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Beaton L, Rodriguez A, Humphris G, Anderson I, Freeman R. Exploring the engagement behaviours of Smile4life practitioners: lessons from an evaluation of the national oral health improvement programme for people experiencing homelessness in Scotland. Front Oral Health 2024; 4:1289348. [PMID: 38239231 PMCID: PMC10794537 DOI: 10.3389/froh.2023.1289348] [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: 09/05/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness, aimed at reducing oral health inequalities experienced by this population. This study forms part of an evaluation of how the Smile4life intervention was being implemented within Scottish NHS Boards. The aim was to investigate the influence of the Smile4life intervention upon the engagement behaviours of Smile4life practitioners. Methods Focus groups were conducted with Smile4life practitioners, to provide an insight into how the Smile4life intervention affected their skills, attitudes and experiences while interacting with people experiencing homelessness and their services providers. A purposive sample of oral health practitioners, including dental health support workers, oral health promoters/educators, and oral health improvement coordinators working in three NHS Boards were invited to take part. One focus group was conducted in each of the three NHS Boards. The focus groups were audio-recorded and transcribed. The COM-B model of behaviour was used as a framework for analysis. Results Eleven Smile4life practitioners took part in the focus groups. All had first-hand experience of working with the Smile4life intervention. The average focus group length was 67 min. Working on the Smile4life intervention provided the Smile4life practitioners with: (i) the capability (physical and psychological), (ii) the opportunity (to establish methods of communication and relationships with service providers and service users) and (iii) the motivation to engage with Third Sector homelessness services and service users, by reflecting upon their positive and negative experiences delivering the intervention. Enablers and barriers to this engagement were identified according to each of the COM-B categories. Enablers included: practitioners' sense of responsibility, reflecting on positive past experiences and success stories with service users. Barriers included: lack of resources, negative past experiences and poor relationships between Smile4life practitioners and Third Sector staff. Conclusion The Smile4life programme promoted capability, provided opportunities and increased motivation in those practitioners who cross disciplinary boundaries to implement the Smile4life intervention, which can be conceptualised as "boundary spanning". Practitioners who were found to be boundary spanners often had a positive mindset and proactive attitude towards the creation of strategies to overcome the challenges of implementation by bridging the gaps between the NHS and the Third Sector, and between oral health and homelessness, operating across differing fields to achieve their aims.
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Affiliation(s)
- Laura Beaton
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Andrea Rodriguez
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Ruth Freeman
- School of Dentistry, University of Dundee, Dundee, United Kingdom
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Beaton L, Knights J, Barnsley L, Araujo M, Clarkson J, Freeman R, Young L, Yuan S, Humphris G. Longitudinal online diaries with dental practitioners and dental care professionals during the COVID-19 pandemic: A trajectory analysis. Front Oral Health 2022; 3:1074655. [PMID: 36620124 PMCID: PMC9815696 DOI: 10.3389/froh.2022.1074655] [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: 10/19/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The COVID-19 pandemic resulted in a series of significant changes and adjustments within dentistry, as dental professionals dealt with temporary closures of dental practices, increased use of personal protective equipment, a reduction of clinical procedures, and extensions to training programmes. Recent research has illustrated the impact of the pandemic on the dental profession, indicating that many dental professionals felt emotionally exhausted and experienced significant uncertainty and anxiety. This qualitative study aimed to understand how these experiences and emotions changed over the course of six months, in dental trainees and primary dental care staff in Scotland. Methods A longitudinal diary study was conducted (June-December 2020) with dental trainees and primary dental care staff. The diary asked respondents to answer three questions related to their emotional exhaustion, on a weekly basis. There was also an open question asking respondents to describe any significant issues or concerns they had experienced during the preceding week because of the impact of the COVID-19 pandemic on their work or training. This qualitative data was explored using a trajectory analysis approach to determine specifically changes over time. Results The trajectory analysis revealed several key concerns prevalent amongst respondents, and how they fluctuated over the six months. Concerns included: the impact of the pandemic on respondents' future careers and on dentistry more generally; adapting to new working environments; the impact on their patients' dental treatment and oral health; the impact on their health and wellbeing; financial considerations and adjusting to new safety measures as part of the remobilization of dental services. Discussion In the second half of 2020, as the UK was adjusting to the introduction of new COVID-19 safety measures in everyday life, the dental profession were grappling with significant changes to their working environment, including PPE, redeployment, use of aerosol generating procedures (AGPs), and timelines for re-opening practices. This longitudinal diary study has shown some parts of the dental profession in Scotland expressed very varied and personal concerns and anxieties related to COVID-19. Respondents' candor in their diary entries revealed explicit, frequent and high levels of uncertainty and worry related to their training and career. Collectively, the data corpus highlighted the emotional toll these anxieties have taken on the dental professions in Scotland. Conclusion These findings demonstrate the need for (a) increased provision of mental health and wellbeing support services for dental staff and (b) the study of the linkage between organization of pandemic management to the working practices of staff delivering services. Interventions, at various levels, should take into consideration the fluctuating nature of dental professionals' concerns and anxieties over time, to address both immediate and longer-term issues.
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Affiliation(s)
- Laura Beaton
- NHS Education for Scotland, Edinburgh, United Kingdom,Correspondence: Laura Beaton
| | | | | | | | - Jan Clarkson
- NHS Education for Scotland, Edinburgh, United Kingdom,School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Ruth Freeman
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Linda Young
- NHS Education for Scotland, Edinburgh, United Kingdom
| | - Siyang Yuan
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
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Brown MEL, Lim JH, Horsburgh J, Pistoll C, Thakerar V, Maini A, Johnson C, Beaton L, Mahoney C, Kumar S. Identity Development in Disorientating Times: the Experiences of Medical Students During COVID-19. Med Sci Educ 2022; 32:995-1004. [PMID: 35936649 PMCID: PMC9340721 DOI: 10.1007/s40670-022-01592-z] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Professional identity development is a central aim of medical education, which has been disrupted during COVID-19. Yet, no research has qualitatively explored COVID-19's impact across institutions or countries on medical students' identities. Kegan proposes a cognitive model of identity development, where 'disorientating dilemmas' prompt student development. Given the potential of COVID-related disruption to generate disorientating dilemmas, the authors investigated the ways in which COVID-19 influenced students' identity development. METHODS The authors conducted an international qualitative study with second year medical students from Imperial College London, and third year students from Melbourne Medical School. Six focus groups occurred 2020-2021, with three to six students per group. Authors analysed data using reflexive thematic analysis, applying Kegan's model as a sensitising theoretical lens. RESULTS COVID-19 has resulted in a loss of clinical exposure, loss of professional relationships, and a shift in public perception of physicians. Loss of exposure to clinical practice removed the external validation from patients and seniors many students depended on for identity development. Students' experiences encouraged them to assume the responsibilities of the profession and the communities they served, in the face of conflicting demands and risk. Acknowledging and actioning this responsibility facilitated identity development as a socially responsible advocate. CONCLUSIONS Educators should consider adapting medical education to support students through Kegan's stages of development. Measures to foster relationships between students, patients, and staff are likely necessary. Formal curricula provisions, such as spaces for reflection and opportunities for social responsibility, may aid students in resolving the conflict many have recently experienced. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01592-z.
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Affiliation(s)
- Megan E. L. Brown
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Jun Hua Lim
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Chance Pistoll
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Viral Thakerar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Arti Maini
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Caroline Johnson
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Laura Beaton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Claire Mahoney
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Sonia Kumar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
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Beaton L, Tregidgo HFJ, Znati SA, Forsyth S, Counsell N, Clarkson MJ, Bandula S, Chouhan M, Lowe HL, Thin MZ, Hague J, Sharma D, Pollok JM, Davidson BR, Raja J, Munneke G, Stuckey DJ, Bascal ZA, Wilde PE, Cooper S, Ryan S, Czuczman P, Boucher E, Hartley JA, Atkinson D, Lewis AL, Jansen M, Meyer T, Sharma RA. Phase 0 Study of Vandetanib-Eluting Radiopaque Embolics as a Preoperative Embolization Treatment in Patients with Resectable Liver Malignancies. J Vasc Interv Radiol 2022; 33:1034-1044.e29. [PMID: 35526675 DOI: 10.1016/j.jvir.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess the safety and tolerability of a vandetanib-eluting radiopaque embolic (BTG-002814) for transarterial chemoembolization (TACE) in patients with resectable liver malignancies. MATERIALS AND METHODS The VEROnA clinical trial was a first-in-human, phase 0, single-arm, window-of-opportunity study. Eligible patients were aged ≥18 years and had resectable hepatocellular carcinoma (HCC) (Child-Pugh A) or metastatic colorectal cancer (mCRC). Patients received 1 mL of BTG-002814 transarterially (containing 100 mg of vandetanib) 7-21 days prior to surgery. The primary objectives were to establish the safety and tolerability of BTG-002814 and determine the concentrations of vandetanib and the N-desmethyl vandetanib metabolite in the plasma and resected liver after treatment. Biomarker studies included circulating proangiogenic factors, perfusion computed tomography, and dynamic contrast-enhanced magnetic resonance imaging. RESULTS Eight patients were enrolled: 2 with HCC and 6 with mCRC. There was 1 grade 3 adverse event (AE) before surgery and 18 after surgery; 6 AEs were deemed to be related to BTG-002814. Surgical resection was not delayed. Vandetanib was present in the plasma of all patients 12 days after treatment, with a mean maximum concentration of 24.3 ng/mL (standard deviation ± 13.94 ng/mL), and in resected liver tissue up to 32 days after treatment (441-404,000 ng/g). The median percentage of tumor necrosis was 92.5% (range, 5%-100%). There were no significant changes in perfusion imaging parameters after TACE. CONCLUSIONS BTG-002814 has an acceptable safety profile in patients before surgery. The presence of vandetanib in the tumor specimens up to 32 days after treatment suggests sustained anticancer activity, while the low vandetanib levels in the plasma suggest minimal release into the systemic circulation. Further evaluation of this TACE combination is warranted in dose-finding and efficacy studies.
