during the peak of the COVID-19 pandemic in MI. Methods Beaumont is an 1100 bed hospital in Southeast MI. In March, testing was initially performed with the EUA Luminex NxTAG CoV Extended Panel until March 28, 2020 when testing was converted to the EUA Cepheid Xpert Xpress SARS-CoV-2 for quicker turnaround times. Each assay was validated with a combination of patient samples and contrived specimens. Results During the initial week of testing there was > 20 % specimen positivity. As the prevalence grew the positivity rate reached 68% by the end of March (Figure 1). Many state and hospital initiatives were implemented during the outbreak, including social distancing and screening of asymptomatic patients to increase case-finding and prevent transmission. We also adopted a process for clinical review of symptomatic patients who initially tested negative for SARS-CoV-2 by a group of infectious disease physicians (Figure 2). This process was expanded to include other trained clinicians who were redeployed from other departments in the hospital. Repeat testing was performed to allow consideration of discontinuation of isolation precautions. During the surge of community cases from March 16 to April 30, 2020, we identified patients with negative PCR tests who subsequently had repeat testing based on clinical evaluation, with 7.1% (39/551) returning positive for SARS- CoV2. Of the patients who expired due to COVID-19 during this period, 4.3% (9/206) initially tested negative before ultimately testing positive. Figure 1 BH RO testing Epicurve ![]()
Figure 2: Screening tool for repeat COVID19 testing and precautions ![]()
Conclusion Many state and hospital initiatives helped us flatten the curve for COVID-19. Our hospital testing experience indicate that repeat testing may be warranted for those patients with clinical features suggestive of COVID-19. We will further analyze these cases and clinical features that prompted repeat testing. Disclosures All Authors: No reported disclosures
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Abstract
The flow of carbon from atmosphere to sediment fauna and sediments reduces atmospheric CO2, which in turn reduces warming. Here, during the Changing Arctic Ocean Seafloor programme, we use comparable methods to those used in the Antarctic (vertical, calibrated camera drops and trawl-collected specimens) to calculate the standing stock of zoobenthic carbon throughout the Barents Sea. The highest numbers of morphotypes, functional groups and individuals were found in the northernmost sites (80-81.3° N, 29-30° E). Ordination (non-metric multidimensional scaling) suggested a cline of faunal transition from south to north. The functional group dominance differed across all six sites, despite all being apparently similar muds. Of the environmental variables we measured, only water current speed could significantly explain any of our spatial carbon differences. We found no obvious relationship with sea ice loss and thus no evidence of Arctic blue carbon-climate feedback. Blue carbon in the Barents Sea can be comparable with the highest levels in Antarctic shelf sediments. This article is part of the theme issue 'The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.
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Affiliation(s)
- T. A. Souster
- Ulster University, Coleraine Campus, Coleraine, UK
- Biological Sciences, British Antarctic Survey, UKRI, Cambridge, UK
- e-mail:
| | - D. K. A. Barnes
- Biological Sciences, British Antarctic Survey, UKRI, Cambridge, UK
| | - J. Hopkins
- Marine Physics and Ocean Climate, National Oceanography Centre, Liverpool, UK
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Karatuna O, Dance DAB, Matuschek E, Åhman J, Turner P, Hopkins J, Amornchai P, Wuthiekanun V, Cusack TP, Baird R, Hennessy J, Norton R, Armstrong M, Zange S, Zoeller L, Wahab T, Jacob D, Grunow R, Kahlmeter G. Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off values. Clin Microbiol Infect 2020; 27:S1198-743X(20)30384-0. [PMID: 32653660 DOI: 10.1016/j.cmi.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Melioidosis, caused by Burkholderia pseudomallei, requires intensive antimicrobial treatment. However, standardized antimicrobial susceptibility testing (AST) methodology based on modern principles for determining breakpoints and ascertaining performance of methods are lacking for B. pseudomallei. This study aimed to establish MIC and zone diameter distributions on which to set epidemiological cut-off (ECOFF) values for B. pseudomallei using standard EUCAST methodology for non-fastidious organisms. METHODS Non-consecutive, non-duplicate clinical B. pseudomallei isolates (9-70 per centre) were tested at eight study centres against eight antimicrobials by broth microdilution (BMD) and the EUCAST disc diffusion method. Isolates without and with suspected resistance mechanisms were deliberately selected. The EUCAST Development Laboratory ensured the quality of study materials, and provided guidance on performance of the tests and interpretation of results. Aggregated results were analysed according to EUCAST recommendations to determine ECOFFs. RESULTS MIC and zone diameter distributions were generated using BMD and disc diffusion results obtained for 361 B. pseudomallei isolates. MIC and zone diameter ECOFFs (mg/L; mm) were determined for amoxicillin-clavulanic acid (8; 22), ceftazidime (8; 22), imipenem (2; 29), meropenem (2; 26), doxycycline (2; none), tetracycline (8; 23), chloramphenicol (8; 22) and trimethoprim-sulfamethoxazole (4; 28). CONCLUSIONS We have validated the use of standard BMD and disc diffusion methodology for AST of B. pseudomallei. The MIC and zone diameter distributions generated in this study allowed us to establish MIC and zone diameter ECOFFs for the antimicrobials studied. These ECOFFs served as background data for EUCAST to set clinical MIC and zone diameter breakpoints for B. pseudomallei.
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Affiliation(s)
- O Karatuna
- EUCAST Development Laboratory, Växjö, Sweden.
