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Magness DR, Hoang L, Belote RT, Brennan J, Carr W, Stuart Chapin F, Clifford K, Morrison W, Morton JM, Sofaer HR. Management Foundations for Navigating Ecological Transformation by Resisting, Accepting, or Directing Social–Ecological Change. Bioscience 2021. [DOI: 10.1093/biosci/biab083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Despite striking global change, management to ensure healthy landscapes and sustained natural resources has tended to set objectives on the basis of the historical range of variability in stationary ecosystems. Many social–ecological systems are moving into novel conditions that can result in ecological transformation. We present four foundations to enable a transition to future-oriented conservation and management that increases capacity to manage change. The foundations are to identify plausible social–ecological trajectories, to apply upstream and deliberate engagement and decision-making with stakeholders, to formulate management pathways to desired futures, and to consider a portfolio approach to manage risk and account for multiple preferences across space and time. We use the Kenai National Wildlife Refuge in Alaska as a case study to illustrate how the four foundations address common land management challenges for navigating transformation and deciding when, where, and how to resist, accept, or direct social–ecological change.
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Affiliation(s)
- Dawn R Magness
- US Fish and Wildlife Service (USFWS), Kenai National Wildlife Refuge, Soldotna, Alaska, United States
| | - Linh Hoang
- US Forest Service's Northern Region, Missoula, Montana, United States
| | | | - Jean Brennan
- USFWS and is now the climate adaptation coordinator for the Giant Sequoia Lands Coalition, Three Rivers, California, United States
| | - Wylie Carr
- National Park Service, Fort Collins, Colorado, United States
| | - F Stuart Chapin
- University of Alaska's Institute of Arctic Biology, Fairbanks, Alaska, United States
| | | | - Wendy Morrison
- National Oceanic and Atmospheric Administration Fisheries, Silver Springs, Maryland, United States
| | - John M Morton
- USFWS and is now vice president of the Alaska Wildlife Alliance, Anchorage, Alaska, United States
| | - Helen R Sofaer
- USGS Pacific Island Ecosystems Research Center, Hawaii National Park, Honolulu, Hawaii, United States
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Kallmyer B, Daven M, Thornhill L, Clifford K, Conant R, Carrillo M. Editorial: Impact of Aduhelm Approval on Care and Policy. J Prev Alzheimers Dis 2021; 8:396-397. [PMID: 34585211 DOI: 10.14283/jpad.2021.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The more than 6 million Americans living with Alzheimer’s disease face a future filled with progressive loss of their cognitive abilities ending with certain death (1). They will eventually require help in all aspects of daily living, and that help is provided by over 11 million unpaid caregivers (2). At this time, Alzheimer’s remains a clinical diagnosis and unfortunately, many individuals who would meet the diagnostic criteria are not diagnosed (3). The Food and Drug Administration’s (FDA) accelerated approval of aducanumab (Aduhelm™) as a treatment for Alzheimer’s makes early detection, accurate diagnosis and quality care even more critical, to ensure individuals receive the most benefit at the earliest point possible. Furthermore, the approval of this treatment opens up a new landscape in Alzheimer’s care that comes with many implications for effective public policy to enhance access to quality care.