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Affiliation(s)
- Laura Beaton
- University College London Cancer Institute, University College London, London, United Kingdom.
| | - Henry F J Tregidgo
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sami A Znati
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Sharon Forsyth
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, United Kingdom
| | - Matthew J Clarkson
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Steven Bandula
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Manil Chouhan
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Helen L Lowe
- University College London Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, University College London, London, United Kingdom
| | - May Zaw Thin
- Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Julian Hague
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Dinesh Sharma
- Division of Transplantation and Immunology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Joerg-Matthias Pollok
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Hepatopancreatobiliary Surgery and Liver Transplantation, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Brian R Davidson
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Hepatopancreatobiliary Surgery and Liver Transplantation, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Jowad Raja
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Graham Munneke
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Daniel J Stuckey
- Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Zainab A Bascal
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Paul E Wilde
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Sarah Cooper
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Samantha Ryan
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Peter Czuczman
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Eveline Boucher
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - John A Hartley
- University College London Cancer Institute, University College London, London, United Kingdom; University College London Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, University College London, London, United Kingdom
| | - David Atkinson
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Andrew L Lewis
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Marnix Jansen
- University College London Cancer Institute, University College London, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tim Meyer
- University College London Cancer Institute, University College London, London, United Kingdom; Department of Oncology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Centre, University College London Cancer Institute, London, United Kingdom
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Knights J, Beaton L, Young L, Araujo M, Yuan S, Clarkson J, Humphris G, Freeman R. Uncertainty and Fears Around Sustainability: A Qualitative Exploration of the Emotional Reactions of Dental Practitioners and Dental Care Professionals During COVID-19. Front Oral Health 2022; 2:799158. [PMID: 35128524 PMCID: PMC8813960 DOI: 10.3389/froh.2021.799158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Recent cross-sectional surveys have shown the detrimental impact of COVID-19 on the health and well-being of dental practitioners and dental care professionals. This qualitative study complements the growing quantitative evidence base with an in-depth exploration of the lived experiences of those working in primary care dental teams in Scotland. METHODS Focus groups were carried out with primary care dental team members and trainees between July and October 2020. Olsen's tripartite framework of health service sustainability was operationalised to explore how participants experienced uncertainty and their attempts to sustain dental services. RESULTS Analysis revealed significant concerns surrounding the sustainability of dental services and dental training programmes as a consequence of the emergency level response to the pandemic. Restrictions on dentistry were seen to be severely impeding desirable clinical outcomes, particularly for the most vulnerable groups. Participants experienced being unable to deliver high quality care to their patients as both confusing and distressing. The capability of the dental health care system to meet a growing backlog of dental need and manage this effectively in a pandemic era was called in to serious question. Ongoing uncertainties were affecting how participants were thinking about their professional futures, with stress about income and employment, along with heightened experiences of professional isolation during the pandemic, resulting in some looking at possibilities for retraining or even considering leaving their profession altogether. DISCUSSION The impact of the pandemic has produced considerable uncertainty regarding the sustainability of dental services in the medium to longer term. It has also served to expose the uncertainties practitioners grapple with routinely as they attempt to sustain their NHS dental service delivery. CONCLUSION This study brings in to sharp focus the diversity of challenges, confusions and uncertainties experienced by dental practitioners and dental care professionals during the COVID-19 pandemic and the need for suitable and ongoing measures to be put in place to support their mental well-being.
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Affiliation(s)
| | - Laura Beaton
- NHS Education for Scotland, Edinburgh, United Kingdom
| | - Linda Young
- NHS Education for Scotland, Edinburgh, United Kingdom
| | | | - Siyang Yuan
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Jan Clarkson
- NHS Education for Scotland, Edinburgh, United Kingdom
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, United Kingdom
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Humphris G, Knights J, Beaton L, Araujo M, Yuan S, Clarkson J, Young L, Freeman R. Exploring the Effect of the COVID-19 Pandemic on the Dental Team: Preparedness, Psychological Impacts and Emotional Reactions. Front Oral Health 2022; 2:669752. [PMID: 35048012 PMCID: PMC8757713 DOI: 10.3389/froh.2021.669752] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/31/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems. Aim: To investigate features of health and well-being as an outcome of the uncertainties surrounding COVID-19 for dentists and dental health professionals in primary dental care and for those in training. In addition, the study examined the well-being indices with reference to normative values. Finally a theoretical model was explored to explain depressive symptoms and investigate its generalisability across dentists and dental health professionals in primary dental care and those in postgraduate training. Methods: A cross-sectional survey of dental trainees and primary dental care staff in Scotland was conducted in June to October 2020. Assessment was through “Portal,” an online tool used for course bookings/management administered by NHS Education for Scotland. A non-probability convenience sample was employed to recruit participants. The questionnaire consisted of four multi-item scales including: preparedness (14 items of the DPPPS), burnout (the 9 item emotional exhaustion subscale and 5 items of the depersonalisation subscale of the MBI), the 22 item Impact of Event Scale-Revised, and depressive symptomatology using the Patient Health Questionnaire-2. Analysis was performed to compare the levels of these assessments between trainees and primary dental care staff and a theoretically based path model to explain depressive symptomology, utilising structural equation modelling. Results: Approximately, 27% of all 329 respondents reported significant depressive symptomology and 55% of primary care staff rated themselves as emotionally exhausted. Primary care staff (n = 218) felt less prepared for managing their health, coping with uncertainty and financial insecurity compared with their trainee (n = 111) counterparts (all p's < 0.05). Depressive symptomology was rated higher than reported community samples (p < 0.05) The overall fit of the raw data applied to the theoretical model confirmed that preparedness (negative association) and trauma associated with COVID-19 (positive association) were significant factors predicting lowered mood (chi-square = 46.7, df = 21, p = 0.001; CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). Burnout was indirectly implicated and a major path from trauma to burnout was found to be significant in primary care staff but absent in trainees (p < 0.002). Conclusion: These initial findings demonstrate the possible benefit of resourcing staff support and interventions to assist dental staff to prepare during periods of high uncertainty resulting from the recent COVID-19 pandemic.
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Affiliation(s)
- Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Laura Beaton
- NHS Education for Scotland, Edinburgh, United Kingdom
| | | | - Siyang Yuan
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Jan Clarkson
- NHS Education for Scotland, Edinburgh, United Kingdom.,Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Linda Young
- NHS Education for Scotland, Edinburgh, United Kingdom
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, United Kingdom
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Cousins M, Patel K, Araujo M, Beaton L, Scott C, Stirling D, Young L, Knights J. A qualitative analysis of dental professionals' beliefs and concerns about providing aerosol generating procedures early in the COVID-19 pandemic. BDJ Open 2022; 8:2. [PMID: 35031596 PMCID: PMC8758920 DOI: 10.1038/s41405-022-00094-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In response to the COVID-19 pandemic, the Scottish Dental Clinical Effectiveness Programme (SDCEP) initiated a rapid review of the evidence related to the generation and mitigation of aerosols in dental practice. To support this review, a survey was distributed to better understand the provision of aerosol generating procedures (AGPs) in dentistry. METHODS An online questionnaire was distributed to dental professionals asking about their current practice and beliefs about AGPs. Data were analysed using qualitative content analysis. RESULTS Analysis revealed confusion and uncertainty regarding mitigation of AGPs. There was also frustration and scepticism over the risk of SARS-COV-2 transmission within dental settings, the evidence underpinning the restrictions and the leadership and guidance being provided, as well as concern over financial implications and patient and staff safety. DISCUSSION The frustration and concerns expressed by respondents mirrored findings from other recent studies and suggest there is a need for reflection within the profession so that lessons can be learned to better support staff and patients. CONCLUSION Understanding the profession's views about AGP provision contributed to the SDCEP rapid review and provides insights to help inform policymakers and leaders in anticipation not only of future pandemics but in considering the success of any large scale and/or rapid organisational change.
