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Jiang A, Perry T, Walker K, Burfoot A, Patterson L. Surgical sensation during caesarean section: a qualitative analysis. Int J Obstet Anesth 2024; 57:103935. [PMID: 37925355 DOI: 10.1016/j.ijoa.2023.103935] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/13/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Caesarean section (CS) is a major abdominal surgery performed usually on a young and healthy population under neuraxial anesthesia with little to no sedation. This creates a distinct surgical experience whereby patients are aware of the surgical process, physical sensations, and their environment. This study aimed to provide an in-depth descriptive assessment of subjective surgical experience during CS under regional anaesthesia. We expected the information gained would enhance our current understanding and better alleviate patient anxiety through informed counselling. METHODS This qualitative descriptive study was conducted at a Canadian academic centre. Twenty patients participated in semi-structured interviews within a week of CS, using an interview guide developed for this study. Patient medical records were reviewed to collect demographic and surgical information. Thematic analysis was conducted using an inductive approach to determine common themes. RESULTS Nine themes were identified. Five themes were identified in the category of surgical sensation and four themes were identified in the category of peri-operative education. CONCLUSIONS Patients commonly experienced pressure and movement sensations at varying intensity, and most did not experience pain. Environmental factors, including sounds and distraction by the newborn, affected perception of surgical sensation. Patients wish to receive pre-operative counselling regarding potential surgical sensations, as well as ongoing communication from their anaesthesiologist. These results can be used to guide informed discussions with patients and direct further investigation in this area.
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Affiliation(s)
- A Jiang
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
| | - T Perry
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - K Walker
- Department of Sociology, Queen's University, Kingston, Ontario, Canada
| | - A Burfoot
- Department of Sociology, Queen's University, Kingston, Ontario, Canada
| | - L Patterson
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
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Eugene N, Kuryba A, Martin P, Oliver CM, Berry M, Moppett IK, Johnston C, Hare S, Lockwood S, Murray D, Walker K, Cromwell DA. Development and validation of a prognostic model for death 30 days after adult emergency laparotomy. Anaesthesia 2023; 78:1262-1271. [PMID: 37450350 DOI: 10.1111/anae.16096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
The probability of death after emergency laparotomy varies greatly between patients. Accurate pre-operative risk prediction is fundamental to planning care and improving outcomes. We aimed to develop a model limited to a few pre-operative factors that performed well irrespective of surgical indication: obstruction; sepsis; ischaemia; bleeding; and other. We derived a model with data from the National Emergency Laparotomy Audit for patients who had emergency laparotomy between December 2016 and November 2018. We tested the model on patients who underwent emergency laparotomy between December 2018 and November 2019. There were 4077/40,816 (10%) deaths 30 days after surgery in the derivation cohort. The final model had 13 pre-operative variables: surgical indication; age; blood pressure; heart rate; respiratory history; urgency; biochemical markers; anticipated malignancy; anticipated peritoneal soiling; and ASA physical status. The predicted mortality probability deciles ranged from 0.1% to 47%. There were 1888/11,187 deaths in the test cohort. The scaled Brier score, integrated calibration index and concordance for the model were 20%, 0.006 and 0.86, respectively. Model metrics were similar for the five surgical indications. In conclusion, we think that this prognostic model is suitable to support decision-making before emergency laparotomy as well as for risk adjustment for comparing organisations.
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Affiliation(s)
- N Eugene
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - A Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - P Martin
- Department of Applied Health Research, University College London, London, UK
| | - C M Oliver
- UCL Division of Surgery and Interventional Science, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Berry
- Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - I K Moppett
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, University of Nottingham, Nottingham, UK
| | - C Johnston
- Department of Anaesthesia, St George's Hospital, London, UK
| | - S Hare
- Department of Anaesthesia, Medway Maritime Hospital, Gillingham, Kent, UK
| | - S Lockwood
- Colorectal Surgery Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - D Murray
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - K Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D A Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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3
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Walker K, Shah D. Does the management of buprenorphine during pregnancy affect neonatal outcomes? Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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4
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Kuryba AJ, Boyle JM, van der Meulen J, Aggarwal A, Walker K, Fearnhead NS, Braun MS. Severity of Dementia and Survival in Patients Diagnosed with Colorectal Cancer: A National Cohort Study in England and Wales. Clin Oncol (R Coll Radiol) 2023; 35:e67-e76. [PMID: 36216698 DOI: 10.1016/j.clon.2022.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 01/04/2023]
Abstract
AIMS There is little evidence about the survival of patients with colorectal cancer (CRC) also diagnosed with dementia. We quantified dementia severity and estimated how it is associated with 2-year overall survival. MATERIALS AND METHODS Records of patients aged 65 years or older diagnosed with CRC in England and Wales were identified. A novel proxy for dementia severity combined dementia diagnosis in administrative hospital data with Eastern Cooperative Oncology Group performance status. Cox regression was used to estimate hazard ratios with and without risk adjustment. RESULTS In total, 4033 of 105 250 CRC patients (3.8%) had dementia recorded. Two-year survival decreased with increasing dementia severity from 65.4% without dementia, 53.5% with mild dementia, 33.0% with moderate dementia to 16.5% with severe dementia (hazard ratio comparing severe with no dementia: 2.97; 95% confidence interval 2.79, 3.16). Risk adjustment for comorbidity and cancer stage reduced this association slightly (hazard ratio 2.52; 95% confidence interval 2.37, 2.68) and additional adjustment for treatment factors reduced it further (hazard ratio 1.60; 95% confidence interval 1.50, 1.70). CONCLUSIONS Survival of CRC patients varied strongly according to dementia severity, suggesting that a 'one-size-fits-all' policy for the care of CRC patients with dementia is not appropriate. Comprehensive assessment of cancer patients with dementia that considers dementia severity is essential in a shared decision-making process that ensures patients receive the most appropriate treatment for their individual needs and preferences.
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Affiliation(s)
- A J Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - J M Boyle
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M S Braun
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK; School of Medical Sciences, University of Manchester, Manchester, UK
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5
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Walker K, O'Rourke B, Dennis J. Dr Peter John Healy: 1940-2019. Aust Vet J 2023; 101:80-81. [PMID: 36468199 DOI: 10.1111/avj.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/07/2022]
Affiliation(s)
- K Walker
- Elizabeth Macarthur Agricultural Institute, Menangle, Australia
| | - B O'Rourke
- Elizabeth Macarthur Agricultural Institute, Menangle, Australia
| | - J Dennis
- Elizabeth Macarthur Agricultural Institute, Menangle, Australia
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Chan A, Begum Y, Robertson A, Walker K, Westmacott R, Shroff M, Dlamini N, Narang I. The Impact of Experimental Sleep Restriction on Neurocognition in Healthy Adolescents. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.564] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chan A, Begum Y, Robertson A, Walker K, Westmacott R, Shroff M, Dlamini N, Narang I. The Impact of Experimental Sleep Restriction on Endothelial Function in Healthy Adolescents. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.563] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Choi I, McCormick B, Fox J, Xu A, Zinovoy M, Mueller B, Park P, Millar M, Walker K, Tung C, Huang S, Florio P, Chen C, Crandell I, Hanlon A, Bakst R, LaPlant Q, Khan A, Powell S, Cahlon O. Comparative Evaluation of Brachial Plexus Sparing for Comprehensive Reirradiation of High Risk Recurrent or New Primary Breast Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2175] [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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Aughey H, Jardine J, Knight H, Gurol-Urganci I, Walker K, Harris T, van de Meulen J, Hawdon J, Pasupathy D, The Nmpa Project Team. Iatrogenic and spontaneous preterm birth in England: a population-based cohort study. BJOG 2022; 130:33-41. [PMID: 36073305 PMCID: PMC10092353 DOI: 10.1111/1471-0528.17291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals. DESIGN Cohort study using electronic health records. SETTING English National Health Service. POPULATION Singleton births between 1st April 2015 and 31st March 2017. METHODS Multivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors. MAIN OUTCOME MEASURES Preterm births (<37 weeks gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour. RESULTS 6.1% of births were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub-groups are associated with previous preterm birth, extremes of maternal age, socioeconomic deprivation and smoking. Iatrogenic preterm birth was associated with higher BMI (adjRR BMI >40 1.59 (1.50, 1.69)), and previous caesarean (adjRR 1.88 (1.83, 1.95)). Spontaneous preterm birth was less common in women with a higher BMI (adjRR BMI>40 0.77 (0.70, 0.84)) and in women with a previous caesarean (adjRR 0.87 (0.83, 0.90)). More variation between NHS hospital trusts was observed in rates of iatrogenic, compared to spontaneous, preterm births. CONCLUSIONS Just over half of all preterm births resulted from iatrogenic intervention. Iatrogenic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub-groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different prevention strategies. This is feasible using routinely acquired hospital data.