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Affiliation(s)
- B Kallmyer
- Maria C. Carrillo, PhD, Alzheimer's Association, 225 N. Michigan Ave. Floor 17, Chicago, IL 60601, E-mail: , (312)335-5722
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Clifford K, Ten Hove R, Dawson L, Grootegoed L, Palma S. The development of an evidenced based case study database to demonstrate the value and impact of physiotherapy. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.133] [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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Palma S, Clifford K, Hayward-Giles S. CSP leadership development programme: an approach to developing leadership capacity within the UK physiotherapy profession. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.171] [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: 10/18/2022]
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Lord A, Ten Hove R, Clifford K, Palma S. Physiotherapy in primary care: making the economic case. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Palma S, Clifford K, Hayward-Giles S. Sharing knowledge and experience: a UK professional organisation approach to establishing a network of mentoring relationships. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.135] [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: 10/18/2022]
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7
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Clifford K, Thornton H. An exploration of leadership perceptions with chartered society of physiotherapy members to inform the development of the physiotherapy works programme. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.310] [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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8
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Guha A, Wang L, Tanenbaum A, Esmaeili-Firidouni P, Wendelken LA, Busovaca E, Clifford K, Desai A, Ances BM, Valcour V. Intrinsic network connectivity abnormalities in HIV-infected individuals over age 60. J Neurovirol 2015; 22:80-7. [PMID: 26265137 DOI: 10.1007/s13365-015-0370-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
Individuals infected with HIV are living longer due to effective treatment with combination antiretroviral therapy (cART). Despite these advances, HIV-associated neurocognitive disorders (HAND) remain prevalent. In this study, we analyzed resting state functional connectivity (rs-fc) data from HIV-infected and matched HIV-uninfected adults aged 60 years and older to determine associations between HIV status, neuropsychological performance, and clinical variables. HIV-infected participants with detectable plasma HIV RNA exhibited decreased rs-fc within the salience (SAL) network compared to HIV-infected participants with suppressed plasma HIV RNA. We did not identify differences in rs-fc within HIV-infected individuals by HAND status. Our analysis identifies focal deficits in the SAL network that may be mitigated with suppression of plasma virus. However, these findings suggest that rs-fc may not be sensitive as a marker of HAND among individuals with suppressed plasma viral loads.
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Affiliation(s)
- Anika Guha
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Liang Wang
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Aaron Tanenbaum
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Pardis Esmaeili-Firidouni
- Memory and Aging Center, Sandler Neurosciences Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Lauren A Wendelken
- Memory and Aging Center, Sandler Neurosciences Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Edgar Busovaca
- Memory and Aging Center, Sandler Neurosciences Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Katherine Clifford
- Memory and Aging Center, Sandler Neurosciences Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Akash Desai
- Memory and Aging Center, Sandler Neurosciences Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Beau M Ances
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.,Department of Biomedical Engineering, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Victor Valcour
- Memory and Aging Center, Sandler Neurosciences Center, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.
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Portmann T, Yang M, Mao R, Panagiotakos G, Ellegood J, Dolen G, Bader PL, Grueter BA, Goold C, Fisher E, Clifford K, Rengarajan P, Kalikhman D, Loureiro D, Saw NL, Zhengqui Z, Miller MA, Lerch JP, Henkelman M, Shamloo M, Malenka RC, Crawley JN, Dolmetsch RE. Behavioral abnormalities and circuit defects in the basal ganglia of a mouse model of 16p11.2 deletion syndrome. Cell Rep 2014; 7:1077-1092. [PMID: 24794428 DOI: 10.1016/j.celrep.2014.03.036] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 02/06/2014] [Accepted: 03/07/2014] [Indexed: 01/22/2023] Open
Abstract
A deletion on human chromosome 16p11.2 is associated with autism spectrum disorders. We deleted the syntenic region on mouse chromosome 7F3. MRI and high-throughput single-cell transcriptomics revealed anatomical and cellular abnormalities, particularly in cortex and striatum of juvenile mutant mice (16p11(+/-)). We found elevated numbers of striatal medium spiny neurons (MSNs) expressing the dopamine D2 receptor (Drd2(+)) and fewer dopamine-sensitive (Drd1(+)) neurons in deep layers of cortex. Electrophysiological recordings of Drd2(+) MSN revealed synaptic defects, suggesting abnormal basal ganglia circuitry function in 16p11(+/-) mice. This is further supported by behavioral experiments showing hyperactivity, circling, and deficits in movement control. Strikingly, 16p11(+/-) mice showed a complete lack of habituation reminiscent of what is observed in some autistic individuals. Our findings unveil a fundamental role of genes affected by the 16p11.2 deletion in establishing the basal ganglia circuitry and provide insights in the pathophysiology of autism.