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Beaton L, Daly M, Tregidgo HF, Grimes H, Moinuddin S, Stacey C, Znati S, Hague J, Bascal ZA, Wilde PE, Cooper S, Bandula S, Lewis AL, Clarkson MJ, Sharma RA. Radiopaque drug-eluting embolisation beads as fiducial markers for stereotactic liver radiotherapy. Br J Radiol 2021; 95:20210594. [PMID: 34762499 PMCID: PMC8822567 DOI: 10.1259/bjr.20210594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: To determine the feasibility of using radiopaque (RO) beads as direct tumour surrogates for image-guided radiotherapy (IGRT) in patients with liver tumours after transarterial chemoembolisation (TACE). Methods: A novel vandetanib-eluting RO bead was delivered via TACE as part of a first-in-human clinical trial in patients with either hepatocellular carcinoma or liver metastases from colorectal cancer. Following TACE, patients underwent simulated radiotherapy imaging with four-dimensional computed tomography (4D-CT) and cone-beam CT (CBCT) imaging. RO beads were contoured using automated thresholding, and feasibility of matching between the simulated radiotherapy planning dataset (AVE-IP image from 4D data) and CBCT scans assessed. Additional kV, MV, helical CT and CBCT images of RO beads were obtained using an in-house phantom. Stability of RO bead position was assessed by comparing 4D-CT imaging to CT scans taken 6–20 days following TACE. Results: Eight patients were treated and 4D-CT and CBCT images acquired. RO beads were visible on 4D-CT and CBCT images in all cases and matching successfully performed. Differences in centre of mass of RO beads between CBCT and simulated radiotherapy planning scans (AVE-IP dataset) were 2.0 mm mediolaterally, 1.7 mm anteroposteriorally and 3.5 mm craniocaudally. RO beads in the phantom were visible on all imaging modalities assessed. RO bead position remained stable up to 29 days post TACE. Conclusion: RO beads are visible on IGRT imaging modalities, showing minimal artefact. They can be used for on-set matching with CBCT and remain stable over time. Advances in knowledge: The role of RO beads as fiducial markers for stereotactic liver radiotherapy is feasible and warrants further exploration as a combination therapy approach.
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Affiliation(s)
- Laura Beaton
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Mairead Daly
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Henry Fj Tregidgo
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Helen Grimes
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Syed Moinuddin
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chris Stacey
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Znati
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Julian Hague
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Zainab A Bascal
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Paul E Wilde
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Sarah Cooper
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Steven Bandula
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew L Lewis
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Matthew J Clarkson
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ricky A Sharma
- University College London Cancer Institute, University College London, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Centre, University College London Cancer Institute, London, United Kingdom
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Cassie H, Mistry V, Beaton L, Black I, Clarkson JE, Young L. An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach. BMJ Open Qual 2021; 10:bmjoq-2019-000839. [PMID: 33849904 PMCID: PMC8051365 DOI: 10.1136/bmjoq-2019-000839] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/11/2021] [Accepted: 03/20/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives Ensuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry. Design A multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies. Results One hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement. Conclusions Findings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.
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Affiliation(s)
- Heather Cassie
- School of Dentistry, University of Dundee, Dundee, UK
- Clinical Effectiveness Workstream, NHS Education for Scotland, Dundee, UK
| | - Vinay Mistry
- Maxillofacial Unit, Huddersfield Royal Infirmary, Huddersfield, UK
| | - Laura Beaton
- School of Dentistry, University of Dundee, Dundee, UK
- Clinical Effectiveness Workstream, NHS Education for Scotland, Dundee, UK
| | - Irene Black
- NHS Education for Scotland West Region, Glasgow, UK
| | | | - Linda Young
- Clinical Effectiveness Workstream, NHS Education for Scotland, Dundee, UK
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10
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Beaton L, Williams I, Sanci L. Exploring adolescent and clinician perspectives on Australia's national digital health record, My Health Record. Aust J Prim Health 2021; 27:PY20169. [PMID: 33715770 DOI: 10.1071/py20169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022]
Abstract
Adolescence is often a time when risk-taking behaviours emerge and attendance at primary health care is low. School-based health services can serve to improve access to health care. Clinicians play a key role in improving adolescents' health literacy and capacity to make informed care decisions. Australia's national digital health record, My Health Record (MHR), has posed significant challenges for both clinicians and adolescents in understanding impacts on patient privacy. Guidance is required on how best to communicate about MHR to adolescents. This exploratory qualitative study aims to examine adolescents' understanding of MHR, clinicians' knowledge of MHR and their use of MHR with adolescents. Focus groups with students, school health and well-being staff and semistructured interviews with GPs and nurses were undertaken in one regional and one urban secondary school-based health service in Victoria. Transcripts from audio recorded sessions were examined using thematic analysis. Resulting themes include minimal understanding and use of MHR, privacy and security concerns, possible benefits of MHR and convenience. The results suggest opportunities to address gaps in understanding and to learn from adolescents' preferences for digital health literacy education. This will support primary care clinicians to provide best-practice health care for adolescents.
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Affiliation(s)
- Laura Beaton
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia; and Corresponding author
| | - Ian Williams
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
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11
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Abstract
BACKGROUND It has been a decade since a landmark Lancet publication declared that 'climate change is the biggest global health threat of the 21st century'. Since then, Australia has experienced unprecedented warming related to climate change and an associated increase in the frequency and intensity of extreme weather events, including heatwaves, droughts, storms, bushfires and air pollution. These events have had major impacts on community physical and mental health. OBJECTIVE The aim of this article is to describe the health impacts of climate change and the role of general practitioners (GPs) in responding to these impacts. DISCUSSION While the clinical skills that underpin general practice have not changed, the environmental and planetary context has shifted. A 'planetary health' approach is required. Climate change should now be considered a health emergency. GPs have a critical role in mitigation and adaptation. Responding to climate change aligns with principles of preventive health and can produce 'co-benefits' for individual and population health.
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Affiliation(s)
- Catherine Georgia Anne Pendrey
- BMedSci (Hons), MBBS (Hons), GDipEcon, DCH, FRACGP, General Practitioner, NT; Victoria State Committee Member, Doctors for the Environment Australia, Vic; Member, Environmental Impacts in General Practice Special Interests Group, RACGP, NT
| | - Laura Beaton
- BMedSci (Hons), GDipSciComm, MD, FRACGP, General Practitioner, Vic; Lecturer @ Primary Care, Department of General Practice, Melbourne Medical School, University of Melbourne, Vic; Victoria State Committee Member, Doctors for the Environment Australia, Vic
| | - Jessica Alice Kneebone
- MBBS (Hons), DRANZCOG, FRACGP, MPH, General Practitioner, Tas; Chair, Environmental Impacts in General Practice Special Interests Group, RACGP, Tas; Biodiversity Committee Member, Doctors for the Environment Australia, Tas
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12
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Raman S, Mou B, Hsu F, Valev B, Cheung A, Vallières I, Ma R, McKenzie M, Beaton L, Rackley T, Gondara L, Nichol A. Whole Brain Radiotherapy Versus Stereotactic Radiosurgery in Poor-Prognosis Patients with One to 10 Brain Metastases: A Randomised Feasibility Study. Clin Oncol (R Coll Radiol) 2020; 32:442-451. [DOI: 10.1016/j.clon.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
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13
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Beaton L, Nica L, Tyldesley S, Sek K, Ayre G, Aparicio M, Gondara L, Speers C, Nichol A. PET/CT of breast cancer regional nodal recurrences: an evaluation of contouring atlases. Radiat Oncol 2020; 15:136. [PMID: 32487183 PMCID: PMC7268399 DOI: 10.1186/s13014-020-01576-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/19/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To validate the Radiation Therapy Oncology Group (RTOG) and European Society for Radiotherapy and Oncology (ESTRO) breast cancer nodal clinical target volumes (CTVs) and to investigate the Radiotherapy Comparative Effectiveness Consortium (RADCOMP) Posterior Neck volume in relation to regional nodal recurrences (RNR). METHODS From a population-based database, 69 patients were identified who developed RNR after curative treatment for breast cancer. RNRs were detected with 18-fluorodeoxyglucose-positron emission tomography-computed tomography (PET/CT). All patients were treatment-naïve for RNR when imaged. The RTOG and ESTRO nodal CTVs and RADCOMP Posterior Neck volumes were contoured onto a template patient's CT. RNRs were contoured on each PET/CT and deformed onto the template patient's CT. Each RNR was represented by a 5 mm diameter epicentre, and categorized as 'inside', 'marginal' or 'outside' the CTV boundaries. RESULTS Sixty-nine patients with 226 nodes (median 2, range 1-11) were eligible for inclusion. Thirty patients had received adjuvant tangent and regional nodal radiotherapy, 16 tangent-only radiotherapy and 23 no adjuvant radiotherapy. For the RTOG CTVs, the RNR epicentres were 70% (158/226) inside, 4% (8/226) marginal and 27% (60/226) outside. They included the full extent of the RNR epicentres in 38% (26/69) of patients. Addition of the RADCOMP Posterior Neck volume increased complete RNR coverage to 48% (33/69) of patients. For the ESTRO CTVs, the RNR epicentres were 73% (165/226) inside, 2% (4/226) marginal and 25% (57/226) outside. They included the full extent of the RNR epicentres in 57% (39/69) of patients. Addition of the RADCOMP Posterior Neck volume increased complete RNR coverage to 70% (48/69) of patients. CONCLUSIONS The RTOG and ESTRO breast cancer nodal CTVs do not fully cover all potential areas of RNR, but the ESTRO nodal CTVs provided full coverage of all RNR epicentres in 19% more patients than the RTOG nodal CTVs. With addition of the RADCOMP Posterior Neck volume to the ESTRO CTVs, 70% of patients had full coverage of all RNR epicentres.