| | - D A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - E Matuschek
- EUCAST Development Laboratory, Växjö, Sweden
| | - J Åhman
- EUCAST Development Laboratory, Växjö, Sweden
| | - P Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - J Hopkins
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - P Amornchai
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - V Wuthiekanun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - T-P Cusack
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; National Infection Service, Public Health England, London, UK
| | - R Baird
- Royal Darwin Hospital, Darwin, NT, Australia
| | - J Hennessy
- Royal Darwin Hospital, Darwin, NT, Australia
| | - R Norton
- Townsville Hospital, Townsville, QLD, Australia
| | - M Armstrong
- Townsville Hospital, Townsville, QLD, Australia
| | - S Zange
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - L Zoeller
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - T Wahab
- Public Health Agency of Sweden, Stockholm, Sweden
| | - D Jacob
- Robert Koch Institute, Berlin, Germany
| | - R Grunow
- Robert Koch Institute, Berlin, Germany
| | - G Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden
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Abstract
INTRODUCTION Laparostomy is important in the management of patients with intra-abdominal gastrointestinal catastrophe or trauma. It carries significant risk and is resource intensive, both in terms of nursing and surgically. The main goal is to achieve prompt myofascial closure (MFC) in order to minimise morbidity and mortality. Early MFC was initially defined as within 2-3 weeks but there is growing evidence that this should be measured in days. METHODS Retrospective analysis was undertaken of laparostomy cases between 2016 and 2018 at an acute trust and trauma centre serving a population of 500,000. Indication, duration of open abdomen (OA), number of relook procedures and consultant presence were examined to see whether they affected MFC rates, morbidity and mortality. RESULTS Overall, 76 laparostomies were performed during the 3-year study period. The most common indication was peritonitis (68.4%). As duration of OA and number of relook procedures increased, the chances of MFC fell significantly. After day 1, MFC rates fell by 20% with each subsequent 24 hours. Leaving the abdomen open primarily at index procedure compared with performing laparostomy following a postoperative complication was associated with significantly higher MFC rates (92.6% vs 68.2%, (p=0.006). The mortality rate was 15.8%. CONCLUSIONS If the OA is not closed within five days or by the third relook procedure, then achieving MFC is unlikely. Alternative methods should be employed to close the abdomen rather than continuing to take the patient back to theatre for relook laparotomies while increasing the risk of morbidity and mortality. A proactive strategy to forming primary laparostomy at the index procedure has high closure rates.
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Thomas WR, Karkhanis S, Hopkins J, Duddy M. Translumbar Embolization of Type II Endoleaks: 12 Years of Experience at a Regional Vascular Centre. Vasc Endovascular Surg 2020; 54:389-394. [DOI: 10.1177/1538574420918972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: The management of persistent type II endoleaks (T2E) is often problematic for the endovascular specialist, with a lack of clear evidence for the best approach for embolization. The aim of this study was to evaluate the safety and efficacy of translumbar embolization (TLE) for T2E following endovascular aneurysm repair (EVAR). Methods: This retrospective review included 27 embolizations performed on 23 patients with a median age of 78 (range 67-94 years; male: female 15:9), during the period September 2006 to July 2018. Primary outcome was freedom from aneurysm sac growth defined as <2 mm sac diameter increase on subsequent computed tomography. Results: The initial technical success rate was 100%, with complete “on table” embolization of the T2E on fluoroscopy; however, 4 (15%) patients needed repeat TLE due to persistent endoleak identified on follow-up computed tomography or because of further sac expansion. Satisfactory stasis was achieved in these 4 cases following a second embolization. The mean volume of embolic injected was 7.4 mL per case. Feeding vessels were identified on angiography in all cases; the nidus was supplied by lumbar branches in 21 cases, by the inferior mesenteric artery in 1 case and by both in a further 5 cases. Freedom from aneurysm sac growth (defined as < 2 mm) following 1 or 2 separate TLE was achieved in 18 (78%) and 20 (86%) patients, respectively. The major complication rate was <5% with one case of psoas abscess presenting 7 months following embolization; there were 2 minor complications in the form of intraprocedural transient abdominal pain. Conclusion: The translumbar approach is a safe and effective technique to treat T2E, as evidenced by the low complication and reintervention rate.
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Affiliation(s)
- Wiliam Rhodri Thomas
- Department of Interventional Radiology, University Hospital, Cardiff, United Kingdom
| | - Salil Karkhanis
- Department of Interventional Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jonathan Hopkins
- Department of Interventional Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Martin Duddy
- Department of Interventional Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
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15
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Brereton PA, Robb P, Sargent CM, Crews HM, Wood R, Caputi A, Carrington J, Chetaneau B, Cohen S, Davies RW, Davis WS, Dix E, Ennion; RA, Furniss S, Gardner JW, Griffin J, Hampton I, Harrison N, Heide C, Hollywood F, Hopkins J, Liddle P, Meagher J, Osborne PY, Piatt T, Postlethwaite K, Procter J, Reynolds EB, Robinson J, Smith M, Sparkes S, Stangroom SG, Stevens R, Sutton P, Swain S, Turnbull J, Vidal JP, Waller JM, Zaiger K. Determination of Lead in Wine by Graphite Furnace Atomic Absorption Spectrophotometry: Interlaboratory Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.6.1287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
An interlaboratory study of a graphite furnace atomic absorption spectrophotometry (GFAAS) method for the determination of lead in wine was conducted. Seventeen laboratories from France, United States, and the United Kingdom, using a variety of GFAAS instruments, took part in the study. The method incorporated a novel matrix-matching procedure to minimize matrix effects between standards and samples. Six wine test materials were prepared and sent to participants as 12 blind duplicate or split level samples. There was good agreement between results obtained from participants and target values (24–279 μg/L) obtained with an inductively coupled plasma-mass spectrometry method. The precision of the GFAAS method was well within the range predicted by the Horwitz equation for the 6 test materials analyzed. Repeatability standard deviations ranged from 3 to 17%. Reproducibility standard deviations were in the range of 10 to 30%. The method is recommended for use for official purposes.
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Affiliation(s)
- Paul A Brereton
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Paul Robb
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Christine M Sargent
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Helen M Crews
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Roger Wood
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
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Premaratne S, Hopkins J, Duddy M, Sang KT, Kay M, Rogoveanu R, Nicholl P, Tiwari A. Abdominal Aortic Aneurysm Repair in Renal and Liver Transplant Recipients. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Premaratne S, Hopkins J, Duddy M, Tai KS, Kay M, Rogoveanu R, Nicholl P, Tiwari A. Abdominal Aortic Aneurysm Repair in Renal and Liver Transplant Recipients. Vasc Endovascular Surg 2019; 54:51-57. [PMID: 31601161 DOI: 10.1177/1538574419880673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) repair in patients with organ transplant remains a challenge. We looked at AAA repair in patients with organ transplants at our tertiary liver and kidney transplant unit. METHODS A retrospective analysis of a prospectively maintained database was undertaken from January 2008 to July 2018. We looked at patient demographics, type of repair, and technical success including reinterventions, perioperative transplant organ function, and 30-day and 1-year survival rate. Eight of 662 patients who underwent AAA repair had a solid organ transplant. Of these, 5 were kidney transplants, 2 liver transplants, and 1 had kidney and liver transplant; 75% were male; and average age was 63.4 (range: 49-83). All patients had asymptomatic AAAs, and 6 were treated with standard endovascular repair, 1 standard repair with iliac branch device, and 1 open repair. Adjunctive techniques such as CO2 angiograms, deployment of main body through contralateral iliac, low-profile sheaths, custom-made stent grafts, and temporary axillo-femoral shunting were used to protect transplant organs. Thirty-day survival was 100% with 1 death at 5 months from liver failure, and 1 patient has a persistent type-2 endoleak 3 years after the procedure. CONCLUSION Abdominal aortic aneurysm repair in patients with organ transplants can be undertaken using adjunctive endovascular and open surgical techniques.