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Affiliation(s)
- Thomas Portmann
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,School of Medicine, Stanford University, Stanford, CA 94305-5345, USA
| | - Mu Yang
- Laboratory of Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD 20892-9663, USA
| | - Rong Mao
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,School of Medicine, Stanford University, Stanford, CA 94305-5345, USA
| | - Georgia Panagiotakos
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,School of Medicine, Stanford University, Stanford, CA 94305-5345, USA.,Neurosciences Program, Stanford University, Stanford, CA 94305-5345, USA
| | - Jacob Ellegood
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, ON M5T 3H7, Canada
| | - Gul Dolen
- Department of Neuroscience, Brain Science Institute, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Patrick L Bader
- School of Medicine, Stanford University, Stanford, CA 94305-5345, USA.,Department of Molecular and Cellular Physiology, Stanford University, Stanford, CA 94305-5345, USA
| | - Brad A Grueter
- School of Medicine, Stanford University, Stanford, CA 94305-5345, USA.,Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5345, USA
| | - Carleton Goold
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,School of Medicine, Stanford University, Stanford, CA 94305-5345, USA
| | - Elaine Fisher
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,School of Medicine, Stanford University, Stanford, CA 94305-5345, USA
| | - Katherine Clifford
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,School of Medicine, Stanford University, Stanford, CA 94305-5345, USA
| | - Pavitra Rengarajan
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,School of Medicine, Stanford University, Stanford, CA 94305-5345, USA
| | - David Kalikhman
- Laboratory of Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD 20892-9663, USA
| | - Darren Loureiro
- Laboratory of Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD 20892-9663, USA
| | - Nay L Saw
- Stanford Behavioral and Functional Neuroscience Laboratory, Stanford, CA 94305-5345, USA
| | - Zhou Zhengqui
- Stanford Behavioral and Functional Neuroscience Laboratory, Stanford, CA 94305-5345, USA
| | - Michael A Miller
- Stanford Behavioral and Functional Neuroscience Laboratory, Stanford, CA 94305-5345, USA
| | - Jason P Lerch
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, ON M5T 3H7, Canada.,Deparment of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Mark Henkelman
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, ON M5T 3H7, Canada.,Deparment of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Mehrdad Shamloo
- School of Medicine, Stanford University, Stanford, CA 94305-5345, USA.,Stanford Behavioral and Functional Neuroscience Laboratory, Stanford, CA 94305-5345, USA.,Stanford Institute for Neuro-Innovation and Translational Neurosciences, Stanford, CA 94305-5345, USA
| | - Robert C Malenka
- School of Medicine, Stanford University, Stanford, CA 94305-5345, USA.,Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5345, USA
| | - Jacqueline N Crawley
- Laboratory of Behavioral Neuroscience, National Institute of Mental Health, Bethesda, MD 20892-9663, USA
| | - Ricardo E Dolmetsch
- Department of Neurobiology, Stanford University, Stanford, CA 94305-5345, USA.,Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
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10
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Mason R, Kaplan SA, Clifford K. Bibliography of Frederica de Laguna. Arctic Anthropology 2006. [DOI: 10.1353/arc.2011.0008] [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: 11/11/2022]
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11
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Abstract
The value of high resolution computerized tomography (CT) prior to routine mastoid surgery for cholesteatoma remains controversial. Doubts about sensitivity and specificity, in detecting the extent of underlying pathology and in predicting asymptomatic complications, prevent widespread adoption. This retrospective study looks at the influence of pre-operative scanning on the surgical management of chronic suppurative otitis media over an 18-month period. The radiological findings determined the choice of surgical approach, but contributed less to the decision to operate and the prediction of potential hazards. CT is of most value when the otologist can be flexible in surgical technique, tailoring it to imaging findings.