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Affiliation(s)
- H Aughey
- Royal College of Obstetricians and Gynaecologists, London, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Jardine
- Royal College of Obstetricians and Gynaecologists, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - H Knight
- Royal College of Obstetricians and Gynaecologists, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - I Gurol-Urganci
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - T Harris
- Royal College of Obstetricians and Gynaecologists, London, UK.,Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - J van de Meulen
- Royal College of Obstetricians and Gynaecologists, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J Hawdon
- Royal College of Obstetricians and Gynaecologists, London, UK.,Royal Free NHS Foundation Trust, London, UK
| | - D Pasupathy
- Royal College of Obstetricians and Gynaecologists, London, UK.,Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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Aguilar-Arevalo AA, Alves DSM, Biedron S, Boissevain J, Borrego M, Chavez-Estrada M, Chavez A, Conrad JM, Cooper RL, Diaz A, Distel JR, D'Olivo JC, Dunton E, Dutta B, Elliott A, Evans D, Fields D, Greenwood J, Gold M, Gordon J, Guarincerri E, Huang EC, Kamp N, Kelsey C, Knickerbocker K, Lake R, Louis WC, Mahapatra R, Maludze S, Mirabal J, Moreno R, Neog H, deNiverville P, Pandey V, Plata-Salas J, Poulson D, Ray H, Renner E, Schaub TJ, Shaevitz MH, Smith D, Sondheim W, Szelc AM, Taylor C, Thompson WH, Thornton RT, Tripathi M, Van Berg R, Van de Water RG, Verma S, Walker K. First Leptophobic Dark Matter Search from the Coherent-CAPTAIN-Mills Liquid Argon Detector. Phys Rev Lett 2022; 129:021801. [PMID: 35867467 DOI: 10.1103/physrevlett.129.021801] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
We report the first results of a search for leptophobic dark matter (DM) from the Coherent-CAPTAIN-Mills (CCM) liquid argon (LAr) detector. An engineering run with 120 photomultiplier tubes (PMTs) and 17.9×10^{20} protons on target (POT) was performed in fall 2019 to study the characteristics of the CCM detector. The operation of this 10-ton detector was strictly light based with a threshold of 50 keV and used coherent elastic scattering off argon nuclei to detect DM. Despite only 1.5 months of accumulated luminosity, contaminated LAr, and nonoptimized shielding, CCM's first engineering run has already achieved sensitivity to previously unexplored parameter space of light dark matter models with a baryonic vector portal. With an expected background of 115 005 events, we observe 115 005+16.5 events which is compatible with background expectations. For a benchmark mediator-to-DM mass ratio of m_{V_{B}}/m_{χ}=2.1, DM masses within the range 9 MeV≲m_{χ}≲50 MeV are excluded at 90% C. L. in the leptophobic model after applying the Feldman-Cousins test statistic. CCM's upgraded run with 200 PMTs, filtered LAr, improved shielding, and 10 times more POT will be able to exclude the remaining thermal relic density parameter space of this model, as well as probe new parameter space of other leptophobic DM models.
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Affiliation(s)
| | - D S M Alves
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Biedron
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - J Boissevain
- Bartoszek Engineering, Aurora, Illinois 60506, USA
| | - M Borrego
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - A Chavez
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J M Conrad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R L Cooper
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - A Diaz
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J R Distel
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J C D'Olivo
- Universidad Nacional Autónoma de México, CDMX 04510, México
| | - E Dunton
- Columbia University, New York, New York 10027, USA
| | - B Dutta
- Texas A&M University, College Station, Texas 77843, USA
| | - A Elliott
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - D Evans
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D Fields
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - J Greenwood
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - M Gold
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - J Gordon
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - E Guarincerri
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - E C Huang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - N Kamp
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - C Kelsey
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - K Knickerbocker
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Lake
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - W C Louis
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Mahapatra
- Texas A&M University, College Station, Texas 77843, USA
| | - S Maludze
- Texas A&M University, College Station, Texas 77843, USA
| | - J Mirabal
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Moreno
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - H Neog
- Texas A&M University, College Station, Texas 77843, USA
| | - P deNiverville
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - V Pandey
- University of Florida, Gainesville, Florida 32611, USA
| | - J Plata-Salas
- Universidad Nacional Autónoma de México, CDMX 04510, México
| | - D Poulson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - H Ray
- University of Florida, Gainesville, Florida 32611, USA
| | - E Renner
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T J Schaub
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - M H Shaevitz
- Columbia University, New York, New York 10027, USA
| | - D Smith
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - W Sondheim
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A M Szelc
- University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
| | - C Taylor
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - W H Thompson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R T Thornton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Tripathi
- University of Florida, Gainesville, Florida 32611, USA
| | - R Van Berg
- Bartoszek Engineering, Aurora, Illinois 60506, USA
| | - R G Van de Water
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Verma
- Texas A&M University, College Station, Texas 77843, USA
| | - K Walker
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
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Parvanta C, Hammond RW, He W, Zemen R, Boddupalli S, Walker K, Chen H, Harner RN. Face Value: Remote facial expression analysis adds predictive power to perceived effectiveness for selecting anti-tobacco PSAs. J Health Commun 2022; 27:281-291. [PMID: 35838201 DOI: 10.1080/10810730.2022.2100016] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Perceived effectiveness (PE) is a validated tool for predicting the potential impact of anti-tobacco public service announcements (PSAs). We set out to evaluate the added predictive value of facial expression analysis when combined with PE in a remote (online) survey. Each of 302 tobacco users watched 3 PSAs and allowed transmission of webcam videos from which metrics for "attention" (head position) and "facial action units" (FAU) were computed. The participants completed scales for their subjective emotions, willingness to share on social media, and intention to quit smoking using the Tobacco Free Florida website. Based on PE, both ready to quit (RTQ) and not ready (NR) respondents favored the same PSAs but RTQs assigned higher PE scores. Negative PSAs ("sad" or "frightening") were more compelling overall but RTQs also favored surprising ads and were more willing to share them on social media. Logistic regression showed that the combination of Attention + FAU+ PE (AUC = .816, p < .0001) outperformed single factors or factor combinations in distinguishing RTQ from NR. This study demonstrates that on-line assessment of facial expressions enhances the predictive value of PE and can be deployed on large remote samples.