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Affiliation(s)
- Laura Beaton
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Luminita Nica
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Kenny Sek
- Department of Nuclear Medicine, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Gareth Ayre
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Maria Aparicio
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Caroline Speers
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada.
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada.
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14
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Beaton L, Humphris G, Rodriguez A, Freeman R. Community-based oral health interventions for people experiencing homelessness: a scoping review. Community Dent Health 2020; 37:150-160. [PMID: 32212437 DOI: 10.1922/cdh_00014beaton11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the characteristics of community-based oral health interventions for people experiencing homelessness. BASIC RESEARCH DESIGN A scoping review was conducted, adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Scoping Reviews) checklist. A search strategy was developed using MeSH terms and key words, and used to search the following electronic databases: Medline/PubMed, CINAHL, ProQuest Assia, Scopus, Web of Science and PsychNet. Key journals and reference lists were also hand-searched. Two reviewers then read the abstracts of all papers, excluding duplicates and papers that did not meet the eligibility criteria. The reviewers then read to full-texts of the studies to be included in the review. RESULTS Eighteen studies met the inclusion criteria and were included in the study. These studies were predominantly evaluations of community-based dental services or other oral health interventions. Several recommendations were extracted. Interventions should involve co-design with homeless service users; multidisciplinary working, collaboration with dental practitioners, and working with educational establishments. The location of community-based services was also found to be of importance. CONCLUSION This review has highlighted several recommendations, as well as gaps in the literature. These gaps suggest a need for more non-clinical oral health interventions for the homeless population, and a closer look at the role that non-dental practitioners can play in the delivery of oral health care.
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Affiliation(s)
- L Beaton
- DHSRU, School of Dentistry, University of Dundee
| | - G Humphris
- Medical School, University of St Andrews
| | - A Rodriguez
- DHSRU, School of Dentistry, University of Dundee
| | - R Freeman
- DHSRU, School of Dentistry, University of Dundee
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15
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Beaton L, Chan EK, Tyldesley S, Gondara L, Speers C, Nichol A. In the Era After the European Organisation for Research and Treatment of Cancer 'Boost' Study, is the Additional Radiotherapy to the Breast Tumour Bed Still Beneficial for Young Women? Clin Oncol (R Coll Radiol) 2020; 32:373-381. [PMID: 32057620 DOI: 10.1016/j.clon.2020.01.025] [Citation(s) in RCA: 4] [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: 03/28/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
Abstract
AIMS The European Organisation for Research and Treatment of Cancer (EORTC) 22,881-10,882 trial showed significant benefit of a radiotherapy boost (RTB) in women ≤40 years in a pre-hormone therapy (HT) era. We determined how the use of HT and RTB changed in response to clinical guidelines and whether the benefit of routine RTB was still observed in the HT era. MATERIALS AND METHODS Between 1996 and 2004, a provincial database identified all women ≤40 years with breast cancer who met the inclusion criteria of the EORTC trial. In total, 411 patients were classified into three eras defined by the guidelines: era 1 (discretionary HT, discretionary RTB); era 2 (routine HT, discretionary RTB); era 3 (routine HT, routine RTB). HT use, RTB use and cumulative incidence of local recurrence were calculated and compared across eras. RESULTS HT use increased after the first policy change from 13% to 75% for oestrogen receptor-positive patients (P < 0.01). RTB use also increased from 33% to 76% following the second policy change (P < 0.01). At 10 years, the cumulative incidence of local recurrence was 12% in era 1, 6% in era 2 and 6% in era 3 (era 2 versus era 3, P = 0.92). For patients in the routine HT era (eras 2 and 3 combined) there was no significant difference in local recurrence between RTB and 'no RTB' patients (6% versus 7%, P = 0.81). CONCLUSIONS The routine use of HT and RTB increased significantly after new practice guidelines. Introduction of the HT guideline was associated with a 6% improvement in local recurrence at 10 years. No improvement in local recurrence was associated with the introduction of the RTB guideline in the HT era. The routine use of a boost in unselected young women with negative margins should be re-evaluated in the current HT era.
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Affiliation(s)
- L Beaton
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - E K Chan
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - S Tyldesley
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada; Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - L Gondara
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - C Speers
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - A Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada; Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada.
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16
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Warburton DW, Feldsine PT, Falbo-Nelson MT, Ackerl J, Adamik D, Aldenrath S, Allain P, Arling V, Beaton L, Bowen B, Brocklehurst F, Catherwood K, Cavadini J, Coignaud C, Cooper A, Coulter R, Davis T, Douey D, Downey W, Drummond J, Durzi S, Dzogan S, Foster R, Fox C, Gibson E, Gour L, Gover G, Gray M, Heidebrecht P, Kerwood J, Krohn G, Kupskay B, LaFreniere D, Massicotte R, McDonagh S, Molleken B, Oggle J, Perlette M, Pugh P, Purvis U, Saint W, Trottier Y, Vinet J, West D, Wheeler B, Zebchuk A. Modified Immunodiffusion Method for Detection of Salmonella in Raw Flesh and Highly Contaminated Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/78.1.59] [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] [Indexed: 11/12/2022]
Abstract
Abstract
A total of 19 government and private industry laboratories in Canada and the United States participated in the collaborative study. Naturally contaminated ground poultry and animal meals, as well as inoculated raw shrimp, were examined for presence of Salmonella by both the modified immunodiffusion method and the Bacteriological Analytical Manual culture method, resulting in an agreement rate of 93.1%. The 2 methods are statistically equivalent for all food types at each inoculation level and for all lots of naturally contaminated foods evaluated in this study. The modification of the AOAC Official Method 989.13, immunodiffusion (1–2 TEST) method for detection of motile Salmonella in all foods, has been adopted revised first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Donald W Warburton
- Health Canada, Health Protection Branch, Food Directorate, Bureau of Microbial Hazards, Evaluation Division, Sir Frederick G. Banting Research Center, Ottawa, ON, K1A OL2, Canada
| | - Philip T Feldsine
- BioControl Systems, Inc., 19805 North Creek Parkway, Bothell, WA 98011
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Nichol A, Raman S, Mou B, Hsu F, Valev B, Cheung A, Vallières I, Beaton L, Rackley T, Gondara L. CMET-31. WHOLE BRAIN RADIOTHERAPY VERSUS STEREOTACTIC RADIOSURGERY IN POOR-PROGNOSIS PATIENTS WITH 1 – 10 BRAIN METASTASES: A RANDOMIZED FEASIBILITY STUDY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.232] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
The clinical advantage of stereotactic radiosurgery (SRS) over whole brain radiotherapy (WBRT) in patients with brain metastases and poor prognosis is controversial. To investigate the feasibility of a phase III clinical trial in a population of patients with poor prognosis, we conducted a randomized feasibility study of WBRT versus SRS.
METHODS
Patients with Karnofsky performance status (KPS) ≥ 70, life expectancy of 3–6 months, based on both Diagnosis-Specific Graded Prognostic Assessments and attending oncologist opinion, and 1– 10 brain metastases with a diameter ≤ 4 cm were enrolled at six Canadian cancer centers. Patients were randomly assigned to WBRT (20 Gy in 5 fractions) or SRS (15 Gy in 1 fraction). The primary endpoint was the rate of accrual. A secondary endpoint was the ratio of screened subjects to accrued subjects. This trial is registered with ClinicalTrials.gov (NCT02220491).
RESULTS
Between January 2015 and November 2017, 210 were screened to enroll 22 patients (9.5 screened/participant) and 20 patients were randomized. The accrual rate was 0.63 patients / month. The most common reasons for exclusion were: estimated median survival outside 3–6 months (n = 40), baseline KPS below 70 (n = 28), and > 10 brain metastases (n = 28). The median survival was 7.0 months. The overall survival was 9.5 months (n = 11) for patients who had subsequent systemic therapy, compared to 3.7 months (n = 9) in patients who had none. In both arms, the cumulative incidence of retreatment with brain radiotherapy was 40%.
CONCLUSIONS
Accrual was slow and the median survival was longer than expected, but a randomized trial evaluating WBRT vs SRS in patients with poor prognosis would likely be feasible by enrolling only patients with no remaining systemic therapy options.