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Affiliation(s)
- A Banerjee
- Department of Otorhinolaryngology, North Riding Infirmary, Middlesbrough, UK
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12
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Abstract
The history of surgery for middle ear cholesteatoma is of an evolution of techniques to meet the challenges of inaccessible disease and of post-operative cavity management. The concept has traditionally been of exploration guided by awareness and anticipation of all, possibly asymptomatic, complications. Modern imaging reliably demonstrates surgical anatomy, dictating the ideal approach, forewarns of complications and may reveal the extent of disease. An apparent resistance amongst otologists to universal CT scanning prior to mastoidectomy contrasts with the enthusiasm of skull base surgeons or rhinologists for appropriate imaging.
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Affiliation(s)
- P D Yates
- Department of Otolaryngology, North Riding Infirmary, Newport Road, Middlesbrough TS1 5JE, UK
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13
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Abstract
Glomus tumours can present in several sites in the head and neck. A red mass in the middle ear, visible on otoscopy generally indicates a glomus tympanicum or glomus jugulare. We present photographic and radiologic evidence of such a lesion arising from the course of the intra-tympanic facial nerve, the Fallopian canal, and review the differential diagnoses.
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Affiliation(s)
- M N H Waldron
- Department of Otolaryngology, North Riding Infirmary, Middlesbrough, UK
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Watts S, Flood LM, Clifford K. A systematic approach to interpretation of computed tomography scans prior to surgery of middle ear cholesteatoma. J Laryngol Otol 2000; 114:248-53. [PMID: 10845037 DOI: 10.1258/0022215001905454] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The foundation of mastoid surgery for cholesteatoma has traditionally been a thorough knowledge of the anatomy and familiarity with landmarks, constant alertness to detect unsuspected complications and the experience to tailor the surgery to the pathology encountered. Whilst not indispensable, computed tomography (CT) scanning is a useful adjunct whose potential predictive value is only truly appreciated by skilled interpretation. We present a guide to analysis to maximize the value of pre-operative radiology.
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Affiliation(s)
- S Watts
- Department of Otolaryngology, North Riding Infirmary, Middlesbrough, UK
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Abstract
Endometrial natural killer (NK) cells were compared in luteal-phase endometrial samples from women with recurrent miscarriage and from normal subjects. Cryostat sections were labelled using a monoclonal antibody to CD56 using an avidin-biotin complex method and a morphometric study performed. Increased mean numbers of CD56+ cells were documented in the endometrium of women with recurrent early miscarriage only. These findings suggest a possible role for NK cells in the pathogenesis of recurrent early pregnancy loss.
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Affiliation(s)
- K Clifford
- Departments of Obstetrics and Gynaecology and Histopathology, Imperial College School of Medicine at St Mary's, London W2 1NY, UK
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Clifford K, Flanagan A, Regan L. P-168. The endometrial CD56+ natural killer cell population in women with recurrent miscarriage. Hum Reprod 1999. [DOI: 10.1093/humrep/14.suppl_3.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clifford K, Huck W, Shan M, Tosiello R, Echols RM, Heyd A. Double-blind comparative trial of ciprofloxacin versus clarithromycin in the treatment of acute bacterial sinusitis. Sinusitis Infection Study Group. Ann Otol Rhinol Laryngol 1999; 108:360-7. [PMID: 10214783 DOI: 10.1177/000348949910800408] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This multicenter, randomized, double-blind trial compared the efficacy and safety of ciprofloxacin (CIP; 500 mg twice daily for 10 days, placebo for 4 days) to those of clarithromycin (CLARI; 500 mg twice daily for 14 days) in 560 adults with clinically documented and radiologically confirmed acute sinusitis. Of 457 efficacy-valid adults (236 CIP, 221 CLARI), clinical resolution plus improvement at the end of therapy was 84% for CIP-treated patients compared to 91% of CLARI recipients (CI95 = -0.131, -0.013). At the 1-month follow-up, more than twice as many CLARI-treated patients, 18 (10%), experienced a relapse, compared to 7 (4%) CIP-treated patients. The combined clinical response analyses (end of therapy and 1 -month follow-up) demonstrated that CIP and CLARI were statistically equivalent (CI95 = -0.106, 0.044). Diarrhea, nausea, headache, and dizziness were the most frequently reported drug-related adverse events in both treatment groups; diarrhea and taste perversion were reported more frequently among CLARI recipients. In summary, the combined end of therapy and follow-up clinical evaluation analyses revealed that CIP and CLARI were equally effective in the management of acute sinusitis, although twice as many relapses were reported among CLARI recipients.