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Affiliation(s)
- Claudia Parvanta
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - R W Hammond
- Muma College of Business, Center for Marketing and Sales Innovation, University of South Florida, Tampa, Florida, USA
| | - W He
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - R Zemen
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - S Boddupalli
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - K Walker
- Zimmerman School of Mass Communication and Advertising, University of South Florida, Tampa, Florida, USA
| | - H Chen
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - R N Harner
- Muma College of Business, Center for Marketing and Sales Innovation, University of South Florida, Tampa, Florida, USA
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Dobranowski P, Qin H, Walker K, Butcher J, Gowing A, Singleton R, Mayne J, Mack DR, Figeys D, Stintzi A. A234 IN VITRO GUT MICROBIOME AND METABOLITE RESPONSES TO RESISTANT STARCH ARE INDIVIDUALIZED. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859390 DOI: 10.1093/jcag/gwab049.233] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Gut microbes degrade and ferment resistant starch (RS) into metabolites that help maintain gut homeostasis. Clinical trials have evaluated RS for various health conditions, but individuals respond to RS with profound variability. The reason for this variability is unclear. Aims Using in vitro culturing methods and multi-omic analyses, we hypothesize that individuals will elicit variable responses to RS with respect to overall fermentation, bacterial composition, short chain acid production, and metabolite flux. Methods As part of an ongoing clinical trial, we have selected 4 pediatric patients with inflammatory bowel disease to better understand microbiome-RS interactions. We cultured stools anaerobically using a high-throughput platform (“RapidAIM”) with 9 different pre-digested RS. After 18-hour incubations, media supernatants were used to measure pH and perform targeted and semi-targeted metabolomic analyses with a panel of 116 compounds. Bacterial pellets were isolated for 16S rRNA gene sequencing analyses to evaluate changes in microbiome compositions. Data were analyzed with generalized linear mixed models, principal component analysis (PCA), random forest (RF) classification with feature selection, and network construction with graphical lasso. Results Changes in several microbiome parameters were different across individuals, including the magnitude of pH changes, metabolite signatures, and relative abundances of important bacterial taxa. Bacterial species known to degrade RS were more abundant in individuals showing stronger RS fermentation. Inter-individual discrimination was accomplished with PCA and RF, from which we could identify metabolite signatures. The robustness of microbiome networks corresponded to RS fermentation and butyrate production. Conclusions We report a novel perspective on how individuals respond to RS’ differently. Butyrate remains an important hub of the microbiome architecture with respect to RS fermentation. Future work will interrogate the roles of individualized metabolomic responses on host physiology. In vivo responses to RS are being evaluated in an ongoing clinical trial. Funding Agencies CCC, CIHRGenome Ontario, Genome Canada
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Affiliation(s)
- P Dobranowski
- Biochemistry, Microbiology and Immunology, University of Ottawa Faculty of Medicine, Surrey, BC, Canada
| | - H Qin
- Biochemistry, Microbiology and Immunology, University of Ottawa Faculty of Medicine, Surrey, BC, Canada
| | - K Walker
- Biochemistry, Microbiology and Immunology, University of Ottawa Faculty of Medicine, Surrey, BC, Canada
| | - J Butcher
- Biochemistry, Microbiology and Immunology, University of Ottawa Faculty of Medicine, Surrey, BC, Canada
| | - A Gowing
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - R Singleton
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - J Mayne
- Biochemistry, Microbiology and Immunology, University of Ottawa Faculty of Medicine, Surrey, BC, Canada
| | - D R Mack
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - D Figeys
- Biochemistry, Microbiology and Immunology, University of Ottawa Faculty of Medicine, Surrey, BC, Canada
| | - A Stintzi
- Biochemistry, Microbiology and Immunology, University of Ottawa Faculty of Medicine, Surrey, BC, Canada
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Morrow A, Walker K, Calder-MacPhee N, Ozakinci G. The active ingredients of physical activity and / or dietary workplace-based interventions to achieve weight loss in overweight and obese healthcare staff: a systematic review. J Behav Med 2022; 45:331-349. [PMID: 35132501 DOI: 10.1007/s10865-021-00279-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/27/2021] [Indexed: 01/14/2023]
Abstract
This systematic review aims to synthesize the active ingredients, and identify a list of promising behaviour change techniques (BCTs), likely to be present within physical activity and / or dietary interventions in achieving weight loss in overweight and obese healthcare staff. Four electronic databases were searched in February 2021: PsychINFO, CINAHL, PubMed and MEDLINE (no start date-2021). Studies were eligible for inclusion if they: (1) described a quasi-experimental or cluster, cohort or randomised control trial; (2) implemented workplace-based physical activity and / or dietary interventions versus a less intensive intervention or usual care; (3) targeted predominantly (> 50% of participants) overweight or obese healthcare professionals; and (4) reported a weight loss related outcome and included data on that outcome at least 3 months after the intervention began. Three reviewers used the Behaviour Change Technique Taxonomy v1 to extract BCTs with the aim of identifying a list of "promising" BCTs, which were those that were present in interventions that reported a statistically significant difference in weight loss. Nine studies were included in the review. The majority (n = 7) reported a significant reduction in weight post-intervention. A combined physical activity and dietary intervention (n = 8) was the most common type of intervention. Twenty-five BCTs were identified as "promising". Instruction on how to perform the behaviour (n = 9), behaviour practice/rehearsal (n = 8) and self-monitoring of behaviour (n = 6) were the most promising BCTs. The contents of behaviour change interventions are complex and rely on accurate reporting of intervention components and BCTs to allow concrete and robust assumptions to be made regarding which factors are most effective at achieving a desired outcome. Fundamentally the lack of research exploring the effectiveness of physical activity and dietary interventions on weight loss in overweight and obese healthcare staff and the poor quality of existing research, warrant more investigation.
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Affiliation(s)
- Alison Morrow
- NHS Fife, Cameron House, Windygates, Leven, Fife, KY8 5RG, Scotland.
| | - Kimberley Walker
- Iona Hub, The State Hospital, Carstairs, Lanark, ML11 8RP, Scotland
| | | | - Gozde Ozakinci
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, FK9 4LA, Scotland
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14
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Falconer R, Semple C, Cleland J, Walker K, Watson A. 751 Improving Engagement with Home-Based Surgical Skills Simulation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.834] [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
Introduction
Surgical simulation has been repeatedly shown to facilitate technical skill acquisition. However, trainee engagement with self-directed practice remains variable, despite access to resources. Understanding the motivators and barriers to participation is crucial to develop modules which can effectively meet the learning needs of current, and future, surgical trainees. The aim of this qualitative study was to examine factors which influence trainee engagement with home-based surgical skills simulation.
Method
A series of one-to-one semi-structured interviews were conducted remotely with ST3 vascular trainees who had previously consented to take part in a national programme of home-based technical skills simulation. Interview data was transcribed and thematically analysed.
Results
12 trainees were interviewed during a 4-week period. Overall, trainees valued simulation but found it difficult to balance against clinical commitments and mandatory training requirements, particularly if there were limited opportunities for skill transfer to the real-world environment. Although simulation was acknowledged to be a safe environment for experiential learning, trainees alluded to an underlying culture of perfection which limited willingness to learn from mistakes, even within a simulated setting. In addition, traditional attitudes about the apprenticeship model of surgical training prevail, with simulation often viewed as inferior to learning “on the job” in theatre.
Conclusions
Trainee engagement with home-based surgical skills simulation may be influenced by a range of systemic factors. In future, formal certification of simulation modules, mandating simulated competencies and curricular integration may help improve participation, as well as supporting cultural shift towards recognition of simulation as a vital component of modern surgical training.
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Affiliation(s)
- R Falconer
- Centre for Health Science, Inverness, United Kingdom
| | - C Semple
- Department of Vascular Surgery, Victoria Hospital, Kirkcaldy, United Kingdom
| | - J Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K Walker
- Centre for Health Science, Inverness, United Kingdom
- Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
| | - A Watson
- Centre for Health Science, Inverness, United Kingdom
- Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
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15
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Jardine J, Gurol-Urganci I, Harris T, Hawdon J, Pasupathy D, van der Meulen J, Walker K. Associations between ethnicity and admission to intensive care among women giving birth: a cohort study. BJOG 2021; 129:733-742. [PMID: 34545995 DOI: 10.1111/1471-0528.16891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period. DESIGN Cohort study. SETTING Maternity and intensive care units in England and Wales. POPULATION OR SAMPLE A total of 631 851 women who had a record of a registerable birth between 1 April 2015 and 31 March 2016 in a database used for national audit. METHODS Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data. MAIN OUTCOME MEASURES Admission to intensive care in pregnancy or postnatal period to 6 weeks after birth. RESULTS In all, 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (odds ratio [OR] 2.21, 95% CI 1.82-2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjusted OR 1.69, 95% CI 1.37-2.09). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups. CONCLUSIONS Black women have an increased risk of intensive care admission that cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission. TWEETABLE ABSTRACT Black women are almost twice as likely as White women to be admitted to intensive care during pregnancy and the postpartum period; this risk remains after accounting for demographic, health, lifestyle, pregnancy and birth factors.
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Affiliation(s)
- J Jardine
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - I Gurol-Urganci
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK
| | - T Harris
- Centre for Reproduction Research, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - J Hawdon
- Royal Free London NHS Foundation Trust, London, UK
| | - D Pasupathy
- Department of Women and Children's Health, King's College London, St Thomas's Hospital, London, UK.,Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - J van der Meulen
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K Walker
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
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16
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Marsh T, Walker K, Reyes Gonzalez C, Toups K, Hamadi H, Xu J, Hicks-Roof K. Nutrition Professionals’ Knowledge, Consumption and Recommendations of Whole Grains. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Roy B, Walker K, Morgan C, Finch-Edmondson M, Galea C, Epi M, Badawi N, Novak I. Epidemiology and pathogenesis of stroke in preterm infants: A systematic review. J Neonatal Perinatal Med 2021; 15:11-18. [PMID: 34219672 PMCID: PMC8842753 DOI: 10.3233/npm-200597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Perinatal stroke is one of the principal causes of cerebral palsy (CP) in preterm infants. Stroke in preterm infants is different from stroke in term infants, given the differences in brain maturation and the mechanisms of injury exclusive to the immature brain. We conducted a systematic review to explore the epidemiology and pathogenesis of periventricular hemorrhagic infarction (PVHI), perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT) in preterm infants. METHODS: Studies were identified based on predefined study criteria from MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE electronic databases from 2000 –2019. Results were combined using descriptive statistics. RESULTS: Fourteen studies encompassed 546 stroke cases in preterm infants between 23 –36 weeks gestational ages and birth weights between 450 –3500 grams. Eighty percent (436/546) of the stroke cases were PVHI, 17%(93/546) were PAIS and 3%(17/546) were CSVT. Parietal PVHI was more common than temporal and frontal lobe PVHI. For PAIS, left middle cerebral artery (MCA) was more common than right MCA or cerebellar stroke. For CSVT partial or complete thrombosis in the transverse sinus was universal. All cases included multiple possible risk factors, but the data were discordant precluding aggregation within a meta-analysis. CONCLUSION: This systematic review confirms paucity of data regarding the etiology and the precise causal pathway of stroke in preterm infants. Moreover, the preterm infants unlike the term infants do not typically present with seizures. Hence high index of clinical suspicion and routine cUS will assist in the timely diagnosis and understanding of stroke in this population.