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Affiliation(s)
- Sobath Premaratne
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Jonathan Hopkins
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Martin Duddy
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Ket Sang Tai
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Mark Kay
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Radu Rogoveanu
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Phil Nicholl
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Alok Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
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18
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Hopkins J, Fidanovski K, Lauto A, Mawad D. All-Organic Semiconductors for Electrochemical Biosensors: An Overview of Recent Progress in Material Design. Front Bioeng Biotechnol 2019; 7:237. [PMID: 31608275 PMCID: PMC6773807 DOI: 10.3389/fbioe.2019.00237] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022] Open
Abstract
Organic semiconductors remain of major interest in the field of bioelectrochemistry for their versatility in chemical and electrochemical behavior. These materials have been tailored using organic synthesis for use in cell stimulation, sustainable energy production, and in biosensors. Recent progress in the field of fully organic semiconductor biosensors is outlined in this review, with a particular emphasis on the synthetic tailoring of these semiconductors for their intended application. Biosensors ultimately function on the basis of a physical, optical or electrochemical change which occurs in the active material when it encounters the target analyte. Electrochemical biosensors are becoming increasingly popular among organic semiconductor biosensors, owing to their good detection performances, and simple operation. The analyte either interacts directly with the semiconductor material in a redox process or undergoes a redox process with a moiety such as an enzyme attached to the semiconductor material. The electrochemical signal is then transduced through the semiconductor material. The most recent examples of organic semiconductor biosensors are discussed here with reference to the material design of polymers with semiconducting backbones, specifically conjugated polymers, and polymer semiconducting dyes. We conclude that direct interaction between the analyte and the semiconducting material is generally more sensitive and cost effective, despite being currently limited by the need to identify, and synthesize selective sensing functionalities. It is also worth noting the potential roles of highly-sensitive, organic transistor devices and small molecule semiconductors, such as the photochromic and redox active molecule spiropyran, as polymer pendant groups in future biosensor designs.
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Affiliation(s)
- Jonathan Hopkins
- School of Materials Science and Engineering, University of New South Wales Sydney, Sydney, NSW, Australia.,Centre for Advanced Macromolecular Design, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Kristina Fidanovski
- School of Materials Science and Engineering, University of New South Wales Sydney, Sydney, NSW, Australia.,Centre for Advanced Macromolecular Design, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Antonio Lauto
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Damia Mawad
- School of Materials Science and Engineering, University of New South Wales Sydney, Sydney, NSW, Australia.,Centre for Advanced Macromolecular Design, University of New South Wales Sydney, Sydney, NSW, Australia.,Australian Centre for NanoMedicine, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of New South Wales Sydney, Sydney, NSW, Australia
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Hopkins J, Collins L. How linked are national HIV and SRHR strategies? A review of SRHR and HIV strategies in 60 countries. Health Policy Plan 2018; 32:iv57-iv66. [PMID: 29194540 PMCID: PMC5886072 DOI: 10.1093/heapol/czw119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
The connection between HIV and sexual and reproductive health and rights (SRHR) is widely recognised along with the benefits of linking them at the legal/policy, health systems, and service delivery levels. However, despite increased rhetoric about the need for this three-tiered approach, integrated service delivery has not been fully addressed at the legal/policy level through national strategies. Thus a review of HIV and SRHR strategies was conducted for 60 countries, determining the extent to which they reflected the intersections between HIV and SRHR. Each HIV strategy was scored on whether five key SRHR components were incorporated and had an associated measurable target. SRHR strategies were similarly assessed for incorporation of five HIV components and associated targets. HIV strategies had a higher level of inclusion of SRHR components with a global average of 6.6/10 compared to 3.7/10 for SRHR strategies. The highest scoring component was the elimination of mother-to-child transmission of HIV (EMTCT) and the lowest was SRHR of people living with HIV. Countries with higher scores in one strategy tended to have higher scores in the other but there was no difference over time. Whilst there has been increased global commitment since 2004 to link SRHR and HIV, insufficient headway has been made in linking related national strategies. Although EMTCT is included with targets in the majority of HIV and SRHR strategies, the broader SRHR needs of women living with HIV are not. Also, condoms are not being considered an effective triple protection tool. HIV and SRHR strategies provide direction and targets which ultimately may influence funding and vice versa. Therefore, it is essential that these strategies are right-based and incorporate the key connections between SRHR and HIV with measurable targets to realise the full benefits of a joint response.
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20
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Lobo D, DeBenedet C, Fehlner-Gardiner C, Nadin-Davis S, Anderson M, Buchanan T, Middel K, Filejski C, Hopkins J. Raccoon rabies outbreak in Hamilton, Ontario: A progress report. Can Commun Dis Rep 2018; 44:116-121. [PMID: 31007622 PMCID: PMC6449115 DOI: 10.14745/ccdr.v44i05a05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Raccoon rabies is caused by a variant of the rabies virus found in raccoons but transmissible to other mammalian species, including humans. The disease of rabies caused by raccoon variant rabies virus is indistinguishable from rabies caused by other rabies virus variants. OBJECTIVE This paper describes the raccoon rabies outbreak in Ontario (identified in December 2015) and the control measures undertaken to curb the spread of the epizootic using the One Health approach. INVESTIGATION AND RESULTS Representatives from local, provincial and federal agencies collectively activated a raccoon rabies response that involved policy updates, enhanced surveillance, a public education campaign and mass vaccination of wildlife and domestic animals. Between December 2015 and June 2017, 338 animals tested positive for raccoon rabies in Ontario. While the majority of the cases were raccoons, there was significant spillover into striped skunks, as well as other species including two cats, a fox and a llama. Viral genome sequencing determined that this epizootic was likely caused by long-distance translocation from the United States. CONCLUSION This outbreak of raccoon rabies is by far the largest to have occurred in Canada and the first raccoon rabies outbreak documented in a densely populated urban area. This is also the first time this rabies virus variant has been identified in a domestic animal in Canada. A collaborative approach involving numerous stakeholders in the public and private sectors has been instrumental in addressing this epizootic. Though case incidence appears to be declining, several years will likely be required to reach elimination. Continued collaboration between these agencies is necessary to achieve this goal.