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Caroline C, Clifford K, Cohen J, Inglis S, Naughton M, Pickering S, Richardson K, Smith A, Venables A. Structuring health care for the future. Nurs Manag (Harrow) 1998; 5:23-7. [PMID: 9874976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Wong D, Larrabee S, Clifford K, Tremblay J, Friend D. USP Dissolution Apparatus III (reciprocating cylinder) for screening of guar-based colonic delivery formulations. J Control Release 1997. [DOI: 10.1016/s0168-3659(97)01633-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The future pregnancy outcome of 201 consecutive women, median age 34 years (range 22-43), with a history of unexplained recurrent first trimester miscarriage (median 3; range 3-13), was studied. All women and their partners had normal peripheral blood karyotypes; none had antiphospholipid antibodies and none hypersecreted luteinizing hormone (LH). No pharmacological treatment was prescribed and early pregnancy supportive care was encouraged. Women aged < or = 30 years had a subsequent miscarriage rate of 25% (14/57) which rose to 52% (13/25) in women aged > or = 40 years (P = 0.02). After three consecutive miscarriages, the risk of miscarriage of the next pregnancy was 29% (34/119) but increased to 53% (9/17) after six or more previous losses (P = 0.04). A past history of a livebirth did not influence the outcome of the next pregnancy. Supportive care in early pregnancy conferred a significant beneficial effect on pregnancy outcome. Of 160 women who attended the early pregnancy clinic, 42 (26%) miscarried in the next pregnancy compared with 21 out of 41 (51%) who did not attend the clinic (P = 0.002). After thorough investigation, women with unexplained recurrent first trimester miscarriage have an excellent pregnancy outcome without pharmacological intervention if offered supportive care alone in the setting of a dedicated miscarriage clinic.
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Affiliation(s)
- K Clifford
- Department of Obstetrics and Gynaecology, Imperial College School of Medicine at St. Mary's, London, UK
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22
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Clifford K, Rai R, Watson H, Franks S, Regan L. Does suppressing luteinising hormone secretion reduce the miscarriage rate? Results of a randomised controlled trial. BMJ 1996; 312:1508-11. [PMID: 8646142 PMCID: PMC2351255 DOI: 10.1136/bmj.312.7045.1508] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine whether prepregnancy pituitary suppression of luteinising hormone secretion with a luteinising hormone releasing hormone analogue improves the outcome of pregnancy in ovulatory women with a history of recurrent miscarriage, polycystic ovaries, and hypersecretion of luteinising hormone. DESIGN Randomised controlled trial. SETTING Specialist recurrent miscarriage clinic. SUBJECTS 106 women with a history of three or more consecutive first trimester miscarriages, polycystic ovaries, and hypersecretion of luteinising hormone. INTERVENTIONS Women were randomised before conception to receive pituitary suppression with a luteinising hormone releasing hormone analogue followed by low dose ovulation induction and luteal phase progesterone (group 1) or were allowed to ovulate spontaneously and then given luteal phase progesterone alone or luteal phase placebo alone (group 2). No drugs were prescribed in pregnancy. MAIN OUTCOME MEASURES Conception and live birth rates over six cycles. RESULTS Conception rates in the pituitary suppression and luteal phase support groups were 80% (40/50 women) and 82% (46/56) respectively (NS). Live birth rates were 65% (26/40) and 76% (35/46) respectively (NS). In the luteal phase support group there was no difference in the outcome of pregnancy between women given progesterone and those given placebo pessaries. Live birth rates from an intention to treat analysis were 52% (26/50 pregnancies) in the group given pituitary suppression and 63% (35/56) in the controls (NS). CONCLUSIONS Prepregnancy suppression of high luteinising hormone concentrations in ovulatory women with recurrent miscarriage and hypersecretion of luteinising hormone does not improve the outcome of pregnancy. The outcome of pregnancy without pituitary suppression is excellent.