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Affiliation(s)
- B Roy
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,School of Medicine, The University of Notre Dame Australia, Sydney, Australia.,The Mater Hospital, Sydney, Australia
| | - K Walker
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,The George Institute for Global Health, Sydney, Australia.,Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - C Morgan
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - M Finch-Edmondson
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - C Galea
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | | | - N Badawi
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Westmead, Australia
| | - I Novak
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
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18
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Connelly A, Thwaites V, Turnbull H, Neil J, Walker K, Short A, Keast T, Sweeney L, Jenkins A. P.29 Predicting post-delivery anaemia: Development of the MABL table. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Sydeman WJ, Schoeman DS, Thompson SA, Hoover BA, García-Reyes M, Daunt F, Agnew P, Anker-Nilssen T, Barbraud C, Barrett R, Becker PH, Bell E, Boersma PD, Bouwhuis S, Cannell B, Crawford RJM, Dann P, Delord K, Elliott G, Erikstad KE, Flint E, Furness RW, Harris MP, Hatch S, Hilwig K, Hinke JT, Jahncke J, Mills JA, Reiertsen TK, Renner H, Sherley RB, Surman C, Taylor G, Thayer JA, Trathan PN, Velarde E, Walker K, Wanless S, Warzybok P, Watanuki Y. Hemispheric asymmetry in ocean change and the productivity of ecosystem sentinels. Science 2021; 372:980-983. [PMID: 34045354 DOI: 10.1126/science.abf1772] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/20/2021] [Indexed: 11/02/2022]
Abstract
Climate change and other human activities are causing profound effects on marine ecosystem productivity. We show that the breeding success of seabirds is tracking hemispheric differences in ocean warming and human impacts, with the strongest effects on fish-eating, surface-foraging species in the north. Hemispheric asymmetry suggests the need for ocean management at hemispheric scales. For the north, tactical, climate-based recovery plans for forage fish resources are needed to recover seabird breeding productivity. In the south, lower-magnitude change in seabird productivity presents opportunities for strategic management approaches such as large marine protected areas to sustain food webs and maintain predator productivity. Global monitoring of seabird productivity enables the detection of ecosystem change in remote regions and contributes to our understanding of marine climate impacts on ecosystems.
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Affiliation(s)
| | - D S Schoeman
- Global-Change Ecology Research Group, School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,Centre for African Conservation Ecology, Department of Zoology, Nelson Mandela University, Gqeberha, South Africa
| | | | | | | | - F Daunt
- UK Centre for Ecology and Hydrology, Bush Estate, Penicuik, Midlothian, UK
| | - P Agnew
- Oamaru Blue Penguin Colony, Oamaru, New Zealand
| | - T Anker-Nilssen
- Norwegian Institute for Nature Research (NINA), Trondheim, Norway
| | - C Barbraud
- Centre d'Etudes Biologiques de Chizé, CNRS UMR7372, Villiers en Bois, France
| | - R Barrett
- UiT The Arctic University of Norway, Tromsø, Norway
| | - P H Becker
- Institute of Avian Research, Wilhelmshaven, Germany
| | - E Bell
- Wildlife Management International, Blenheim, New Zealand
| | - P D Boersma
- Center for Ecosystem Sentinels, Department of Biology, University of Washington, Seattle, WA, USA
| | - S Bouwhuis
- Institute of Avian Research, Wilhelmshaven, Germany
| | - B Cannell
- Murdoch University, Murdoch, Western Australia, and University of Western Australia, Perth, Western Australia
| | - R J M Crawford
- Department of Environment, Forestry and Fisheries, Cape Town, South Africa
| | - P Dann
- Phillip Island Nature Parks, Cowes, Victoria, Australia
| | - K Delord
- Centre d'Etudes Biologiques de Chizé, CNRS UMR7372, Villiers en Bois, France
| | - G Elliott
- New Zealand Department of Conservation, Wellington, New Zealand
| | - K E Erikstad
- Norwegian Institute for Nature Research (NINA), FRAM Centre, Tromsø, Norway and Centre for Biodiversity Dynamics (CBD), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - E Flint
- U.S. Fish and Wildlife Service, Honolulu, HI, USA
| | - R W Furness
- University of Glasgow, Glasgow, Scotland, UK
| | - M P Harris
- UK Centre for Ecology and Hydrology, Bush Estate, Penicuik, Midlothian, UK
| | - S Hatch
- Institute for Seabird Research and Conservation, Anchorage, AK, USA
| | - K Hilwig
- U.S. Fish and Wildlife Service, Anchorage, AK, USA
| | - J T Hinke
- Antarctic Ecosystem Research Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA, USA
| | - J Jahncke
- Point Blue Conservation Science, Petaluma, CA, USA
| | | | - T K Reiertsen
- Norwegian Institute for Nature Research (NINA), FRAM Centre, Tromsø, Norway
| | - H Renner
- U.S. Fish and Wildlife Service, Anchorage, AK, USA
| | - R B Sherley
- Centre for Ecology and Conservation, University of Exeter, Cornwall, UK
| | - C Surman
- Halfmoon Biosciences, Ocean Beach, Western Australia, Australia
| | - G Taylor
- New Zealand Department of Conservation, Wellington, New Zealand
| | | | | | - E Velarde
- Universidad Veracruzana, Veracruz, Mexico
| | - K Walker
- New Zealand Department of Conservation, Wellington, New Zealand
| | - S Wanless
- UK Centre for Ecology and Hydrology, Bush Estate, Penicuik, Midlothian, UK
| | - P Warzybok
- Point Blue Conservation Science, Petaluma, CA, USA
| | - Y Watanuki
- Hokkaido University, Hakodate, Hokkaido, Japan
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20
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Walker K, Keward A, Botha E, Knepil G. 256 Antimicrobial Stewardship in Skin Cancer Surgery. Assessing Best Practice in Reducing Significant Post-Operative Complications. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.392] [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: 11/14/2022]
Abstract
Abstract
Introduction
Antibiotic prescription is variable and with the growing frequency of antibiotic resistance, responsible use of antibiotics is necessary in keeping with Public Health England (PHE) Antimicrobial Stewardship guidelines. An audit was conducted to assess current practice of prophylactic antibiotics prescription in Skin Cancer Surgery in the department of Oral & Maxillofacial surgery.
Method
A retrospective case note review of patients who had undergone reconstructive surgery following skin cancer excision, recorded use of systemic and topical antibiotics and infective outcomes. Inclusion criteria were patients that had undergone surgical excision and reconstruction of skin cancer, followed by a wound assessment in an outpatient’s clinic with the outcome measure of infection defined by PHE Surgical Site Infection guidelines. A standard of 5% infection rate which is recognised by the British Association of Dermatologists was used.
Results
There was a 2% significant post op infection rate in patients with topical antibiotics used and 4.5% where neither systemic nor topical antibiotics were used. Immunocompromised patients had no increased incidence in significant post op infections occurring in either group.
Conclusions
The standard was met illustrating the low infection rate following reconstruction of Skin Cancer defects with or without prophylactic antibiotics and support a more discerning approach to antimicrobial prescribing.
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Affiliation(s)
- K Walker
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - A Keward
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - E Botha
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - G Knepil
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
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21
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Shivank K, Ilin R, Walker K, Brennan P. 525 Automated Continuous Instrument Tracking in Laparoscopic Box Trainers Predicts Performance at Assessment: A Prospective Cohort Study in Core Surgical Trainees. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.007] [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: 11/14/2022]
Abstract
Abstract
Introduction
Box-trainers enable deliberate practice of laparoscopic skills and can be equipped with instrument tracking metrics to provide feedback. However, the relationship between metrics, assessment outcomes and practice are unclear.
Method
Core surgical trainees were provided take-home box trainers with SurgTrac™ instrument tracking metrics for practice (eoSurgical Ltd., Scotland, UK). Practice was incentivised by certification and video assessment of a basic task, peg capping. Assessment was by consultant general surgeons, using objective structured assessment of technical skills (OSATS). The following metrics were analysed: task duration, distance moved by instruments, average instrument speed, average instrument acceleration, left- or right-handedness and instrument smoothness. Metrics were correlated to OSATS scores using regression analysis. Threshold for significance was p = 0.05.
Results
During the study period, there were 1639 peg capping performances by 85 trainees; 103 video recordings were submitted for assessment. All metrics were significantly associated with OSATS score, except instrument acceleration. The multiple linear regression model was highly correlated with actual scores (Pearson correlation 0.658; p < 0.001). Practice was positively correlated with regression model predicted OSATS score (regression analysis; ANOVA p < 0.001).