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Affiliation(s)
| | | | | | - Fred Hsu
- BC Cancer, Abbotsford, BC, Canada
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18
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Beaton L, Tregidgo HFJ, Znati SA, Forsyth S, Clarkson MJ, Bandula S, Chouhan M, Lowe HL, Zaw Thin M, Hague J, Sharma D, Pollok JM, Davidson BR, Raja J, Munneke G, Stuckey DJ, Bascal ZA, Wilde PE, Cooper S, Ryan S, Czuczman P, Boucher E, Hartley JA, Lewis AL, Jansen M, Meyer T, Sharma RA. VEROnA Protocol: A Pilot, Open-Label, Single-Arm, Phase 0, Window-of-Opportunity Study of Vandetanib-Eluting Radiopaque Embolic Beads (BTG-002814) in Patients With Resectable Liver Malignancies. JMIR Res Protoc 2019; 8:e13696. [PMID: 31579027 PMCID: PMC6777276 DOI: 10.2196/13696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is the current standard of care for patients with intermediate-stage hepatocellular carcinoma (HCC) and is also a treatment option for patients with liver metastases from colorectal cancer. However, TACE is not a curative treatment, and tumor progression occurs in more than half of the patients treated. Despite advances and technical refinements of TACE, including the introduction of drug-eluting beads-TACE, the clinical efficacy of TACE has not been optimized, and improved arterial therapies are required. OBJECTIVE The primary objectives of the VEROnA study are to evaluate the safety and tolerability of vandetanib-eluting radiopaque embolic beads (BTG-002814) in patients with resectable liver malignancies and to determine concentrations of vandetanib and the N-desmethyl metabolite in plasma and resected liver following treatment with BTG-002814. METHODS The VEROnA study is a first-in-human, open-label, single-arm, phase 0, window-of-opportunity study of BTG-002814 (containing 100 mg vandetanib) delivered transarterially, 7 to 21 days before surgery in patients with resectable liver malignancies. Eligible patients have a diagnosis of colorectal liver metastases, or HCC (Childs Pugh A), diagnosed histologically or radiologically, and are candidates for liver surgery. All patients are followed up for 28 days following surgery. Secondary objectives of this study are to evaluate the anatomical distribution of BTG-002814 on noncontrast-enhanced imaging, to evaluate histopathological features in the surgical specimen, and to assess changes in blood flow on dynamic contrast-enhanced magnetic resonance imaging following treatment with BTG-002814. Exploratory objectives of this study are to study blood biomarkers with the potential to identify patients likely to respond to treatment and to correlate the distribution of BTG-002814 on imaging with pathology by 3-dimensional modeling. RESULTS Enrollment for the study was completed in February 2019. Results of a planned interim analysis were reviewed by a safety committee after the first 3 patients completed follow-up. The recommendation of the committee was to continue the study without any changes to the dose or trial design, as there were no significant unexpected toxicities related to BTG-002814. CONCLUSIONS The VEROnA study is studying the feasibility of administering BTG-002814 to optimize the use of this novel technology as liver-directed therapy for patients with primary and secondary liver cancer. TRIAL REGISTRATION ClinicalTrial.gov NCT03291379; https://clinicaltrials.gov/ct2/show/NCT03291379. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13696.
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Affiliation(s)
- Laura Beaton
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Henry F J Tregidgo
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sami A Znati
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Sharon Forsyth
- Cancer Research UK University College London Cancer Trials Centre, London, United Kingdom
| | - Matthew J Clarkson
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Steven Bandula
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Manil Chouhan
- University College London Centre for Medical Imaging, University College London, London, United Kingdom
| | - Helen L Lowe
- University College London Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, University College London, London, United Kingdom
| | - May Zaw Thin
- Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Julian Hague
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Dinesh Sharma
- Division of Transplantation and Immunology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Joerg-Matthias Pollok
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Hepatopancreatobiliary Surgery and Liver Transplantation, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Brian R Davidson
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Hepatopancreatobiliary Surgery and Liver Transplantation, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Jowad Raja
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Graham Munneke
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Daniel J Stuckey
- Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom
| | | | | | | | | | | | | | - John A Hartley
- University College London Cancer Institute, University College London, London, United Kingdom
| | | | - Marnix Jansen
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Tim Meyer
- University College London Cancer Institute, University College London, London, United Kingdom
- Department of Oncology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Centre, University College London Cancer Institute, London, United Kingdom
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Zhao Y, Yeung R, Beaton L, Liu M, Olson R, Schellenberg D. 228 Outcomes of Stereotactic Ablative Radiotherapy for Lymph Node Oligometastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33291-8] [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: 11/25/2022]
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20
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Beaton L, Bergman A, Nichol A, Aparicio M, Wong G, Gondara L, Speers C, Weir L, Davis M, Tyldesley S. Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines. Clin Transl Radiat Oncol 2019; 19:39-45. [PMID: 31485490 PMCID: PMC6715791 DOI: 10.1016/j.ctro.2019.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 06/12/2019] [Accepted: 08/11/2019] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular risk factors predict for cardiac death after breast radiotherapy. Cardiovascular risk factors should be modified in breast cancer patients. Radiation induced cardiac death at 10-years is low if mean heart dose is <3.3 Gy. Radiation induced cardiac death at 10-years is low if maximum LAD dose is <45.4 Gy. Studies are needed to evaluate heart and LAD constraints in the CT-planning era.
Background Breast/chest wall irradiation (RT) increases risk of cardiovascular death. International Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines state for partial heart irradiation a “V25Gy <10% will be associated with a <1% probability of cardiac mortality” in long-term follow-up after RT. We assessed whether women treated with breast/chest wall RT 10-years ago who died of cardiovascular disease (CVD) violated QUANTEC guidelines. Materials/methods A population-based database identified all cardiovascular deaths in women with early-stage breast cancer <80 years, treated with adjuvant breast/chest wall RT from 2002 to 2006. Ten-year rate of cardiovascular death was calculated using a Kaplan-Meier method. Patients were matched on a 2:1 basis with controls that did not die of CVD. For left-sided cases, the heart and left anterior descending (LAD) artery were retrospectively delineated. Dose-volume histograms were calculated, and heart V25Gy compared to QUANTEC guidelines. Results 5249 eligible patients received breast/chest wall RT from 2002 to 2006: 76 (1.4% at 10-years) died of CVD by June 2015. Forty-two patients received left-sided RT (1.7% CVD death at 10-years), 34 right-sided RT (1.3% at 10-years). Heart V25Gy did not exceed 10% in any left-sided cases. No cardiac dosimetry parameter distinguished left-sided cases from controls. Conclusions QUANTEC guidelines were not violated in any patient that died of CVD after left-sided RT. The risk of radiation induced cardiac death at 10-years appears to be very low if MHD is <3.3 Gy and maximum LAD dose (EQD23 Gy) is <45.4 Gy. Further studies are needed to evaluate heart and LAD constraints in the CT-planning era.
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Affiliation(s)
- Laura Beaton
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alanah Bergman
- Department of Medical Physics, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria Aparicio
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Graham Wong
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Caroline Speers
- Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Lorna Weir
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot Davis
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Yeung R, Beaton L, Rackley T, Weber B, Hamm J, Lee R, Camborde M, Pearson M, Duzenli C, Loewen S, Liu M, Ma R, Schellenberg D. Stereotactic Body Radiotherapy for Small Unresectable Hepatocellular Carcinomas. Clin Oncol (R Coll Radiol) 2019; 31:365-373. [DOI: 10.1016/j.clon.2019.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 12/31/2022]
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22
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Beaton L, Bandula S, Gaze MN, Sharma RA. How rapid advances in imaging are defining the future of precision radiation oncology. Br J Cancer 2019; 120:779-790. [PMID: 30911090 PMCID: PMC6474267 DOI: 10.1038/s41416-019-0412-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 12/13/2022] Open
Abstract
Imaging has an essential role in the planning and delivery of radiotherapy. Recent advances in imaging have led to the development of advanced radiotherapy techniques—including image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy and proton beam therapy. The optimal use of imaging might enable higher doses of radiation to be delivered to the tumour, while sparing normal surrounding tissues. In this article, we review how the integration of existing and novel forms of computed tomography, magnetic resonance imaging and positron emission tomography have transformed tumour delineation in the radiotherapy planning process, and how these advances have the potential to allow a more individualised approach to the cancer therapy. Recent data suggest that imaging biomarkers that assess underlying tumour heterogeneity can identify areas within a tumour that are at higher risk of radio-resistance, and therefore potentially allow for biologically focussed dose escalation. The rapidly evolving concept of adaptive radiotherapy, including artificial intelligence, requires imaging during treatment to be used to modify radiotherapy on a daily basis. These advances have the potential to improve clinical outcomes and reduce radiation-related long-term toxicities. We outline how recent technological advances in both imaging and radiotherapy delivery can be combined to shape the future of precision radiation oncology.
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Affiliation(s)
- Laura Beaton
- Cancer Institute, University College London, London, UK
| | - Steve Bandula
- Cancer Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | - Mark N Gaze
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | - Ricky A Sharma
- Cancer Institute, University College London, London, UK. .,NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK.