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Affiliation(s)
- K Clifford
- Department of Obstetrics and Gynaecology, St. Mary's Hospital Medical School, London
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Affiliation(s)
- R Rai
- Department of Obstetrics and Gynaecology, St. Mary's Hospital Medical School, London, United Kingdom
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Rai RS, Clifford K, Cohen H, Regan L. High prospective fetal loss rate in untreated pregnancies of women with recurrent miscarriage and antiphospholipid antibodies. Hum Reprod 1995; 10:3301-4. [PMID: 8822463 DOI: 10.1093/oxfordjournals.humrep.a135907] [Citation(s) in RCA: 211] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Antiphospholipid antibodies (APA), lupus anticoagulant (LA) and/or anticardiolipin antibodies (ACA), are associated with thrombosis and recurrent miscarriage. We studied the outcome of 20 pregnancies in women (median age 32 years; range 23-41) with APA (14 LA positive; three immunoglobulin (Ig) G ACA positive; two IgM ACA positive and one LA and IgG ACA positive) and history of recurrent miscarriage (median 4; range 3-11) who declined pharmacological treatment in their next pregnancy. Comparison was made with a cohort of 100 consecutive women (median age 33 years; range 23-44) with recurrent miscarriage (median 4; range 3-10), in whom no underlying cause to account for their pregnancy losses was found. Of the 20 women with APA, 18 (90%) miscarried compared to 34 of the 100 women (34%) with normal investigations (P < 0.001). The majority (94%) of miscarriages in women with APA occurred in the first trimester. Fetal heart activity was seen prior to fetal death in 86% of women with APA compared to 43% of women with normal investigations (P < 0.01). The first trimester loss of embryonic pregnancies is the most common type of miscarriage in women with APA. This may be a result of defective implantation and subsequent placentation.
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Affiliation(s)
- R S Rai
- Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, London, UK
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Rai RS, Regan L, Clifford K, Pickering W, Dave M, Mackie I, McNally T, Cohen H. Antiphospholipid antibodies and beta 2-glycoprotein-I in 500 women with recurrent miscarriage: results of a comprehensive screening approach. Hum Reprod 1995; 10:2001-5. [PMID: 8567830 DOI: 10.1093/oxfordjournals.humrep.a136224] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Five hundred consecutive women (median age 33 years; range 19-45) with a history of recurrent miscarriage (median 4; range 3-16) were screened for the presence of antiphospholipid antibodies (APA)-lupus anticoagulant (LA) and/or anticardiolipin antibodies (ACA). The prevalence of persistently positive tests for LA was 9.6% and for immunoglobulin G (IgG) and immunoglobulin M (IgM) ACA was 3.3 and 2.2% respectively. Only seven women (1.4%) were LA and ACA positive. Repeat testing, after an interval of at least 8 weeks, demonstrated that only 65.7% of LA positive, 36.6% IgG ACA positive and 36.0% IgM ACA positive women on initial testing had a second positive test result. The dilute Russell's viper venom time detected the LA significantly more often than either the activated partial thromboplastin time or the kaolin clotting time (P < 0.001). There was no difference in the gestation of previous miscarriages between APA positive and APA negative women. There was no difference in the plasma beta 2-glycoprotein-I concentrations between APA positive and APA negative women with miscarriages and normal women. All women with a history of recurrent miscarriage should be tested for the presence of both LA and ACA. A second confirmatory test should be performed in those with an initial positive test result.