Conclusions
Instrument tracking metrics reliably predict OSATS performance and practice improves predicted score. Trainees can use metrics in unsupervised practice and gauge whether they are improving as expected.
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Affiliation(s)
- K Shivank
- Edinburgh Medical School, Edinburgh, United Kingdom
| | - R Ilin
- eoSurgical Ltd., Edinburgh, United Kingdom
| | - K Walker
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, United Kingdom
- NHS Education for Scotland, Edinburgh, United Kingdom
- Raigmore Hospital and Centre for Health Sciences, Inverness, United Kingdom
| | - P Brennan
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
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22
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Pennati A, Quamine A, Walker K, Hedican C, Ganz O, Surprise N, Meyers R, Capitini C, Galipeau J. Combination immunotherapy with anti-CD38 and ex vivo stimulated aß t-cell depleted pbmcs for multiple myeloma. Cytotherapy 2021. [DOI: 10.1016/s1465324921003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Walker K, Noble S, Mullen K. Cannabis use and tobacco quit rates in a cohort of female patients participating in a tobacco cessation program. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2020.02.017] [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: 10/22/2022] Open
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24
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Attili D, Schill DJ, DeLong CJ, Lim KC, Jiang G, Campbell KF, Walker K, Laszczyk A, McInnis MG, O'Shea KS. Astrocyte-Derived Exosomes in an iPSC Model of Bipolar Disorder. Adv Neurobiol 2020; 25:219-235. [PMID: 32578149 DOI: 10.1007/978-3-030-45493-7_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bipolar I Disorder (BP) is a serious, recurrent mood disorder that is characterized by alternating episodes of mania and depression. To begin to identify novel approaches and pathways involved in BP, we have obtained skin samples from BP patients and undiagnosed control (C) individuals, reprogrammed them to form induced pluripotent stem cells (iPSC), and then differentiated the stem cells into astrocytes. RNAs from BP and C astrocytes were extracted and RNAseq analysis carried out. 501 differentially expressed genes were identified, including genes for cytoskeletal elements, extracellular matrix, signaling pathways, neurodegeneration, and notably transcripts that identify exosomes. When we compared highly expressed genes using hierarchial cluster analysis, "Exosome" was the first and most highly significant cluster identified, p < 5 × 10-13, Benjamini correction. Exosomes are membrane-bound vesicles that package and remove toxic proteins from cells and also enable cell to cell communication. They carry genetic material, including DNA, mRNA and microRNAs, proteins, and lipids to target cells throughout the body. Exosomes are released by cortical neurons and astrocytes in culture and are present in BP vs C postmortem brain tissue. Little is known about what transcripts and proteins are targeted to neurons, how they regulate biological functions of the acceptor cell, or how that may be altered in mood disorders. Since astrocyte-derived exosomes have been suggested to promote neuronal plasticity, as well as to remove toxic proteins in the brain, alterations in their function or content may be involved in neurodevelopmental, neuropathological, and neuropsychiatric conditions. To examine exosome cargos and interactions with neural precursor cells, astrocytes were differentiated from four bipolar disorder (BP) and four control (C) iPSC lines. Culture supernatants from these astrocytes were collected, and exosomes isolated by ultra-centrifugation. Western blot analysis demonstrated the presence of the exosome markers CD9, CD81, and Hsp70. Nanosight technology was used to characterize exosomes from each astrocyte cell line, suggesting that exosomes were slightly more concentrated in culture supernatants derived from BP compared with C astrocytes but there was no difference in the mean sizes of the exosomes. Analysis of their function in neuronal differentiation is being carried out by labeling exosomes derived from bipolar patient and control astrocytes and adding them to control neural progenitor cells. Given the current interest in clearing toxic proteins from brains of patients with neurodegenerative disorders, exosomes may present similar opportunities in BP.
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Affiliation(s)
- D Attili
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - D J Schill
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - C J DeLong
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - K C Lim
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - G Jiang
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - K F Campbell
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - K Walker
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - A Laszczyk
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA
| | - M G McInnis
- Department of Psychiatry, The University of Michigan, Ann Arbor, MI, USA
| | - K S O'Shea
- Department of Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI, USA.
- Department of Psychiatry, The University of Michigan, Ann Arbor, MI, USA.
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25
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Henry A, Holch P, Routledge J, Absolom K, Walker K, Gibson A, Carter R, Brown J, Velikova G. Pilot Randomized Trial of Online Self-Monitoring of Symptoms During Pelvic Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1462] [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: 11/16/2022]
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26
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Henry A, Holch P, Routledge J, Absolom K, Walker K, Gibson A, Carter R, Brown J, Velikova G. OC-0314: Pilot randomised trial of online self-monitoring of symptoms during pelvic radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Bennett N, Crouch S, Hoskins A, Malloy M, Walker K, Worth L. ‘Closing the gap’: Evaluating the success of non-mandatory strategies for influenza vaccination of Victorian healthcare workers. Vaccine 2020; 38:6363-6366. [DOI: 10.1016/j.vaccine.2020.08.013] [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] [Received: 02/17/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/15/2022]
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Krosel M, Gabathuler M, Walker K, Tomsic M, Distler O, Ospelt C, Klein K. SAT0008 INDIVIDUAL FUNCTIONS OF THE HISTONE-ACETYLTRANSFERASES CBP AND P300 IN REGULATING THE INFLAMMATORY RESPONSE BY AFFECTING HISTONE ACETYLATION AND MRNA STABILITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Prolonged TNF-induced H3K27 acetylation (H3K27ac) and increased mRNA stability in rheumatoid arthritis (RA) synovial fibroblasts (SF) are leading to a sustained inflammatory response. Underlying enzymes coordinately regulating these pathways have not been identified so far. The histone acetyltransferases cAMP-response element binding protein binding protein (CBP) and p300 are writers of activating H3K27ac marks and close homologues with widely accepted redundant functions.Objectives:To analyze individual functions of CBP and p300 in regulating the inflammatory response of RA SF.Methods:SF were isolated from patients with RA undergoing joint replacement surgery. The expression of CBP and p300 was silenced by transfection of antisense LNA gapmeRs (12.5 nM). SF were stimulated with TNF (10 ng/ml) for 24h. Actinomycin D (10 µg/ml) was added 4h after TNF-treatment for 2h and 4h (n=3) to test mRNA stability. Transcriptomes were determined by RNA-seq (Illumina NovaSeq 6000, n=6). We mapped raw reads from RNA-seq reference genome using STAR. Counts for genes were obtained using Feature counts. We searched for differential expression genes (DEG) across experimental conditions using general linear models (glm) implemented in ‘edgeR’ package of R. Significantly affected genes (± fold change > 1.5, FDR < 0.05, top 3000 genes included) entered pathway enrichment analysis for Gene Ontology (GO) biological process, and KEGG pathways in DAVID. Changes in the mRNA (n=12-14) and protein expression (n=6-12) were confirmed by quantitative Real-time PCR and ELISA. The levels of activating histone marks H3K27ac and nuclear localization of p50 and p65 were analyzed by Western blotting.Results:DEG revealed that silencing of p300 affected the expression of 6026 and 5138 genes in unstimulated and stimulated SF, respectively. In contrast, only 285 and 1911 genes were affected by CBP silencing in unstimulated and stimulated SF, respectively. In TNF-stimulated SF, pathway enrichment analysis of DEG revealed a key role of CBP in regulating the “type I interferon signaling pathway” (p=2.12x10-6). Both, silencing of CBP and p300 regulated genes enriched in the “TNF signaling pathway” (CBP: p=0.005; p300: p=0.031). In contrast to CBP silencing that had anti-inflammatory effects, silencing of p300 had pro-and anti-inflammatory effects. ELISA experiments suggested that silencing of CBP reduced the secretion of IL6 (p<0.01), CCL2, CXC3L1 (p<0.05), and CXCL12 (p<0.001). Silencing of p300 reduced the secretion of CCL2 (p<0.001) and CXC3L1 (p<0.05) but increased the expression of IL8 (p<0.001) and CXCL2 (p<0.05). Western blotting revealed that neither CBP, nor p300 silencing affected the nuclear expression of the NF-ĸB subunits p65 and p50. Silencing of p300 reduced the levels of H3K27ac by 30% in unstimulated SF, and by 61.4% (p<0.05) in presence of TNF. In addition to regulating H3K27ac, silencing of p300 regulated the expression of TNF-induced cytokines by increasing the mRNA stability of IL8, IL6 and CCL2 mRNA but not of CXCL2. Silencing of CBP reduced H3K27ac by 43.5% only in presence of TNF and did not affect TNF-induced mRNA stability of cytokines. This is in line with the enrichment of the GO biological process “regulation of mRNA stability” (p=2.61x10-8) being enriched only after silencing of p300.Conclusion:Our results suggested that p300 is the major writer for H3K27ac marks in SF. Additionally, p300 regulated cytokine expression by affecting mRNA stability in a target-specific manner. We identified overlapping and distinct functions for CBP and p300 in regulating the inflammatory response of SF.Disclosure of Interests:Monika Krosel: None declared, Marcel Gabathuler: None declared, Kellie Walker: None declared, Matija Tomsic: None declared, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Caroline Ospelt Consultant of: Consultancy fees from Gilead Sciences., Kerstin Klein: None declared
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Wallace D, Cowling TE, Walker K, Suddle A, Gimson A, Rowe I, Callaghan C, Sapisochin G, Mehta N, Heaton N, van der Meulen J. Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma. Br J Surg 2020; 107:1183-1191. [DOI: 10.1002/bjs.11559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/05/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study.