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23
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Zhao Y, Dunne E, Ma R, Liu M, Beaton L, Yeung R, Lund CR, Schellenberg D. Outcomes of stereotactic body radiotherapy for unresectable hepatocellular carcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.401] [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: 11/20/2022] Open
Abstract
401 Background: Stereotactic body radiotherapy (SBRT) is an emerging curative treatment for hepatocellular carcinoma (HCC). We report toxicity and efficacy of all patients treated in British Columbia, one of the largest series to date. Methods: From 2011 to Jan 2018, 99 patients underwent SBRT to 128 HCCs. Fiducials were placed and 4D CT (78.4%) and respiratory gating (19.6%) were used for motion management. Local control (LC), progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier. Cox regression identified outcome predictors. Results: Median Child-Pugh Score (CPS) was A5 (65% A5, 18% A6, 12% B7, 5% B8, 1% B9) and median Albumin-Bilirubin (ALBI) score was -2.55, grade 2 (48% gr1, 45% gr2, 6% gr3). Most (87.7%) had either Hepatitis B or C and 73.7% had prior HCC treatment, with 47.5% going on to further HCC treatment post SBRT and 42.4% deceased at the time of analysis. The median tumor size was 2.8 cm (range 0.8 – 11). The median prescribed biologically effective dose (BED10) was 112.5 Gy, with 45 Gy in 3 fractions (BED10112.5 Gy) in 56.9% of cases and 45 Gy in 5 fractions (BED10 85.5 Gy) in 30.4%. Median follow-up was 18.5 months (range 2.2 – 73.5). At 3 months, 12 (11.8%) patients had a rise in CPS of ≥ 2, and 26 (25.5%) patients had increased ALBI grade (median change in score of +0.16). Excluding laboratory findings, 14 (14.1%) patients developed CTCAE V5 grade 3 / 4 toxicities (ascites n = 12, hepatic failure n = 4, hepatic pain n = 1, nausea n = 1, GI bleed n = 1). The 1-, 2- and 3-year LC were 94.3%, 86.6% and 80.2%. The median PFS was 14.8 months, respectively 53.7%, 39.5% and 23.8% at 1, 2 and 3 years. The median OS was 41.1 months, respectively 80.3%, 63.5% and 55.2% at 1, 2 and 3 years. Univariate factors predicting improved LC were mean dose (Dmean) ≥ BED10 100 Gy to GTV (p < 0.01) and PTV (p = 0.03). Predictors of improved OS were prescription dose ≥ BED10 100 Gy (p = 0.02), GTV Dmean ≥ BED10 100 Gy (p < 0.01), lower CPS (p = 0.04) and lower ALBI score pre-SBRT (p < 0.01), smaller tumor size (p < 0.01), no liver directed therapy post-SBRT (p < 0.01), younger age (p = 0.03) and favorable ECOG (p = 0.01). Conclusions: SBRT achieves excellent LC, with low rates of toxicity and can be included with or without other therapies in HCC treatment.
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Affiliation(s)
| | - Emma Dunne
- BC Cancer Vancouver Centre, Vancouver, BC, Canada
| | - Roy Ma
- BC Cancer Vancouver Centre, Vancouver, BC, Canada
| | - Mitchell Liu
- BC Cancer Vancouver Centre, Vancouver, BC, Canada
| | - Laura Beaton
- BC Cancer Vancouver Centre, Vancouver, BC, Canada
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24
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Rodriguez A, Beaton L, Freeman R. Strengthening Social Interactions and Constructing New Oral Health and Health Knowledge: The Co-design, Implementation and Evaluation of A Pedagogical Workshop Program with and for Homeless Young People. Dent J (Basel) 2019; 7:dj7010011. [PMID: 30717131 PMCID: PMC6473716 DOI: 10.3390/dj7010011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 11/16/2022] Open
Abstract
Young homeless people make up nearly one-third of those experiencing homelessness. The need to provide an educative approach, to strengthen social interacting, and construct new knowledge to increase social inclusivity, is required. The aim of this qualitative exploration was to use critical consciousness as an educative tool, to co-design, implement, and evaluate a series of oral health and health pedagogical workshops to strengthen social engagement and to construct new health knowledge, with, and for, homeless young people and their service providers. An action research design permitted the simultaneous development, implementation, and evaluation of the pedagogical workshop program. A Non-Governmental Organization (NGO), providing supported accommodation for young homeless people, acted as the partner organization. Thirteen young people and five staff members from this NGO participated and co-designed eight workshops. Qualitative data collection included unstructured post-intervention interviews together with verbatim quotes from the group discussions during the workshops and from the post-workshop questionnaires. The qualitative analysis was informed by content analysis to permit the emergence of key themes from the data. The two themes were: 1. ‘trust building and collective engaging’ and 2. ‘constructing knowledge and developing skills’. Theme 1 highlighted engagement with the service provider, illustrating the transformation of the young people’s relationships, strengthening of their social interacting, and enabling their critical reflexive thinking on sensitive issues present in the homelessness trajectory. Theme 2 illustrated the young people’s ability to share, lend, and encode their new health information and convert it into an understandable and useable form. This new comprehension permitted their behavior change and social interaction. These findings provide an approach to increase young people’s knowledge, health literacy, and strengthen their social interacting to support community action.
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Affiliation(s)
- Andrea Rodriguez
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee DD1 4HN, UK.
| | - Laura Beaton
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee DD1 4HN, UK.
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee DD1 4HN, UK.
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Ricketts K, Ahmad R, Beaton L, Cousins B, Critchley K, Davies M, Evans S, Fenuyi I, Gavriilidis A, Harmer QJ, Jayne D, Jefford M, Loizidou M, Macrobert A, Moorcroft S, Naasani I, Ong ZY, Prise KM, Rannard S, Richards T, Schettino G, Sharma RA, Tillement O, Wakefield G, Williams NR, Yaghini E, Royle G. Recommendations for clinical translation of nanoparticle-enhanced radiotherapy. Br J Radiol 2018; 91:20180325. [PMID: 30179039 PMCID: PMC6319829 DOI: 10.1259/bjr.20180325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 01/06/2023] Open
Abstract
A multi-disciplinary cooperative for nanoparticle-enhanced radiotherapy (NERT) has been formed to review the current status of the field and identify key stages towards translation. Supported by the Colorectal Cancer Healthcare Technologies Cooperative, the cooperative comprises a diverse cohort of key contributors along the translation pathway including academics of physics, cancer and radio-biology, chemistry, nanotechnology and clinical trials, clinicians, manufacturers, industry, standards laboratories, policy makers and patients. Our aim was to leverage our combined expertise to devise solutions towards a roadmap for translation and commercialisation of NERT, in order to focus research in the direction of clinical implementation, and streamline the critical pathway from basic science to the clinic. A recent meeting of the group identified barriers to and strategies for accelerated clinical translation. This commentary reports the cooperative's recommendations. Particular emphasis was given to more standardised and cohesive research methods, models and outputs, and reprioritised research drivers including patient quality of life following treatment. Nanoparticle design criteria were outlined to incorporate scalability of manufacture, understanding and optimisation of biological mechanisms of enhancement and in vivo fate of nanoparticles, as well as existing design criteria for physical and chemical enhancement. In addition, the group aims to establish a long-term and widespread international community to disseminate key findings and create a much-needed cohesive body of evidence necessary for commercial and clinical translation.
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Affiliation(s)
- Kate Ricketts
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Reem Ahmad
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Laura Beaton
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | - Brian Cousins
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Kevin Critchley
- School of Physics and Astronomy, University of Leeds, Leeds, UK
| | | | - Stephen Evans
- School of Physics and Astronomy, University of Leeds, Leeds, UK
| | - Ifeyemi Fenuyi
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | | | - David Jayne
- Leeds Institute of Clinical Sciences, St James’s University Hospital, Leeds, UK
| | | | - Marilena Loizidou
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alexander Macrobert
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Sam Moorcroft
- School of Physics and Astronomy, University of Leeds, Leeds, UK
| | | | | | - Kevin M Prise
- Centre for Cancer Research & Cell Biology, Queens University Belfast, Belfast, UK
| | - Steve Rannard
- Department of Chemistry and Materials Innovation Factory, University of Liverpool, Liverpool, UK
| | - Thomas Richards
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Schettino
- Medical Radiation Science Group, National Physical Laboratory, Teddington, UK
| | - Ricky A Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | | | | | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Elnaz Yaghini
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Gary Royle
- Department of Medical Physics and Bioengineering, University College London, London, UK
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26
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Beaton L, Coles E, Freeman R. Homeless in Scotland: An Oral Health and Psychosocial Needs Assessment. Dent J (Basel) 2018; 6:dj6040067. [PMID: 30513713 PMCID: PMC6313727 DOI: 10.3390/dj6040067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/05/2022] Open
Abstract
The aim of this research was to conduct an oral health and psychosocial needs assessment of a homeless population in Scotland to determine the levels of unmet need and provide recommendations for oral health improvement. A non-probability convenience sample of homeless people residing in seven Scottish Health Boards was collected. All consenting participants were asked to complete a questionnaire assessing their health and psychosocial needs, dental anxiety, and oral health-related quality of life. The participants’ oral health was examined by a trained and calibrated dentist and dental nurse. Eight hundred and fifty-three homeless people consented to take part. Participants had a mean D3cvMFT score of 16.9 (95% CI: 16.3, 17.6). Dental anxiety was high, with 20% scoring as dentally phobic. Respondents with higher dental anxiety were found to have significantly greater mean numbers of filled teeth than those with lower dental anxiety (t = −2.9, p < 0.05). Common oral health impacts were painful aching and discomfort while eating, experienced occasionally by 31% and 27% of the respondents, respectively. Fifty-eight percent of participants were found to have a depressive illness, and obvious decay experience was significantly higher among this section of participants (t = −4.3, p < 0.05). Homeless people in Scotland were found to be in need of a more accessible dental service than is currently available. An enhanced service should meet the oral health and psychosocial needs of this population to improve their oral health and quality of life.