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Affiliation(s)
- R S Rai
- Department of Obstetrics and Gynaecology, St. Mary's Hospital Medical School, London, UK
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Clifford K, Rai R, Watson H, Regan L. An informative protocol for the investigation of recurrent miscarriage: preliminary experience of 500 consecutive cases. Hum Reprod 1994; 9:1328-32. [PMID: 7962442 DOI: 10.1093/oxfordjournals.humrep.a138703] [Citation(s) in RCA: 227] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A total of 500 consecutive women (mean age 32.9 years; SD 5 years) presenting with a history of recurrent miscarriages (median 4; range 3-17) were investigated for the presence of antiphospholipid antibodies (APA), polycystic ovaries (PCO), hypersecretion of luteinizing hormone (LH) and chromosome abnormalities in order to detect an underlying cause of their pregnancy losses. All women had details of their previous reproductive history, investigations and treatment documented: 76% of the women had experienced only early pregnancy losses (miscarriage < 13 weeks gestation); 32% had a history of subfertility; and significant parental chromosome rearrangements were present in 3.6% of couples. An ultrasound diagnosis of PCO was made in 56% of women, 58% of whom were demonstrated to hypersecrete LH, based on early morning urinary LH analysis. Circulating APA were found in 14% of women. An underlying cause of recurrent miscarriage--genetic, endocrine or autoimmune--was found in > 50% of couples. Women in the latter two groups are being recruited to randomized treatment trials which are discussed.
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Affiliation(s)
- K Clifford
- Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, London, UK
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Rai RS, Clifford K, Regan L. Myocardial infarction during pregnancy. Br J Obstet Gynaecol 1994; 101:462. [PMID: 8068102 DOI: 10.1111/j.1471-0528.1994.tb11932.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
A home ovulation testing kit, Clearplan, that detects the urinary luteinizing hormone (LH) surge was used by 32 patients on a donor insemination programme for 50 cycles to indicate when to first attend the clinic for a serum LH test to determine ovulation. Using Clearplan significantly reduced the number of clinic attendances (4.06 +/- 1.5) compared to the preceding control cycle (7.06 +/- 2.0 p less than 0.001). One serum LH peak was missed using Clearplan. Ovulation was predicted within 2 days of the serum LH surge in 77% of cycles. Home ovulation determination has the potential to reduce the stress and cost of fertility programmes.
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Affiliation(s)
- L R Leader
- Department of Fertility and Reproductive Endocrinology, Royal Hospital for Women, Sydney, New South Wales
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Abstract
Murine biological fluids and murine cell culture supernatants were analyzed for the presence of soluble murine interleukin 4 receptor (sIL4R) with the use of two monoclonal antibodies directed against the receptor. Mouse urine, serum, ascitic fluid, and cell culture supernatants contained varying levels of immunoreactive protein. All of the immunoreactive protein possessed interleukin 4 (IL 4) binding activity. Following partial purification of ascitic fluid a protein was isolated that binds IL 4 with high affinity. This data is consistent with the fact that murine biological fluids contain a soluble version of the murine IL 4 receptor that arises via secretion of the soluble receptor and/or via shedding of the extracellular portion of the full-length receptor from the cell surface.