Methods
Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics.
Results
In total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235).
Conclusion
TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.
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Affiliation(s)
- D Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - T E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Suddle
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - A Gimson
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I Rowe
- Liver Unit, St James's Hospital and University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - C Callaghan
- Department of Nephrology and Transplantation, Renal Unit, Guy's Hospital, London, UK
| | - G Sapisochin
- Multi-Organ Transplant, Toronto General Surgery, Toronto, Ontario, Canada
- Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - N Mehta
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA
| | - N Heaton
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - J van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Dodd FL, Kennedy DO, Stevenson EJ, Veasey RC, Walker K, Reed S, Jackson PA, Haskell-Ramsay CF. Acute and chronic effects of multivitamin/mineral supplementation on objective and subjective energy measures. Nutr Metab (Lond) 2020; 17:16. [PMID: 32123534 PMCID: PMC7038616 DOI: 10.1186/s12986-020-00435-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 02/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background Vitamins and minerals play an essential role within many cellular processes including energy production and metabolism. Previously, supplementation with a multivitamin/mineral (MVM) for ≥28 days resulted in improvements to cognition and subjective state. We have also demonstrated shifts in metabolism during cognitively demanding tasks following MVM in females, both acutely and following 8-week supplementation. The current study aimed to assess these effects further in males and females using metabolically challenging exercise and cognitive tasks. Methods The current randomised, placebo-controlled, parallel groups study investigated the effects of a MVM complex in 82 healthy young (18-35y) exercisers. Subjective ratings and substrate metabolism were assessed during 30 min each of increasingly effortful incremental exercise and demanding cognitive tasks. Assessments took place on acute study days following a single dose (Day 1) of MVM, containing 3 times recommended daily allowance of water-soluble vitamins plus CoQ10, and following 4-week supplementation (Day 28). Results Energy expenditure (EE) was increased during cognitive tasks following MVM across Day 1 and Day 28, with greater effects in males. In males, MVM also increased carbohydrate oxidation and energy expenditure during exercise across Day 1 and Day 28. In females, mental tiredness was lower during exercise; increases in physical tiredness following 30 min of exercise were attenuated; and stress ratings following cognitive tasks were reduced following MVM. In males, MVM only lowered mental tiredness following 10 min of exercise. These effects were apparent irrespective of day, but effects on mental tiredness were greater on Day 28. Ferritin levels were also higher on Day 28 in those receiving MVM. Conclusion These findings extend on existing knowledge, demonstrating increased carbohydrate oxidation and increased energy expenditure in males following MVM supplementation for the first time. Importantly, they show modulation of energy expenditure and subjective tiredness following a single dose, providing further evidence for acute effects of MVM. Differential effects in men and women suggest that sex may play an important role in the effects of MVM on energy metabolism and should be considered in future research. Trial registration ClinicalTrials.gov, NCT03003442. Registered 22nd November 2016 – retrospectively registered
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Affiliation(s)
- F L Dodd
- 1Brain, Performance and Nutrition Research Centre, Northumbria University, Upon-Tyne, Newcastle, NE1 8ST UK
| | - D O Kennedy
- 1Brain, Performance and Nutrition Research Centre, Northumbria University, Upon-Tyne, Newcastle, NE1 8ST UK
| | - E J Stevenson
- 2Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | - R C Veasey
- 1Brain, Performance and Nutrition Research Centre, Northumbria University, Upon-Tyne, Newcastle, NE1 8ST UK
| | - K Walker
- 3Faculty of Health and Life Sciences, Northumbria University, Upon-Tyne, Newcastle, NE1 8ST UK
| | - S Reed
- 3Faculty of Health and Life Sciences, Northumbria University, Upon-Tyne, Newcastle, NE1 8ST UK
| | - P A Jackson
- 1Brain, Performance and Nutrition Research Centre, Northumbria University, Upon-Tyne, Newcastle, NE1 8ST UK
| | - C F Haskell-Ramsay
- 4Department of Psychology, Northumbria University, Upon-Tyne, Newcastle, NE1 8ST UK
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Wallace D, Cowling TE, Walker K, Suddle A, Rowe I, Callaghan C, Gimson A, Bernal W, Heaton N, van der Meulen J. Short- and long-term mortality after liver transplantation in patients with and without hepatocellular carcinoma in the UK. Br J Surg 2020; 107:896-905. [DOI: 10.1002/bjs.11451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Background
The increasing demand for liver transplantation has led to considerable changes in characteristics of donors and recipients. This study evaluated the short- and long-term mortality of recipients with and without hepatocellular carcinoma (HCC) in the UK between 1997 and 2016.
Methods
First-time elective adult liver transplant recipients in the UK were identified and four successive eras of transplantation were compared. Hazard ratios (HRs) comparing the impact of era on short-term (first 90 days) and longer-term (from 90 days to 5 years) mortality were estimated, with adjustment for recipient and donor characteristics.
Results
Some 1879 recipients with and 7661 without HCC were included. There was an increase in use of organs donated after circulatory death (DCD), from 0 per cent in era 1 to 35·2 per cent in era 4 for recipients with HCC, and from 0·2 to 24·1 per cent for non-HCC recipients. The 3-year mortality rate decreased from 28·3 per cent in era 1 to 16·9 per cent in era 4 (adjusted HR 0·47, 95 per cent c.i. 0·35 to 0·63) for recipients with HCC, and from 20·4 to 9·3 per cent (adjusted HR 0·44, 0·36 to 0·53) for those without HCC. Comparing era 4 with era 1, improvements were more marked in short-term than in long-term mortality, both for recipients with HCC (0–90 days: adjusted HR 0·20, 0·10 to 0·39; 90 days to 5 years: adjusted HR 0·52, 0·35 to 0·75; P = 0·043) and for non-HCC recipients (0–90 days: adjusted HR 0·32, 0·24 to 0·42; 90 days to 5 years: adjusted HR 0·52, 0·40 to 0·67; P = 0·024).
Conclusion
In the past 20 years, the mortality rate after liver transplantation has more than halved, despite increasing use of DCD donors. Improvements in overall survival can be explained by decreases in short-term and longer-term mortality.
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Affiliation(s)
- D Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Cambridge University Hospitals NHS Foundation Trust, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, London, UK
| | - T E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Cambridge University Hospitals NHS Foundation Trust, London, UK
| | - K Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Cambridge University Hospitals NHS Foundation Trust, London, UK
| | - A Suddle
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, London, UK
| | - I Rowe
- Liver Unit, St James's Hospital and University of Leeds, Cambridge University Hospitals NHS Foundation Trust, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Cambridge University Hospitals NHS Foundation Trust, Leeds, UK
| | - C Callaghan
- Department of Transplantation, Renal Unit, Guy's Hospital, Cambridge University Hospitals NHS Foundation Trust, London, UK
| | - A Gimson
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Bernal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, London, UK
| | - N Heaton
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, London, UK
| | - J van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Cambridge University Hospitals NHS Foundation Trust, London, UK
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Vora PS, Estes H, Grigor D, Hodge B, Hurst WJ, LeBlanc D, Shuford C, Walker K, Zimmermann M. High Pressure Liquid Chromatographic Determination of Glycyrrhizic Acid or Glycyrrhizic Acid Salts in Various Licorice Products: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/65.3.572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A collaborative study determining glycyrrhizic acid or glycyrrhizic acid salts content of various licorice products has been conducted using high pressure liquid chromatography (HPLC). Five samples containing various concentrations of glycyrrhizic acid were analyzed in blind replicates by 8 collaborators. The results indicate excellent repeatability and reproducibility with coefficients of variation less than 7.5%. In addition, this method allows the determination of glycyrrhizic acid in less than 15 min compared with 3 days for the conventional gravimetric and colorimetric methods. The method has been adopted official first action.