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Affiliation(s)
- Laura Beaton
- Dental Health Services Research Unit, University of Dundee, Dundee DD1 4HN, Scotland, UK.
| | - Emma Coles
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4NF, Scotland, UK.
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee DD1 4HN, Scotland, UK.
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Beaton L, Coles E, Rodriguez A, Freeman R. Exploring the benefits of Smile4life training: Findings from a pilot study. Community Pract 2016; 89:40-47. [PMID: 29944222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness. Following an oral health and psychosocial needs assessment of 853 homeless people across Scotland, the Smile4life intervention was developed and rolled out across all NHS boards. Dental health and health and social care practitioners were invited to attend a training event at the launch of the Smile4life: Guide for Trainers - a training guide for practitioners working with homeless people. This paper presents results from HoPSCOTCH, a pilot study that took place in four NHS boards to examine the benefits of training for practitioners regarding their awareness of homelessness and the oral health needs of homeless people. Dental health (baseline: 10; follow-up: 8) and health and social care practitioners (baseline: 13; follow-up: 12) completed questionnaires about their knowledge, attitudes and behaviours. The results showed that there were increases in practitioner knowledge, confidence and motivation to help service users access dental care, to provide oral health education and to use motivational interviewing. The authors recommend that future training for practitioners who work with homeless people should include communication skills and advice on how to deliver tailored interventions, with the aim of strengthening practitioners' confidence and motivation to deliver the Smile4life intervention.
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Beaton L, Chan E, Tyldesley S, Gondara L, Speers C, Nichol A. 16: Do Young Women Benefit from Breast Boost Radiotherapy in the Hormone Therapy Era? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beaton L, Ma R, Hsu F, Gondara L, Carolan H, Olson R, Schellenberg D, Germain F, Cheung A, McKenzie M, Nichol A. 122: The Impact of a Central Nervous System Event on Cognitive Function After Radiation Treatment in Patients With One-Ten Brain Metastases. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33521-6] [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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Beaton L, Mazzaferri J, Lalonde F, Hidalgo-Aguirre M, Descovich D, Lesk MR, Costantino S. Non-invasive measurement of choroidal volume change and ocular rigidity through automated segmentation of high-speed OCT imaging. Biomed Opt Express 2015; 6:1694-706. [PMID: 26137373 PMCID: PMC4467714 DOI: 10.1364/boe.6.001694] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 05/26/2023]
Abstract
We have developed a novel optical approach to determine pulsatile ocular volume changes using automated segmentation of the choroid, which, together with Dynamic Contour Tonometry (DCT) measurements of intraocular pressure (IOP), allows estimation of the ocular rigidity (OR) coefficient. Spectral Domain Optical Coherence Tomography (OCT) videos were acquired with Enhanced Depth Imaging (EDI) at 7Hz during ~50 seconds at the fundus. A novel segmentation algorithm based on graph search with an edge-probability weighting scheme was developed to measure choroidal thickness (CT) at each frame. Global ocular volume fluctuations were derived from frame-to-frame CT variations using an approximate eye model. Immediately after imaging, IOP and ocular pulse amplitude (OPA) were measured using DCT. OR was calculated from these peak pressure and volume changes. Our automated segmentation algorithm provides the first non-invasive method for determining ocular volume change due to pulsatile choroidal filling, and the estimation of the OR constant. Future applications of this method offer an important avenue to understanding the biomechanical basis of ocular pathophysiology.
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Affiliation(s)
- L. Beaton
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC,
Canada
| | - J. Mazzaferri
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC,
Canada
| | - F. Lalonde
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC,
Canada
- Département d’ophtalmologie, Université de Montréal, Montréal, QC,
Canada
| | - M. Hidalgo-Aguirre
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC,
Canada
- Institut National de la Recherche Scientifique – Energie, Matériaux et Télécommunications, Varennes, QC,
Canada
| | - D. Descovich
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC,
Canada
| | - M. R. Lesk
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC,
Canada
- Département d’ophtalmologie, Université de Montréal, Montréal, QC,
Canada
| | - S. Costantino
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC,
Canada
- Département d’ophtalmologie, Université de Montréal, Montréal, QC,
Canada
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Wong S, Woolf D, Beaton L, Shoffren O, Powell M. EP-1616: A review of bladder filling protocols for patients receiving radical pelvic radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41608-1] [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: 10/23/2022]
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Abstract
OBJECTIVE The aim of this review was to explore the peer-reviewed literature to answer the question: 'Why are people afraid of the dentist?' METHOD Relevant literature was identified by searching the following on-line databases: PubMed, PsycInfo, the Cochrane Library and Google Scholar. Publications were extracted if they explored the causes and consequences of dental fear, dental anxiety or dental phobia. RESULTS The research evidence suggests that the causes of dental fear, dental anxiety or dental phobia are related to exogenous factors such as direct learning from traumatic experiences, vicarious learning through significant others and the media, and endogenous factors such as inheritance and personality traits. Each individual aetiological factor is supported by the evidence provided. CONCLUSIONS The evidence suggests that the aetiology of dental fear, anxiety or phobia is complex and multifactorial. The findings show that there are clear practical implications indicated by the existing research in this area: a better understanding of dental fear, anxiety and phobia may prevent treatment avoidance.
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Affiliation(s)
- Laura Beaton
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
- *Prof. Ruth Freeman, Dental Health Services Research Unit, 9th Floor, School of Dentistry, University of Dundee, Park Place, Dundee DD1 4HN (UK), E-Mail
| | - Gerry Humphris
- Health Psychology, School of Medicine, University of St Andrews, St Andrews, UK
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Samiee S, Beaton L, Eapen L, E C, Ferrarotto C, Grimes S, Malone K, Wilkins R, Malone S. Dicentric Chromosome Assay: A Potential In Vitro Biomarker for Radiosensitivity. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Saklofske DH, Austin EJ, Mastoras SM, Beaton L, Osborne SE. Relationships of personality, affect, emotional intelligence and coping with student stress and academic success: Different patterns of association for stress and success. Learning and Individual Differences 2012. [DOI: 10.1016/j.lindif.2011.02.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [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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Linterman MA, Pierson W, Lee SK, Kallies A, Kawamoto S, Rayner TF, Srivastava M, Divekar DP, Beaton L, Hogan JJ, Fagarasan S, Liston A, Smith KGC, Vinuesa CG. Foxp3+ follicular regulatory T cells control the germinal center response. Nat Med 2011; 17:975-82. [PMID: 21785433 PMCID: PMC3182542 DOI: 10.1038/nm.2425] [Citation(s) in RCA: 963] [Impact Index Per Article: 74.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 06/27/2011] [Indexed: 12/12/2022]
Abstract
Follicular helper (T(FH)) cells provide crucial signals to germinal center B cells undergoing somatic hypermutation and selection that results in affinity maturation. Tight control of T(FH) numbers maintains self tolerance. We describe a population of Foxp3(+)Blimp-1(+)CD4(+) T cells constituting 10-25% of the CXCR5(high)PD-1(high)CD4(+) T cells found in the germinal center after immunization with protein antigens. These follicular regulatory T (T(FR)) cells share phenotypic characteristics with T(FH) and conventional Foxp3(+) regulatory T (T(reg)) cells yet are distinct from both. Similar to T(FH) cells, T(FR) cell development depends on Bcl-6, SLAM-associated protein (SAP), CD28 and B cells; however, T(FR) cells originate from thymic-derived Foxp3(+) precursors, not naive or T(FH) cells. T(FR) cells are suppressive in vitro and limit T(FH) cell and germinal center B cell numbers in vivo. In the absence of T(FR) cells, an outgrowth of non-antigen-specific B cells in germinal centers leads to fewer antigen-specific cells. Thus, the T(FH) differentiation pathway is co-opted by T(reg) cells to control the germinal center response.