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Affiliation(s)
- D Lobo
- Public Health and Preventive Medicine Residency Program, McMaster University, Hamilton, ON
| | - C DeBenedet
- Hamilton Public Health Services, Hamilton, ON
| | | | | | - M Anderson
- Ontario Ministry of Agriculture, Food and Rural Affairs, Guelph, ON
| | - T Buchanan
- Ministry of Natural Resources and Forestry, Peterborough, ON
| | - K Middel
- Ministry of Natural Resources and Forestry, Peterborough, ON
| | - C Filejski
- Ministry of Health and Long-Term Care, Toronto, ON
| | - J Hopkins
- Region of Peel, Mississauga, ON
- Department of Health Research Methods, Epidemiology, and Impact, McMaster University, Hamilton, ON
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21
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Cragg J, Lowry D, Hopkins J, Parker D, Kay M, Duddy M. Safety and Outcomes of Ipsilateral Antegrade Angioplasty for Femoropopliteal Disease. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Welbourn R, Hopkins J, Dixon JB, Finer N, Hughes C, Viner R, Wass J. Commissioning guidance for weight assessment and management in adults and children with severe complex obesity. Obes Rev 2018; 19:14-27. [PMID: 29024367 DOI: 10.1111/obr.12601] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 05/04/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/26/2022]
Abstract
The challenge of managing the epidemic of patients with severe and complex obesity disease in secondary care is largely unmet. In England, the National Institute of Health and Care Excellence and the National Health Service England have published guidance on the provision of specialist (non-surgical) weight management services. We have undertaken a systematic review of 'what evidence exists for what should happen in/commissioning of: primary or secondary care weight assessment and management clinics in patients needing specialist care for severe and complex obesity?' using an accredited methodology to produce a model for organization of multidisciplinary team clinics that could be developed in every healthcare system, as an update to a previous review. Additions to the previous guidance were multidisciplinary team pathways for children/adolescent patients and their transition to adult care, anaesthetic assessment and recommendations for ongoing shared care with general practitioners, as a chronic disease management pathway.
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Affiliation(s)
- R Welbourn
- Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - J Hopkins
- North Bristol Centre for Weight Loss, Metabolic and Bariatric Surgery, Southmead Hospital, Bristol, UK
| | - J B Dixon
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - N Finer
- UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, UK
| | - C Hughes
- Fakenham Weight Management Service, Norfolk, UK.,University of East Anglia, Norwich, UK
| | - R Viner
- Royal College of Paediatrics and Child Health, UCL GOS Institute of Child Health, University College London, London, UK
| | - J Wass
- Royal College of Physicians, London, UK
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23
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Cragg J, Lowry D, Hopkins J, Parker D, Kay M, Duddy M, Tiwari A. Safety and Outcomes of Ipsilateral Antegrade Angioplasty for Femoropopliteal Disease. Vasc Endovascular Surg 2017; 52:93-97. [DOI: 10.1177/1538574417739762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Previous reports have suggested higher periprocedural complications after ipsilateral antegrade femoral arterial access (AA). We looked at a contemporary series comparing complication rates between AA and contralateral retrograde femoral arterial access (RA) for femoropopliteal angioplasty. Method: A prospective review of all cases between 2010 and 2015 in a United Kingdom tertiary vascular center. Demographical and procedural data were obtained for those undergoing percutaneous femoropopliteal angioplasty. The primary outcome looked at periprocedural complications including retroperitoneal hematoma, pseudoaneurysm, hematoma requiring transfusion, arteriovenous fistulation, and surgical intervention. Secondary outcomes included contrast and radiation doses in addition to procedural failure leading to major amputation. Results: A total of 556 (66% male) patients underwent femoropopliteal angioplasty, 461 (82%) via AA. Groups were of comparable age, sex, comorbidity, and symptomatology. AA patients had a lower body mass index, 26 versus 29 ( P = .005). No significant difference was seen in periprocedural (15.8% AA vs 11.6% RA; P = 0.292) or access site complications (3.7% AA vs 1.1% RA; P = 0.186). There was less need for a closure device, 40.3% AA vs 73% RA ( P < .01), less contrast, 94 mL AA: 114 mL RA ( P < .001), and less radiation, 3487 cGy cm2 AA: 9697 cGy cm2 RA ( P < .001). Arterial access was also associated with greater technical success of 83.8%: 73.3% RA ( P = .002). Conclusions: Arterial access is associated with higher technical success and reduced contrast/radiation doses with no significant difference in complications compared to RA contrary to previous reports.
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Affiliation(s)
- James Cragg
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Danielle Lowry
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Hopkins
- Department of Interventional Radiology, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - David Parker
- Department of Interventional Radiology, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Mark Kay
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin Duddy
- Department of Interventional Radiology, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Alok Tiwari
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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24
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Mayhew SH, Hopkins J, Warren CE. Building integrated health systems: lessons from HIV, sexual and reproductive health integration. Health Policy Plan 2017; 32:iv1-iv5. [PMID: 29194546 PMCID: PMC5886152 DOI: 10.1093/heapol/czx142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan Hopkins
- Independent Consultant, formerly, International Planned Parenthood Federation, London, UK and
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Warren CE, Hopkins J, Narasimhan M, Collins L, Askew I, Mayhew SH. Health systems and the SDGs: lessons from a joint HIV and sexual and reproductive health and rights response. Health Policy Plan 2017; 32:iv102-iv107. [PMID: 29194542 PMCID: PMC5886280 DOI: 10.1093/heapol/czx052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte E Warren
- Population Council, Suite 280, 4301 Connecticut Avenue NW, Washington, DC 20008, USA
| | - Jonathan Hopkins
- International Planned Parenthood Foundation, 4 Newhams Row, London SE1 3UZ, UK
| | | | - Lynn Collins
- UNFPA, 605 Third Avenue, New York, NY 10158, USA and
| | - Ian Askew
- World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Susannah H Mayhew
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Hopkins J, Bigam D, Eurich D, Baracos V, Sawyer M. Role of body composition in early stage colorectal cancer (CRC) outcomes. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mason A, Korostynska O, Louis J, Cordova-Lopez LE, Abdullah B, Greene J, Connell R, Hopkins J. Noninvasive In-Situ Measurement of Blood Lactate Using Microwave Sensors. IEEE Trans Biomed Eng 2017. [PMID: 28622665 DOI: 10.1109/tbme.2017.2715071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
GOAL This paper reports a novel electromagnetic sensor technique for real-time noninvasive monitoring of blood lactate in human subjects. METHODS The technique was demonstrated on 34 participants who undertook a cycling regime, with rest period before and after, to produce a rising and falling lactate response curve. Sensors attached to the arm and legs of participants gathered spectral data, blood samples were measured using a Lactate Pro V2; temperature and heart rate data was also collected. RESULTS Pointwise mutual information and neural networks are used to produce a predictive model. The model shows a good correlation between the standard invasive and novel noninvasive electromagnetic wave based blood lactate measurements, with an error of 13.4% in the range of 0-12 mmol/L. CONCLUSION The work demonstrates that electromagnetic wave sensors are capable of determining blood lactate level without the need for invasive blood sampling. SIGNIFICANCE Measurement of blood metabolites, such as blood lactate, in real-time and noninvasively in hospital environments will reduce the risk of infection, increase the frequency of measurement and ensure timely intervention only when necessary. In sports, such tools will enhance training of athletes, and enable more effecting training regimes to be prescribed.