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Affiliation(s)
- W C Fanslow
- Immunex Corporation, Seattle, Washington 98101
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McCloskey EV, Murray SA, Charlesworth D, Miller C, Fordham J, Clifford K, Atkins R, Kanis JA. Assessment of broadband ultrasound attenuation in the os calcis in vitro. Clin Sci (Lond) 1990; 78:221-5. [PMID: 2155752 DOI: 10.1042/cs0780221] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
1. We have examined the relationship between the attenuation of broadband ultrasound in the os calcis in vitro and its bone mineral density measured by quantitative computed tomography and by physical density. 2. Broadband ultrasound attenuation was found to correlate closely with physical density (r = 0.85, P less than 0.0001), but the correlation was less than that observed between quantitative computed tomography and physical density (r = 0.92, P less than 0.0001). Measurements of broadband ultrasound attenuation and quantitative computed tomography were significantly correlated (r = 0.80, P less than 0.0001). 3. Partial correlation analysis showed a significant relationship between broadband ultrasound attenuation and bone density, but when the effect of physical density was taken into account no significant correlation was found between broadband ultrasound attenuation and quantitative computed tomography (r = 0.08, not significant). 4. Broadband ultrasound attenuation in three prospective amputees showed a high degree of concordance between measurements in vivo and in vitro, with no interference by surrounding soft tissues. 5. The correlation between physical density and broadband ultrasound attenuation was independent of quantitative computed tomography, suggesting that the technique measures aspects of density which differ from its mineral density. Broadband ultrasound attenuation holds promise as a reproducible, rapid, radiation-free assessment of skeletal status.
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Affiliation(s)
- E V McCloskey
- Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Medical School, U.K
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Clifford K, Plomann MP. Is elderly psychiatric care still a gray area? Healthc Financ Manage 1986; 40:83-5. [PMID: 10300705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
It has been previously suggested that glucagon improves the bile duct and gall-bladder opacification obtained by infusion cholangiography. One hundred and ninety consecutive patients referred for intravenous cholangiography were entered into a double-blind study designed to see if glucagon would in fact significantly improve bile duct opacification. All patients received a one hour intravenous infusion of iotroxamide at a rate of 3.15 mg/kg body weight/min. Glucagon did not enhance bile duct opacification, the mean post-injection scores for the two groups being 2.47 +/- 1.11 and 2.29 +/- 1.15 respectively. On the basis of the present study we cannot recommend the routine use of glucagon following infusion cholangiography.
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Bitton G, Chang LT, Farrah SR, Clifford K. Recovery of coliphages from wastewater effluents and polluted lake water by the magnetite-organic flocculation method. Appl Environ Microbiol 1981; 41:93-6. [PMID: 7013703 PMCID: PMC243645 DOI: 10.1128/aem.41.1.93-96.1981] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A magnetite-organic flocculation method was developed for the concentration of coliphages from wastewater effluents and polluted lake water. A high percent (68 to 100%) recovery of coliphages from sewage effluents was achieved by this procedure. Coliphage recovery from Lake Alice, a sewage-contaminated lake, showed phage concentrations ranging from 2.3 X 10(2) to 1.9 X 10(3) plaque-forming units per liter. This method is simple and inexpensive and may be carried out under field conditions.
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Doran J, Clifford K, Martin P, Knapp DR, Bell GD. Drip infusion cholangiography using iotroxamide. Double blind comparison with ioglycamide. Br J Radiol 1980; 53:654-8. [PMID: 7000219 DOI: 10.1259/0007-1285-53-631-654] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A double blind clinical trial was carried out in 200 unselected patients to compare the efficacy and tolerance of ioglycamide and iotroxamide as contrast media for intravenous cholangiography. The two agents were administered by slow infusion at a rate of 2.6 mumoles/kg bodyweight/minute for one hour. Radiological opacification of the bile duct was assessed independently by two radiologists. In patients with serum bilirubin levels of less than 34 mumoles/litre visualization of the bile duct was significantly better with iotroxamide than with ioglycamide (P < 0.001). Toxic side effects were observed in 8% of patients receiving ioglycamide and in only 3% of the patients given iotroxamide.
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Popják G, Edmond J, Clifford K, Williams V. Biosynthesis and structure of a new intermediate between farnesyl pyrophosphate and squalene. J Biol Chem 1969; 244:1897-918. [PMID: 4388617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Popják G, Edmond J, Clifford K, Williams V. Biosynthesis and Structure of a New Intermediate between Farnesyl Pyrophosphate and Squalene. J Biol Chem 1969. [DOI: 10.1016/s0021-9258(18)91765-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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