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Affiliation(s)
- Peter S Vora
- MacAndrews & Forbes Co., Third St and Jefferson Ave, Camden, NJ 08104
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Walker K, Akinnirayne K, Dare A, Goss J. Pilot of a nutrition supplement round on a short stay frailty ward. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.091] [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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Nielson-jones C, Sharpe L, Swinsburg D, Winlaw D, Badawi N, Walker K, Costa D, Sholler G, Kasparian N. 677 Predictors of Maternal Pregnancy-Specific Anxiety After Fetal Cardiac Diagnosis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The Foundation Programme is well established in the UK and serves as the generic training scheme into which newly qualified doctors enter after gaining a medical degree. Although individual programmes have many differences, the range of competencies needing to be fulfilled to progress is uniform across Scotland and the rest of the UK. Some final year medical undergraduates may apply for the Academic Foundation Programme; this is designed to facilitate exposure to academic medicine over and above the clinical experience offered to Foundation Year doctors. This paper describes characteristics of the Academic Foundation Programme in general, with a particular focus on Scotland, which is one Foundation School.
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Affiliation(s)
- G P Currie
- GP Currie, NHS Education for Scotland, (North Region), Forest Grove House, Foresterhill Road, Aberdeen AB25 2ZP, UK,
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Phillip CR, Mancera-Cuevas K, Leatherwood C, Chmiel JS, Erickson DL, Freeman E, Granville G, Dollear M, Walker K, McNeil R, Correia C, Canessa P, Ramsey-Goldman R, Feldman CH. Implementation and dissemination of an African American popular opinion model to improve lupus awareness: an academic-community partnership. Lupus 2019; 28:1441-1451. [PMID: 31594456 DOI: 10.1177/0961203319878803] [Citation(s) in RCA: 9] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Lupus is a chronic, autoimmune disease that disproportionately affects African Americans. We adapted the Centers for Disease Control and Prevention's Popular Opinion Leader model to implement an intervention tailored for African American individuals that leverages an academic-community partnership and community-based social networks to disseminate culturally appropriate lupus education. METHODS Academic rheumatologists, social scientists, and researchers in Boston, MA and Chicago, IL partnered with local lupus support groups, community organizations, and churches in neighborhoods with higher proportions of African Americans to develop curriculum and recruit community leaders with and without lupus (Popular Opinion Leaders; POLs). POLs attended four training sessions focused on lupus education, strategies to educate others, and a review of research methods. POLs disseminated information through their social networks and recorded their impact, which was mapped using a geographic information system framework. RESULTS We trained 18 POLs in greater Boston and 19 in greater Chicago: 97% were African American, 97% were female; and the mean age was 57 years. Fifty-nine percent of Boston POLs and 68% of Chicago POLs had lupus. POLs at both sites engaged members of their social networks and communities in conversations about lupus, health disparities, and the importance of care. Boston POLs documented 97 encounters with 547 community members reached. Chicago POLs documented 124 encounters with 4083 community members reached. CONCLUSIONS An adapted, community-based POL model can be used to disseminate lupus education and increase awareness in African American communities. Further research is needed to determine the degree to which this may begin to reduce disparities in access to care and outcomes.
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Affiliation(s)
- C R Phillip
- Division of Rheumatology, Immunology & Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - K Mancera-Cuevas
- Department of Medicine/Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - C Leatherwood
- Division of Rheumatology, Immunology & Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - J S Chmiel
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - D L Erickson
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | | | - M Dollear
- Lupus Society of Illinois, Chicago, IL
| | - K Walker
- Lupus Society of Illinois Support Group, Hazel Crest, IL
| | - R McNeil
- Lupus Society of Illinois, Trinity United Church of Christ Health Ministries, Chicago, IL
| | - C Correia
- Department of Medicine/Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - P Canessa
- Illinois Public Health Association, Springfield, IL
| | - R Ramsey-Goldman
- Department of Medicine/Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - C H Feldman
- Division of Rheumatology, Immunology & Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Axelrud G, Fink D, Walker K, Hasan S, Rao A, Deb N, Jhavar S. Decreased Frequency of MGMT Promoter Hypermethylation in Locally Relapsed Versus Locally Controlled p16 Negative Head and Neck Squamous Cell Carcinoma Patients after Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eugene N, Oliver C, Bassett M, Poulton T, Kuryba A, Johnston C, Anderson I, Moonesinghe S, Grocott M, Murray D, Cromwell D, Walker K, Cripps M, Cripps P, Davies E, Drake S, Galsworthy M, Goodwin J, Salih T, Lourtie J, Papadimitriou D, Peden C. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model. Br J Anaesth 2018; 121:739-748. [PMID: 30236236 DOI: 10.1016/j.bja.2018.06.026] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/01/2018] [Accepted: 06/20/2018] [Indexed: 01/03/2023] Open
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Vallance AE, van der Meulen J, Kuryba A, Charman SC, Botterill ID, Prasad KR, Hill J, Jayne DG, Walker K. The timing of liver resection in patients with colorectal cancer and synchronous liver metastases: a population-based study of current practice and survival. Colorectal Dis 2018; 20:486-495. [PMID: 29338108 DOI: 10.1111/codi.14019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 07/14/2017] [Accepted: 11/12/2017] [Indexed: 12/13/2022]
Abstract
AIM There is uncertainty regarding the optimal sequence of surgery for patients with colorectal cancer (CRC) and synchronous liver metastases. This study was designed to describe temporal trends and inter-hospital variation in surgical strategy, and to compare long-term survival in a propensity score-matched analysis. METHOD The National Bowel Cancer Audit dataset was used to identify patients diagnosed with primary CRC between 1 January 2010 and 31 December 2015 who underwent CRC resection in the English National Health Service. Hospital Episode Statistics data were used to identify those with synchronous liver-limited metastases who underwent liver resection. Survival outcomes of propensity score-matched groups were compared. RESULTS Of 1830 patients, 270 (14.8%) underwent a liver-first approach, 259 (14.2%) a simultaneous approach and 1301 (71.1%) a bowel-first approach. The proportion of patients undergoing either a liver-first or simultaneous approach increased over the study period from 26.8% in 2010 to 35.6% in 2015 (P < 0.001). There was wide variation in surgical approach according to hospital trust of diagnosis. There was no evidence of a difference in 4-year survival between the propensity score-matched cohorts according to surgical strategy: bowel first vs simultaneous [hazard ratio (HR) 0.92 (95% CI: 0.80-1.06)] or bowel first vs liver first [HR 0.99 (95% CI: 0.82-1.19)]. CONCLUSION There is evidence of wide variation in surgical strategy in dealing with CRC and synchronous liver metastases. In selected patients, the simultaneous and liver-first strategies have comparable long-term survival to the bowel-first approach.
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Affiliation(s)
- A E Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - S C Charman
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - K R Prasad
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Hill
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - D G Jayne
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Vallance AE, van der Meulen J, Kuryba A, Braun M, Jayne DG, Hill J, Cameron IC, Walker K. Socioeconomic differences in selection for liver resection in metastatic colorectal cancer and the impact on survival. Eur J Surg Oncol 2018; 44:1588-1594. [PMID: 29895508 DOI: 10.1016/j.ejso.2018.05.024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in colorectal cancer (CRC) survival are well recognised. The aim of this study was to describe the impact of socioeconomic deprivation on survival in patients with synchronous CRC liver-limited metastases, and to investigate if any survival inequalities are explained by differences in liver resection rates. METHODS Patients in the National Bowel Cancer Audit diagnosed with CRC between 2010 and 2016 in the English National Health Service were included. Linked Hospital Episode Statistics data were used to identify the presence of liver metastases and whether a liver resection had been performed. Multivariable random-effects logistic regression was used to estimate the odds ratio (OR) of liver resection by Index of Multiple Deprivation (IMD) quintile. Cox-proportional hazards model was used to compare 3-year survival. RESULTS 13,656 patients were included, of whom 2213 (16.2%) underwent liver resection. Patients in the least deprived IMD quintile were more likely to undergo liver resection than those in the most deprived quintile (adjusted OR 1.42, 95% confidence interval (CI) 1.18-1.70). Patients in the least deprived quintile had better 3-year survival (least deprived vs. most deprived quintile, 22.3% vs. 17.4%; adjusted hazard ratio (HR) 1.20, 1.11-1.30). Adjusting for liver resection attenuated, but did not remove, this effect. There was no difference in survival between IMD quintile when restricted to patients who underwent liver resection (adjusted HR 0.97, 0.76-1.23). CONCLUSIONS Deprived CRC patients with synchronous liver-limited metastases have worse survival than more affluent patients. Lower rates of liver resection in more deprived patients is a contributory factor.