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Abstract
Integration of services for sexual and reproductive health (SRH) and HIV has been widely promoted globally in the belief that both clients and health providers benefit through improvements in quality, efficient use of resources, and lower costs, helping to maximize limited health resources and provide comprehensive client-centered care. This article builds on the growing body of research on integrated sexual SRH and HIV services. It brings together critical reviews on issues within the wider SRH and rights agenda and synthesizes recent research on integrated services, drawing on the Integra Initiative and other major research. Unintended pregnancy and HIV are intrinsically interrelated SRH issues, however broadening the constellation of services, scaling up, and mainstreaming integration continue to be challenging. Overcoming stigma, reducing gender-based violence, and meeting key populations' SRH needs are critical. Health systems research using SRH as the entry point for integrated services and interaction with communities and clients is needed to realize universal health coverage.
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Affiliation(s)
- R. J. Haworth
- Oxford Rehabilitation Research Unit, Nuffield Orthopaedic Centre, Headington, Oxford
| | - J. Hopkins
- Oxford Rehabilitation Research Unit, Nuffield Orthopaedic Centre, Headington, Oxford
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Doe M, Cole S, Hopkins J, Williamson M, Maddox P. Dedicated training lists can significantly improve traineeS' exposure to open inguinal herniorraphy. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.361] [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: 10/20/2022]
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Haghpanah B, Salari-Sharif L, Pourrajab P, Hopkins J, Valdevit L. Multistable Shape-Reconfigurable Architected Materials. Adv Mater 2016; 28:7915-7920. [PMID: 27384125 DOI: 10.1002/adma.201601650] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/27/2016] [Indexed: 05/19/2023]
Abstract
Multistable shape-reconfigurable architected materials encompassing living hinges and enabling combinations of high strength, high volumetric change, and complex shape-morphing patterns are introduced. Analytical and numerical investigations, validated by experiments, are performed to characterize the mechanical behavior of the proposed materials. The proposed architected materials can be constructed from virtually any base material, at any length scale and dimensionality.
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Affiliation(s)
- Babak Haghpanah
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA, 92697
| | - Ladan Salari-Sharif
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA, 92697
| | - Peyman Pourrajab
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA, 92697
| | - Jonathan Hopkins
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, CA, USA, 90095
| | - Lorenzo Valdevit
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA, 92697.
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Cragg J, Hopkins J. A Patent Sciatic Artery Aneurysm. Eur J Vasc Endovasc Surg 2016; 51:830. [PMID: 27102202 DOI: 10.1016/j.ejvs.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/08/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J Cragg
- Queen Elizabeth Hospital, Birmingham, UK.
| | - J Hopkins
- Queen Elizabeth Hospital, Birmingham, UK
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Kimmick G, Pitcher B, Mandelblatt J, Clapp J, Ballman K, Barginear M, Freedman R, Artz A, Klepin H, Lafky J, Hopkins J, Winer E, Hudis C, Muss H, Cohen H, Jatoi A, Hurria A. Abstract P6-09-10: All-cause survival estimates compared to observed survival in older women with breast cancer in CALGB 49907 and 369901 (Alliance A151503). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-09-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Older adults represent 50% or more of all newly diagnosed cancer patients annually; these patients have multiple morbidities, complicating treatment decision-making.. Discussions about the risks and benefits of cancer treatments might be improved by having data on estimated all-cause survival. ePrognosis (http://eprognosis.ucsf.edu/carey2.php) is an online tool validated in older adults without cancer. We compared survival estimates using ePrognosis to observed survival in a population of women with early stage breast cancer who volunteered for cooperative group studies.
Methods: Participants in CALGB 49907 (n=194) and 369901 (n=809) who were age 70+ were included (total n=1003). Both studies had comparable eligibility: primary, newly diagnosed, invasive, non-metastatic breast cancer. In 49907, eligibly also included PS 0-2; in 369901 there were no PS restrictions, but women who failed a screening cognitive exam were excluded. The Carey 2-year Index from ePrognosis was used to estimate all-cause 2-year survival, based on age, sex, and daily function. Function (needing help from another person to bath and shop for groceries, difficulty walking several blocks and pushing or pulling a heavy object) was derived from the EORTC QLC-30. The Carey index from ePrognosis generates scores from 1-10, with higher scores indicating higher probability of death. Kaplan-Meier methods were used to obtain point estimates and confidence intervals for the observed 2-yr survival. A two sided z-test was used to test the hypothesis that the observed survival rate is equivalent to the predicted survival rate.
Results: At two years from study entry, 921 women were alive; 56 had died, and 26 were lost to follow-up/withdrawn. The population was, on average, 76 years old (SD 4.8), primarily white (89.3%), and the majority had hormone receptor positive tumors (79.4%). In our population, the Carey 2-years index predicated survival was not significantly different than observed rates in the 0-2 points and underestimated the survival rates for patients who had 3-6 points and 7-10 points.
ePrognosis Prediction49907 & 369901 PatientsPointsPredicted Probability of SurvivalNNumber of DeathsObserved Probability of Overall Survival at 2 years (%, 95% CI)p-value0-295%5332595% (93-97%)0.7433-688%4272394% (92-96%)<0.0017-1064%43881% (65-90%)0.017
Conclusions: In this population of older women with breast cancer, using a few readily available data items, ePrognosis provided accurate survival estimates for women with a low probability of death (0-2 points) and underestimated all-cause survival in women with an increased probability of death (3-10 points). Further studies are needed to assess the validity of this tool in samples of cancer patients with higher risks of 2-year mortality. Extended follow-up to validate the tools in predicting 5- and 10-year all-cause and non-cancer mortality risk will further contribute to decision making in older patients.
Citation Format: Kimmick G, Pitcher B, Mandelblatt J, Clapp J, Ballman K, Barginear M, Freedman R, Artz A, Klepin H, Lafky J, Hopkins J, Winer E, Hudis C, Muss H, Cohen H, Jatoi A, Hurria A. All-cause survival estimates compared to observed survival in older women with breast cancer in CALGB 49907 and 369901 (Alliance A151503). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-10.