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Affiliation(s)
- Michelle A Linterman
- Cambridge Institute for Medical Research and the Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
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36
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Linterman MA, Beaton L, Yu D, Ramiscal RR, Srivastava M, Hogan JJ, Verma NK, Smyth MJ, Rigby RJ, Vinuesa CG. IL-21 acts directly on B cells to regulate Bcl-6 expression and germinal center responses. ACTA ACUST UNITED AC 2010; 207:353-63. [PMID: 20142429 PMCID: PMC2822609 DOI: 10.1084/jem.20091738] [Citation(s) in RCA: 600] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
During T cell–dependent responses, B cells can either differentiate extrafollicularly into short-lived plasma cells or enter follicles to form germinal centers (GCs). Interactions with T follicular helper (Tfh) cells are required for GC formation and for selection of somatically mutated GC B cells. Interleukin (IL)-21 has been reported to play a role in Tfh cell formation and in B cell growth, survival, and isotype switching. To date, it is unclear whether the effect of IL-21 on GC formation is predominantly a consequence of this cytokine acting directly on the Tfh cells or if IL-21 directly influences GC B cells. We show that IL-21 acts in a B cell–intrinsic fashion to control GC B cell formation. Mixed bone marrow chimeras identified a significant B cell–autonomous effect of IL-21 receptor (R) signaling throughout all stages of the GC response. IL-21 deficiency profoundly impaired affinity maturation and reduced the proportion of IgG1+ GC B cells but did not affect formation of early memory B cells. IL-21R was required on GC B cells for maximal expression of Bcl-6. In contrast to the requirement for IL-21 in the follicular response to sheep red blood cells, a purely extrafollicular antibody response to Salmonella dominated by IgG2a was intact in the absence of IL-21.
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Affiliation(s)
- Michelle A Linterman
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
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Chisholm G, Kennedy AR, Beaton L, Brook E. Structural motifs in acetoacetanilides: the effect of a fluorine substituent. Acta Crystallogr C 2002; 58:o645-8. [PMID: 12415169 DOI: 10.1107/s0108270102016086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2002] [Accepted: 09/05/2002] [Indexed: 11/11/2022] Open
Abstract
The structures of three fluoro-substituted acetoacetanilides, namely 2'-, 3'- and 4'-fluoroacetoacetanilide, all C(10)H(10)FNO(2), are presented and discussed. We observe a planar structure with intramolecular hydrogen bonding when the F atom is in the ortho position of the aromatic ring, and a twisted structure with intermolecular hydrogen bonding when the F atom is in the meta or para positions. It can be predicted which of these two structural motifs will be adopted by considering the position of any aromatic substituents. In this regard, fluorine appears to mimic the steric effect of a larger substituent, which we attribute to its high electronegativity.
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Affiliation(s)
- Greig Chisholm
- Ciba Specialty Chemicals PLC, Hawkhead Road, Paisley PA2 7BG, Scotland.
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McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV, Connolly DT, Robertson DM. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet 1994; 344:235-6. [PMID: 7913160 DOI: 10.1016/s0140-6736(94)93001-5] [Citation(s) in RCA: 272] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We investigated the role of vascular endothelial growth factor (VEGF) in ovarian hyperstimulation syndrome (OHSS). Two similar peaks of permeability activity were seen in OHSS ascites and liver ascites spiked with recombinant human VEGF (rhVEGF); no activity was seen in control liver ascites. Incubation with rhVEGF antiserum decreased activity in the two OHSS peaks by 79% and 65% and the two spiked liver peaks by 49% and 50%. Control serum produced 24% and 27%, and 17% and 0% reductions, respectively. This is evidence that the major capillary permeability agent in OHSS ascites fluid is VEGF.
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Affiliation(s)
- N McClure
- Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, Victoria, Australia
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39
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Abstract
An antiserum to rat neutrophils was raised and used to follow the distribution of endometrial neutrophils during the peri-implantation period. Uteri from four pregnant and four pseudopregnant rats killed at 14:00, 17:00, 20:30 and 23:00 h on day 5 of pregnancy and 09:00 h on day 6 were sectioned. Four sections from each of four implantation sites and four intersites from each rat were immunostained. There was wide variability among rats in the number of endometrial neutrophils, but a nested analysis of variance showed significantly fewer neutrophils at implantation sites than at intersites from 20:30 h onwards. This difference was primarily due to the presence of more neutrophils in intersite regions of the endometrium. The results from this study do not support a role for neutrophils in the implantation-associated increase in microvascular permeability or decidualization in rats.
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Affiliation(s)
- P A Rogers
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
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40
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Abstract
Eleven endometrial biopsies, taken from six Turner's syndrome patients receiving hormone replacement therapy prior to treatment by oocyte donation and embryo transfer, were assessed by freeze fracture followed by electron microscopy for epithelial tight junctions. Nine of the eleven biopsies had no discernible tight junctions; the other two biopsies had reduced and disorganized junctional structures. Two patients subsequently became pregnant following embryo transfer. It is concluded that compromised epithelial integrity does not prevent embryo implantation in the human, an observation that is consistent with a barrier role for the epithelium except at times when appropriately conditioned with oestrogen and progesterone to induce receptivity for implantation.
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Affiliation(s)
- P A Rogers
- Monash University Department of Obstetrics and Gynaecology, Clayton, Victoria, Australia
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Murphy CR, Rogers PA, Hosie MJ, Leeton J, Beaton L. Tight junctions of human uterine epithelial cells change during the menstrual cycle: a morphometric study. Acta Anat (Basel) 1992; 144:36-8. [PMID: 1514357 DOI: 10.1159/000147282] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tight junctions between luminal epithelial cells of the human uterus were studied by freeze-fracture electron microscopy. It was found that junctional complexity decreased during the menstrual cycle, and we explore how this finding may contribute to the role of the uterus in facilitating implantation.
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Affiliation(s)
- C R Murphy
- Department of Histology and Embryology, University of Sydney, N.S.W., Australia
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Murphy CR, Rogers PA, Kovacs G, Hailes J, Hosie M, Beaton L. Early evaluation of postmenopausal hormonal steroid therapy by scanning electron microscopy of the uterine epithelium. Acta Anat (Basel) 1990; 138:364-6. [PMID: 2220294 DOI: 10.1159/000146968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Scanning electron microscopy has been used in a preliminary study to evaluate the value of steroid replacement therapies in restoring uterine epithelium in postmenopausal patients. All therapies resulted in increased epithelium over controls, but one regime was markedly better than others.
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Affiliation(s)
- C R Murphy
- Department of Histology and Embryology, University of Sydney, N.S.W
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Rogers P, Murphy C, Cameron I, Leeton J, Hosie M, Beaton L, Macpherson A. Uterine receptivity in women receiving steroid replacement therapy for premature ovarian failure: ultrastructural and endocrinological parameters. Hum Reprod 1989; 4:349-54. [PMID: 2745666 DOI: 10.1093/oxfordjournals.humrep.a136906] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Endometrial biopsies and plasma oestradiol (E2) and progesterone (P4) levels in 23 patients were evaluated during 26 replacement therapy cycles for premature ovarian failure. Plasma E2 and P4 levels showed wide patient to patient variability, despite each patient being given the same hormone replacement therapy. Biopsies were studied by conventional histological dating and scanning electron microscopy (SEM). Eight morphological features of the surface epithelium that have previously been linked to uterine receptivity for implantation were identified and quantified. No correlation was found between endometrial surface morphology by SEM and circulating E2 and P4 levels. The results of this study do not support the hypothesis that there is an obligatory link between any of the eight morphological features measured in this study and uterine receptivity for implantation. To date, three ongoing pregnancies have been achieved following 18 embryo transfers to a total of 10 of the women in the study group.
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Affiliation(s)
- P Rogers
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
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Rogers PA, Murphy CR, Leeton J, Hosie M, Beaton L, Macpherson A. Ultrastructural study of human uterine epithelium from a patient with a confirmed pregnancy. Acta Anat (Basel) 1989; 135:176-9. [PMID: 2750472 DOI: 10.1159/000146749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Scanning and transmission electron microscopy have been used to study the uterine epithelial cells from a pregnant human uterus approximately 8 days after ovulation. The ultrastructural appearance of the epithelial cells generally conforms with that previously described as showing receptivity, although some significant regional variability exists.
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Affiliation(s)
- P A Rogers
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Murphy CR, Rogers PA, Leeton J, Hosie M, Beaton L, Macpherson A. Surface ultrastructure of uterine epithelial cells in women with premature ovarian failure following steroid hormone replacement. Acta Anat (Basel) 1987; 130:348-50. [PMID: 3434190 DOI: 10.1159/000146469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Scanning electron microscopy has been used to study the apical surface of uterine epithelial cells in women with premature ovarian failure following steroid hormone replacement therapy. A variety of ultrastructural characteristics are identified which could indicate a uterus that is receptive for blastocyst implantation.
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Affiliation(s)
- C R Murphy
- Department of Histology and Embryology, University of Sydney, NSW, Australia
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Beaton L. Collaboration between the surgeon and the psychiatrist. Med Clin North Am 1967; 51:1425-6. [PMID: 6053032 DOI: 10.1016/s0025-7125(16)32969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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