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Affiliation(s)
- A E Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - M Braun
- Christie NHS Foundation Trust, Manchester, UK
| | - D G Jayne
- The John Goligher Colorectal Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Hill
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - I C Cameron
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Peacock O, Bassett MG, Kuryba A, Walker K, Davies E, Anderson I, Vohra RS. Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction. Br J Surg 2018; 105:1006-1013. [DOI: 10.1002/bjs.10812] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/03/2017] [Accepted: 12/02/2017] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Small bowel obstruction (SBO) is a common indication for emergency laparotomy. There are currently variations in the timing of surgery for patients with SBO and limited evidence on whether delayed surgery affects outcomes. The aim of this study was to evaluate the impact of time to operation on 30-day mortality in patients requiring emergency laparotomy for SBO.
Methods
Data were collected from the National Emergency Laparotomy Audit (NELA) on all patients aged 18 years or older who underwent emergency laparotomy for all forms of SBO between December 2013 and November 2015. The primary outcome measure was 30-day mortality, with date of death obtained from the Office for National Statistics. Patients were grouped according to the time from admission to surgery (less than 24 h, 24–72 h and more than 72 h). A multilevel logistic regression model was used to explore the impact of patient factors, primarily delay to surgery, on 30-day mortality.
Results
Some 9991 patients underwent emergency laparotomy requiring adhesiolysis or small bowel resection for SBO. The overall mortality rate was 7·2 per cent (722 patients). Within each time group, 30-day mortality rates were significantly worse with increasing age, ASA grade, Portsmouth POSSUM score and level of contamination. Patients undergoing emergency laparotomy more than 72 h after admission had a significantly higher risk-adjusted 30-day mortality rate (odds ratio 1·39, 95 per cent c.i. 1·09 to 1·76).
Conclusion
In patients who require an emergency laparotomy with adhesiolysis or resection for SBO, a delay to surgery of more than 72 h is associated with a higher 30-day postoperative mortality rate.
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Affiliation(s)
- O Peacock
- Trent Oesophago-Gastric Unit, Nottingham City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M G Bassett
- NELA Research Fellow, Royal College of Anaesthetists, London, UK
| | - A Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - E Davies
- Department of Surgery, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - I Anderson
- Colorectal Surgery Department, Salford Royal Hospitals NHS Trust, Salford, UK
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Walker K. ENDO 2018 - 100th Annual Meeting and Exposition of the Endocrine Society. Chicago, Illinois, USA - March 16-20, 2018. DRUG FUTURE 2018. [DOI: 10.1358/dof.2018.043.04.2808546] [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: 10/16/2022]
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44
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Kalugina YN, Faure A, van der Avoird A, Walker K, Lique F. Interaction of H2O with CO: potential energy surface, bound states and scattering calculations. Phys Chem Chem Phys 2018; 20:5469-5477. [DOI: 10.1039/c7cp06275c] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present the first scattering calculations for the H2O–CO system based on a high accuracy potential energy surface.
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Affiliation(s)
- Y. N. Kalugina
- Department of Optics and Spectroscopy
- Tomsk State University
- Tomsk 634050
- Russia
| | - A. Faure
- Université Grenoble Alpes
- CNRS
- IPAG
- F-38000 Grenoble
- France
| | - A. van der Avoird
- Institute for Molecules and Materials
- Radboud University
- 6525 AJ Nijmegen
- The Netherlands
| | - K. Walker
- LOMC – UMR 6294
- Normandie Université
- Université du Havre and CNRS
- 76 063 Le Havre cedex
- France
| | - F. Lique
- LOMC – UMR 6294
- Normandie Université
- Université du Havre and CNRS
- 76 063 Le Havre cedex
- France
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45
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Ousey K, Edward KL, Lui S, Stephenson J, Walker K, Duff J, Leaper D. Perioperative, local and systemic warming in surgical site infection: a systematic review and meta-analysis. J Wound Care 2017; 26:614-624. [DOI: 10.12968/jowc.2017.26.11.614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Ousey
- Professor, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - K-L. Edward
- Professor of Nursing and Practice-based Research, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - S. Lui
- Senior Lecturer, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - J. Stephenson
- Senior Lecturer Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - K. Walker
- Professor, School of Health Sciences, University of Tasmania, Darlinghurst, Australia
| | - J. Duff
- Associate Professor, School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - D. Leaper
- Emeritus Professor, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
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Axelrud G, Fink D, Walker K, Nguyen Q, Hasan S, Rao A, Deb N, Jhavar S. MGMT Promoter Hypermethylation is a Common Event in Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1369] [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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Chong R, Berl B, Cook B, Turner P, Walker K. Individuals with a vestibular-related disorder use a somatosensory-dominant strategy for postural orientation after inclined stance. Acta Neurol Scand 2017; 135:635-640. [PMID: 27524740 DOI: 10.1111/ane.12658] [Citation(s) in RCA: 5] [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: 07/14/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The visual, somatosensory, and vestibular systems are critical for establishing a sensorimotor set for postural control and orientation. The goal of this study was to assess how individuals with a vestibular-related disorder keep their balance following prolonged stance on an inclined surface. We hypothesize that subjects will show greater reliance on the somatosensory system than age-matched controls as inferred by the presence of a forward postural lean aftereffect following the inclined stance (i.e., a positive response). RESULTS The results revealed an underlying somatosensory-dominant strategy for postural control in the vestibular group: 100% of the subjects tested positive compared to 58% in the control group (P=.006). CONCLUSION Individuals with a vestibular-related disorder use a somatosensory-dominant strategy for postural orientation following prolonged inclined stance. The implications for the management of this population are discussed.
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Affiliation(s)
- R. Chong
- Department of Physical Therapy; Augusta University; Augusta GA USA
| | - B. Berl
- Department of Physical Therapy; Augusta University; Augusta GA USA
| | - B. Cook
- Department of Physical Therapy; Augusta University; Augusta GA USA
| | - P. Turner
- Department of Physical Therapy; Augusta University; Augusta GA USA
| | - K. Walker
- Department of Physical Therapy; Augusta University; Augusta GA USA
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Patel SG, Roxburgh R, Rodrigues M, Walker K, O’grady G, Poke G, Love D, Parmar P, Hammond-Tooke G, Te Ao B, Theadom A. Pattern and impact of pain in a national survey of genetic muscle disease. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-316074.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chandrasekhar M, Mohammad S, Walker K, Ruiz G, Groninger H. Trends in Palliative Care in Inpatient Advanced Heart Failure After Initiation of a Dedicated Palliative Care Team. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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50
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Vallance AE, vanderMeulen J, Kuryba A, Botterill ID, Hill J, Jayne DG, Walker K. Impact of hepatobiliary service centralization on treatment and outcomes in patients with colorectal cancer and liver metastases. Br J Surg 2017; 104:918-925. [PMID: 28251644 PMCID: PMC5484381 DOI: 10.1002/bjs.10501] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/03/2016] [Accepted: 01/09/2017] [Indexed: 12/24/2022]
Abstract
Background Centralization of specialist surgical services can improve patient outcomes. The aim of this cohort study was to compare liver resection rates and survival in patients with primary colorectal cancer and synchronous metastases limited to the liver diagnosed at hepatobiliary surgical units (hubs) with those diagnosed at hospital Trusts without hepatobiliary services (spokes). Methods The study included patients from the National Bowel Cancer Audit diagnosed with primary colorectal cancer between 1 April 2010 and 31 March 2014 who underwent colorectal cancer resection in the English National Health Service. Patients were linked to Hospital Episode Statistics data to identify those with liver metastases and those who underwent liver resection. Multivariable random‐effects logistic regression was used to estimate the odds ratio of liver resection by presence of specialist hepatobiliary services on site. Survival curves were estimated using the Kaplan–Meier method. Results Of 4547 patients, 1956 (43·0 per cent) underwent liver resection. The 1081 patients diagnosed at hubs were more likely to undergo liver resection (adjusted odds ratio 1·52, 95 per cent c.i. 1·20 to 1·91). Patients diagnosed at hubs had better median survival (30·6 months compared with 25·3 months for spokes; adjusted hazard ratio 0·83, 0·75 to 0·91). There was no difference in survival between hubs and spokes when the analysis was restricted to patients who had liver resection (P = 0·620) or those who did not undergo liver resection (P = 0·749). Conclusion Patients with colorectal cancer and synchronous metastases limited to the liver who are diagnosed at hospital Trusts with a hepatobiliary team on site are more likely to undergo liver resection and have better survival. Better survival
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Affiliation(s)
- A. E. Vallance
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - J. vanderMeulen
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - A. Kuryba
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - I. D. Botterill
- The John Goligher Colorectal Surgery UnitLeeds Teaching Hospitals NHS TrustLondonUK
| | - J. Hill
- Department of General SurgeryManchester Royal InfirmaryManchesterUK
| | - D. G. Jayne
- The John Goligher Colorectal Surgery UnitLeeds Teaching Hospitals NHS TrustLondonUK
- Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - K. Walker
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
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