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Affiliation(s)
- G Kimmick
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - B Pitcher
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - J Mandelblatt
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - J Clapp
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - K Ballman
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - M Barginear
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - R Freedman
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - A Artz
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - H Klepin
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - J Lafky
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - J Hopkins
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - E Winer
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - C Hudis
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - H Muss
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - H Cohen
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - A Jatoi
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
| | - A Hurria
- Duke University Medical Center, Durham, NC; Georgetown University; North Shore Health System; Dana Farber Cancer Institute; University of Chicago; Wake Forest University School of Medicine; Mayo Clinic; Forsyth Regional Cancer Center; Memorial Sloan Kettering Cancer Center; UNC Lineberger Comprehensive Cancer Center; City of Hope
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Kay M, Rogoveanu R, Hodson J, Tallowin S, Hopkins J, Duddy M, Vohra R. Factors Affecting the Results of Superficial Femoral Artery Stenting. Vasc Endovascular Surg 2015; 49:228-35. [PMID: 26584581 DOI: 10.1177/1538574415614405] [Citation(s) in RCA: 3] [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: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to assess the durability of superficial femoral artery (SFA) stents and factors that affect stent patency. METHODS A retrospective assessment of 214 SFA stent procedures between 2003 and 2012 was conducted from a prospectively compiled database. Patency rates and patient outcomes were compiled from case notes and computerized records. Stent patency was confirmed by either duplex scan or clinical examination (palpable distal pulse). Survival and patency were compared across a range of factors using Kaplan-Meier plots and log-rank tests. Factors found to be significant were further assessed by Cox regression models. RESULTS Data were analyzed for 214 limbs in 205 patients. Inclusion criteria included those patients who received an SFA stent for treatment of claudication or critical limb ischemia (CLI) with follow-up data. This gave a study group of 151 limbs divided into 76 claudicant and 75 patients with CLI (male-female ratio = 103:48, mean age 71 years, standard deviation 11.7). Seventy-one percent of procedures were elective and 29% were emergency procedures; 53% of procedures were carried out on a day case basis. Median follow-up was 11 months (range 1 day-89 months). Patency was significantly worse for patients with CLI (P = .009), with a 1- and 3-year patency of 63% and 34% compared to 79% and 60% in patients with claudication. Significant factors associated with patency included oral therapy controlled diabetes (P = .003), lesions located in either the mid-SFA (P = .029) or the mid-popliteal (P = .013), and periprocedural complications (P = .005). There was no significant difference in patency rates between insulin-dependent and nondiabetic patients (hazard ratio: 1.0, 95% confidence interval: 0.4-5.6, P = .983). The overall amputation rate for the total study group was 5%. Patients with 1- and 3-year survival were 98% and 96% in the claudication group and 74% and 51%, respectively, in the CLI group. CONCLUSION SFA stents have superior outcomes in claudicants. Patency is related to severity of disease, diabetes, and location of disease.
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Affiliation(s)
- Mark Kay
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Radu Rogoveanu
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - James Hodson
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Simon Tallowin
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Jonathan Hopkins
- Department of Interventional Radiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Martin Duddy
- Department of Interventional Radiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - Rajiv Vohra
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
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Hopkins M, Doe M, Hopkins J, Dalton S, Brindley M, Pieterson F, Coles J. Engaging the multi-disciplinary team can improve adherence to enhanced recovery guidelines in elective colorectal cancer surgery. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.658] [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: 11/30/2022]
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Affiliation(s)
- H. Kim
- Exercise Sciences, Brigham Young University, Provo, United States
| | - S. Son
- Exercise Sciences, Brigham Young University, Provo, United States
| | - M. Seeley
- Exercise Sciences, Brigham Young University, Provo, United States
| | - J. Hopkins
- Human Performance Research Center, Brigham Young University, Provo, United States
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Mathur K, Ayyappan MK, Hodson J, Hopkins J, Duddy MJ, Tiwari A, Vohra RK. Stenting as a bail-out option after failed percutaneous transluminal angioplasty in infrainguinal vein bypass grafts. Vascular 2015; 24:383-9. [PMID: 26306586 DOI: 10.1177/1708538115602835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the safety and efficacy of bare and covered stents in infrainguinal vein grafts after failure of PTA for treating graft stenoses. METHODS An analysis of a prospective database of all patients who underwent stenting of infrainguinal vein bypass grafts at this institution between 1 January 2008 and 31 December 2012 was carried out. The main outcome considered was primary patency, which was reported at 1, 6 and 12 months. RESULTS A total of 18 patients with a mean age of 73 years (range: 56 to 86) were included. The indications for stent placement were significant recoil (7, 39%), graft rupture (6, 33%), residual vein cusps (3, 17%) and aneurysmal degeneration (2, 11%). There was a high overall technical success rate of 94% (17/18) and arrest of haemorrhage was achieved in all cases of graft rupture. The primary patency at 1, 6 and 12 months was 89%, 71% and 59%, respectively. CONCLUSION The use of bare and covered stents in infrainguinal vein grafts appears safe and effective. They are an excellent bail-out option for the treatment of graft rupture and give acceptable short-term results.
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Affiliation(s)
- K Mathur
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - M K Ayyappan
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - J Hodson
- Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham, UK
| | - J Hopkins
- Department of Interventional Vascular Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - M J Duddy
- Department of Interventional Vascular Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - A Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - R K Vohra
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK
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Abstract
The United Kingdom has experienced several exceptional summer flash floods in recent years and there is growing concern about the frequency of such events and the preparedness of the population. This paper uses a case study of the upper Ryedale flash flood (2005) and questionnaire and interview data to assess local perceptions of upland flash flooding. Experience of a major flash flood may not be associated with increased flood risk perception. Despite local residents' awareness of a trend towards wetter summers and more frequent heavy rainfall, the poor maintenance of rivers was more frequently thought to be a more significant factor influencing local flood risk than climate change. Such findings have important implications for the potential success of contemporary national flood policies, which have put greater emphasis on public responsibility for responding to flooding. This study recommends, therefore, the use of fresh participatory approaches to redistribute and raise awareness of locally-held flood knowledge.
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Affiliation(s)
- Jonathan Hopkins
- Research Assistant - Quantitative Methods, Social, Economic and Geographical Sciences, The James Hutton Institute, United Kingdom
| | - Jeff Warburton
- Reader, Department of Geography, Durham University, United Kingdom
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Mathur K, Ayyappan MK, Hodson J, Hopkins J, Tiwari A, Duddy M, Vohra R. Factors Affecting Medium-Term Outcomes After Crural Angioplasty in Critically Ischemic Legs. Vasc Endovascular Surg 2015; 49:63-8. [DOI: 10.1177/1538574415591001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To study factors affecting patency and medium-term outcomes after crural angioplasty. Materials and Methods: All crural angioplasties between March 2003 and September 2010 were reviewed from a prospective database to analyze primary patency, amputation-free survival, and limb salvage. Results: Five hundred and twenty-seven limbs in 478 patients (58.7% male, mean age 73.9 ± 0.53 years) were treated. In all, 49.1% were diabetic patients and 7.4% were dialysis dependent. Primary patency was 65.5%, 57.8%, 48.5%, and 32.9% at 1, 6, 12, and 36 months, respectively. Amputation-free survival was 75.2% at 1 year and 59.0% at 3 years. Limb salvage at 3 years was 92.7%. Rutherford categories 5 and 6 had a consistent adverse effect on patency. This led to an adverse amputation-free survival and limb salvage at 3 years. Conclusion: Crural angioplasty is an effective treatment for limb salvage. Its outcomes are adversely affected by diabetes, renal disease, coronary disease, and worsening Rutherford grade.
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Affiliation(s)
- K. Mathur
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - M. K. Ayyappan
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Hodson
- Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Hopkins
- Department of Interventional Vascular Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - A. Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - M. Duddy
- Department of Interventional Vascular Radiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Rajiv Vohra
- Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Lusti-Narasimhan M, Collins L, Hopkins J. Lessons learnt from sexual and reproductive health and HIV linkages for multipurpose prevention technology service delivery. BJOG 2014; 121 Suppl 5:87-91. [PMID: 25335845 DOI: 10.1111/1471-0528.12845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Abstract
Provision of comprehensive sexual and reproductive health (SRH) services that meet the complex and diverse needs of women, in particular, within resource-constrained settings, is often exacerbated by separate and uncoordinated reproductive health (RH) and HIV policies and programmes. A Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages was developed to assess bi-directional linkages between SRH and HIV at policy, systems and service delivery levels, as well as to identify gaps and contribute to the development of country-specific action plans. Findings from the implementation of this Assessment Tool are of particular relevance to the successful delivery and uptake of multipurpose prevention technologies (MPTs), which are products in the development pipeline addressing multiple SRH needs of women, including HIV. The findings highlight the need for better coordination between SRH and HIV programmes in countries; support and training for healthcare providers on SRH, HIV and human rights; supporting SRH and HIV integration at the service delivery level through relevant policies, strategic and operational plans; and strengthening logistics and supplies systems to provide a combination approach to prevention. These lessons learnt could help programme managers and service providers to better understand the strategies for positioning multipurpose prevention products in national policy and service contexts.
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Falb KL, Annan J, King E, Hopkins J, Kpebo D, Gupta J. Gender norms, poverty and armed conflict in Côte D'Ivoire: engaging men in women's social and economic empowerment programming. Health Educ Res 2014; 29:1015-1027. [PMID: 25274720 PMCID: PMC4235567 DOI: 10.1093/her/cyu058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/28/2014] [Indexed: 06/03/2023]
Abstract
Engaging men is a critical component in efforts to reduce intimate partner violence (IPV). Little is known regarding men's perspectives of approaches that challenge inequitable gender norms, particularly in settings impacted by armed conflict. This article describes men's experiences with a women's empowerment program and highlights men's perceptions of gender norms, poverty and armed conflict, as they relate to achieving programmatic goals. Data are from 32 Ivorian men who participated in indepth interviews in 2012. Interviews were undertaken as part of an intervention that combined gender dialogue groups for both women and their male partners with women's only village savings and loans programs to reduce IPV against women. Findings suggested that in the context of armed conflict, traditional gender norms and economic stressors experienced by men challenged fulfillment of gender roles and threatened men's sense of masculinity. Men who participated in gender dialogue groups discussed their acceptance of programming and identified improvements in their relationships with their female partners. These men further discussed increased financial planning along with their partners, and attributed such increases to the intervention. Addressing men's perceptions of masculinity, poverty and armed conflict may be key components to reduce men's violence against women in conflict-affected settings.
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Affiliation(s)
- K L Falb
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - J Annan
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - E King
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - J Hopkins
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - D Kpebo
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - J Gupta
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
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Mehrzad H, Bashir W, Hopkins J. Emergency radiology: Peripheral vascular injuries. Trauma 2014. [DOI: 10.1177/1460408614539622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been a growing role for both diagnostic and interventional radiology (IR) in all types of trauma affecting different areas of the body, with imaging becoming an integral part of the multidisciplinary approach to modern trauma care. This article is intended to assess the role of radiology in peripheral trauma and highlight some of the indications, contraindications and treatment options available. It will also touch upon other associated problems encountered by the trauma patient in particular the increased risk of thromboembolic disease. We review some of the common peripheral vascular injuries in our experience in a large trauma hospital.
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Affiliation(s)
- H Mehrzad
- Diagnostic and Interventional Radiology Department, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - W Bashir
- Diagnostic and Interventional Radiology Department, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - J Hopkins
- Diagnostic and Interventional Radiology Department, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
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Palmer-Green D, Brownlow M, Hopkins J, Eley J, Jaques R, Hunter G. EPIDEMIOLOGICAL STUDY OF INJURY AND ILLNESS IN GREAT BRITAIN SHORT-TRACK SPEED SKATING. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Blackwell KL, Hamilton EP, Marcom PK, Peppercorn J, Spector N, Kimmick G, Hopkins J, Favaro J, Rocha G, Parks M, Love C, Scotland P, Dave SS. Abstract S4-03: Exome sequencing reveals clinically actionable mutations in the pathogenesis and metastasis of triple negative breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s4-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Triple negative breast cancer (TNBC) represents a particularly aggressive and difficult to treat form of breast cancer. No specific genetic alterations have been described as characteristic of the disease, with the exception of association with BRCA1/2, EGFR, and KRAS mutations. In this study, we sought to define clinically actionable mutations in untreated metastatic tumors as well as compare the mutational status of metastatic samples with germ-line and primary tumors using whole exome sequencing.
We prospectively enrolled 38 patients with newly diagnosed metastatic TNBC and collected matched specimens of germ-line DNA, primary tumor and metastatic tumor. Median DFI from time of initial primary diagnosis to recurrence was 18 months (IQR = 1-24 months) and 9 patients presented with de novo metastatic disease. 34/38 patients went on to receive first-line treatment with nab-paclitaxel, carboplatin, and bevacizumab and ORR/PFS/OS are available.
Sites of TNBC metastatic tissue (n = 31) included: liver (10), chest wall (13), non-regional lymph nodes (4), and lung (4). 7 patients had inadequate metastatic tumor for sequencing. We performed whole-exome sequencing for all samples using the Agilent solution-based system of exon capture, which uses RNA baits to target all protein coding genes (CCDS database), as well as ∼700 human miRNAs from miRBase (v13). In all, we generated over 10 GB of sequencing data using high throughput sequencing on the Illumina platform.
We observed striking genetic heterogeneity among the metastatic and primary tumors. There was no single driver mutation that was common to the metastatic tumors indicating the diverse genetic pathways that contribute to metastasis. Early analysis suggests that mutations in APC and MTOR occur more frequently in metastatic tumors than in primary tumors. Nonsense mutations of ER were detected in both primary and metastatic tumors but not in germ-line DNA. EGFR and HER2 mutations were not found in any of the primary or metastatic TNBC samples.
This data provides the most comprehensive genetic portrait of metastatic and primary TNBC to date, and represents a significant first step in identifying the genetic causes of the disease, drivers of recurrence, and potential therapeutic targets. Full results, including the primary versus metastatic tumor mutational analysis will be presented.
This study was funded by a Susan G. Komen Grant SAC 100001.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S4-03.
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Affiliation(s)
- KL Blackwell
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - EP Hamilton
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - PK Marcom
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - J Peppercorn
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - N Spector
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - G Kimmick
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - J Hopkins
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - J Favaro
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - G Rocha
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - M Parks
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - C Love
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - P Scotland
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - SS Dave
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
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Harvey J, Hopkins J, McCafferty I, Jones R. Inferior vena cava filters: What radiologists need to know. Clin Radiol 2013; 68:721-32. [DOI: 10.1016/j.crad.2013.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
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Au Yong T, Harrison G, Duddy M, Hopkins J, Vohra R. Endovascular Repair of Aortic Aneurysm through Bilateral Common Iliac Stents with a Repositionable Stent-graft. Eur J Vasc Endovasc Surg 2012. [DOI: 10.1016/j.ejvs.2012.08.013] [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: 10/27/2022]
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Podgornik R, Hopkins J, Parsegian VA, Muthukumar M. Polymers pushing Polymers: Polymer Mixtures in Thermodynamic Equilibrium with a Pore. Macromolecules 2012; 45:8921-8928. [PMID: 23226877 DOI: 10.1021/ma3017508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigate polymer partitioning from polymer mixtures into nanometer size cavities by formulating an equation of state for a binary polymer mixture assuming that only one (smaller) of the two polymer components can penetrate the cavity. Deriving the partitioning equilibrium equations and solving them numerically allows us to introduce the concept of "polymers-pushing-polymers" for the action of non-penetrating polymers on the partitioning of the penetrating polymers. Polymer partitioning into a pore even within a very simple model of a binary polymer mixture is shown to depend in a complicated way on the composition of the polymer mixture and/or the pore-penetration penalty. This can lead to enhanced as well as diminished partitioning, due to two separate energy scales that we analyse in detail.
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Affiliation(s)
- R Podgornik
- Department of Physics, University of Massachusetts, Amherst MA 01003, USA ; Department of Physics, Faculty of Mathematics and Physics, University of Ljubljana, and Department of Theoretical Physics, J. Stefan Institute, 1000 Ljubljana, Slovenia
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Hopkins J, Tudhope GR. The effects of drugs on erythrocytes in vitro: Heinz body formation, glutathione peroxidase inhibition and changes in mechanical fragility. Br J Clin Pharmacol 2012; 1:191-5. [PMID: 22454946 DOI: 10.1111/j.1365-2125.1974.tb00235.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
1 The relationship between mechanical fragility, glutathione peroxidase inhibition and Heinz body formation, in erythrocytes exposed to oxidant drugs in vitro, has been investigated. All drugs tested caused Heinz body formation, and with the exception of acetyl salicylic acid and salicylic acid, also caused increased erythrocyte mechanical fragility. 2 There was a direct relationship between mechanical fragility and drug concentration. Mechanical fragility increased in parallel with Heinz body formation, with primaquine, gentisic acid, ascorbic acid and potassium chlorate. In contrast Heinz body formation occurred at drug concentrations which did not cause a marked increase in mechanical fragility in the case of menadione, acetyl phenylhydrazine and phenylhydrazine. 3 The degree of inhibition of glutathione peroxidase was directly related to increased mechanical fragility with menadione, gentisic acid and potassium chlorate. However other substances causing increased mechanical fragility resulted in little or no loss of glutathione peroxidase activity. 4 The results show that there is no constant relationship between mechanical fragility caused by drugs, the formation of Heinz bodies and the inhibition of glutathione peroxidase. The factors contributing to oxidant drug-induced haemolysis appear to be variable and depend upon the drug concerned.
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Affiliation(s)
- J Hopkins
- Department of Pharmacology and Therapeutics, University of Dundee
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Smith J, Hopkins J, Neary W. Extrinsic Compression of the Popliteal Vessels after Knee Arthoplasty: An Interesting Case of Claudication. Eur J Vasc Endovasc Surg 2012. [DOI: 10.1016/j.ejvs.2011.10.023] [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: 11/15/2022]
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DiBiasio CM, Durand KV, Hopkins J, Traina Z, Slocum AH, Vasilyev NV, del Nido PJ. Design of a Surgical Port for Minimally Invasive Beating-Heart Intracardial Procedures. J Med Device 2011. [DOI: 10.1115/1.4004867] [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: 11/08/2022] Open
Abstract
Direct-access, minimally invasive, beating-heart intracardial procedures have the potential to replace many traditional surgical procedures requiring cardio-pulmonary bypass as long as micro-emboli are prevented from entering the cardiovascular system. A new surgical port was developed to introduce surgical instruments into chambers of the beating heart during minimally invasive, intracardial surgical procedures without allowing the introduction of micro-emboli 0.1 mm or larger in size. The design consists of an outer port body that is secured to the heart wall using a purse string suture and a series of inner tubular sleeves that form the interface between the port and the transecting instrument. The design enables rapid tool changes and accommodates a wide variety of instruments. The port uses a fluid purging system to dislodge and remove emboli from a surgical instrument. Laboratory and clinical tests show that the port adequately seals around a surgical instrument and prevents the introduction of emboli with diameters greater than 0.1 mm into the heart while minimizing hemorrhage.
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Affiliation(s)
| | | | | | | | - Alexander H. Slocum
- Massachusetts Institute of Technology, Department of Mechanical Engineering, Cambridge, MA 02139
| | | | - Pedro J. del Nido
- Children’s Hospital of Boston, Department of Cardiac Surgery, Boston, MA 02115
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