1
|
Taylor B, Cross-Sudworth F, Rimmer M, Quinn L, Morris RK, Johnston T, Morad S, Davidson L, Kenyon S. Induction of labour care in the UK: A cross-sectional survey of maternity units. PLoS One 2024; 19:e0297857. [PMID: 38416750 PMCID: PMC10901341 DOI: 10.1371/journal.pone.0297857] [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: 01/17/2023] [Accepted: 01/10/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice. DESIGN National survey. SETTING Hospital maternity services in all four nations of the UK. SAMPLE Convenience sample of 71 UK maternity units. METHODS An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher's Exact and ANOVA. MAIN OUTCOME MEASURES Induction rates, criteria, processes, delays, incidents, safety concerns. RESULTS 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported 'often/always' in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 'often/always'). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work. CONCLUSIONS There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.
Collapse
Affiliation(s)
- Beck Taylor
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Michael Rimmer
- Medical Research Council Centre for Reproductive Health, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - R. Katie Morris
- Professor of Obstetrics and Maternal Fetal Medicine, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Tracey Johnston
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Sharon Morad
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Louisa Davidson
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Sara Kenyon
- Professor of Evidence Based Maternity Care, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | |
Collapse
|
2
|
Šimková I, Aiglová R, Koubek F, Přeček J, Látal J, Buriánková E, Quinn L, Henzlová L, Táborský M, Švébišová H, Tučková L, Melichar B. Carcinoid syndrome with right-sided valve involvement - a case report and review of the literature. Klin Onkol 2024; 38:139-145. [PMID: 38697823 DOI: 10.48095/ccko2024139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND The survival of patients with neuroendocrine tumors has substantially improved with modern treatment options. Although the associated carcinoid syndrome can be diagnosed early and controlled effectively, cardiologists still encounter patients with cardiac manifestations, particularly among individuals with persistently high levels of vasoactive mediators. Treatment options have been limited to surgical valve replacement in fully manifested disease. Since surgery is not always feasible, transcatheter valve implantation is becoming an interesting alternative. CASE A case of a 50-year-old woman with carcinoid syndrome and right-sided valvular heart disease is presented. Moderate pulmonary valve stenosis and severe tricuspid valve regurgitation were diagnosed during the evaluation and treatment of neuroendocrine tumor. The possibility of rare valve involvement and the need for interdisciplinary cooperation in the diagnosis, monitoring and treatment of patients with neuroendocrine tumors producing vasoactive substances must be emphasized. CONCLUSION The patient had a typically presenting carcinoid syndrome with a rare cardiac manifestation. Although monitoring and treatment were carried out in accordance with recommendations and appropriate to the clinical condition, rapid progression of the metastatic disease ultimately precluded invasive cardiac intervention.
Collapse
|
3
|
Quinn L, Bird P, Remsing S, Reeves K, Lilford R. Unintended consequences of the 18-week referral to treatment standard in NHS England: a threshold analysis. BMJ Qual Saf 2023; 32:712-720. [PMID: 37669876 PMCID: PMC10803960 DOI: 10.1136/bmjqs-2023-015949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/11/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE In 2012, an '18-week referral to treatment standard' was introduced in England. Among people on the list of those waiting for hospital treatment at a point in time, the standard states that at least '92% of patients should have been waiting for less than 18 weeks'. Targets can have unintended consequences, where patients are prioritised based on the target rather than clinical need. Such an effect will be evident as a spike in the number of hospital trusts at the target threshold, referred to as a threshold effect. This study examines for threshold effects across all non-specialist acute NHS England hospital trusts by financial year. METHODS A retrospective observational study of publicly available data examined waiting times for patients on the waiting list. We examined trust performance against the 92% target by financial year, from 2015/16 to 2021/22, using Cattaneo et al's manipulation density test (test for discontinuity/spike in data around target threshold) for all patients and by type of treatment. RESULTS The proportion of NHS hospital trusts meeting the 92% target deteriorated over time. From 2015/16 to 2019/20, there was strong evidence of a threshold effect at the 92% target (p<0.001). There was no evidence of a threshold effect in 2020/21 (p=0.063) or 2021/22 (p=0.090). Threshold effects were present across most types of treatment in 2016/17 and fewer types from 2017/18 onwards. CONCLUSION We observed striking evidence of a threshold effect suggesting that while targets change behaviour, they do so in a selective way, focusing on the threshold rather than a pervasive improvement in practice. However, at the height of the pandemic, as almost no trusts could reach the target, the threshold effect disappeared.
Collapse
Affiliation(s)
- Laura Quinn
- University of Birmingham, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Paul Bird
- Institute for Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- West Midlands Academic Health Science Network, Birmingham, UK
| | - Sandra Remsing
- Health Data Science Team, Research Development & Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Katharine Reeves
- Health Data Science Team, Research Development & Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
4
|
Alidu L, Al-Khudairy L, Bharatan I, Bird P, Campbell N, Currie G, Hemming K, Jolly K, Kudrna L, Lilford R, Martin J, Quinn L, Schmidtke KA, Yates J. Protocol for a cluster randomised waitlist-controlled trial of a goal-based behaviour change intervention for employees in workplaces enrolled in health and wellbeing initiatives. PLoS One 2023; 18:e0282848. [PMID: 37769002 PMCID: PMC10538707 DOI: 10.1371/journal.pone.0282848] [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: 05/09/2022] [Accepted: 02/19/2023] [Indexed: 09/30/2023] Open
Abstract
Many workplaces offer health and wellbeing initiatives to their staff as recommended by international and national health organisations. Despite their potential, the influence of these initiatives on health behaviour appears limited and evaluations of their effectiveness are rare. In this research, we propose evaluating the effectiveness of an established behaviour change intervention in a new workplace context. The intervention, 'mental contrasting plus implementation intentions', supports staff in achieving their health and wellbeing goals by encouraging them to compare the future with the present and to develop a plan for overcoming anticipated obstacles. We conducted a systematic review that identified only three trials of this intervention in workplaces and all of them were conducted within healthcare organisations. Our research will be the first to evaluate the effectiveness of mental contrasting outside a solely healthcare context. We propose including staff from 60 organisations, 30 in the intervention and 30 in a waitlisted control group. The findings will contribute to a better understanding of how to empower and support staff to improve their health and wellbeing. Trial registration: ISRCTN17828539.
Collapse
Affiliation(s)
- Lailah Alidu
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Lena Al-Khudairy
- Warwick Medical School, Health Sciences, University of Warwick, Coventry, England
| | - Ila Bharatan
- Warwick Business School, Entrepreneurship & Innovation Group, University of Warwick, Coventry, England
| | - Paul Bird
- West Midlands Academic Health Science Network, West Midlands, England
| | - Niyah Campbell
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Graeme Currie
- Warwick Business School, Entrepreneurship & Innovation Group, University of Warwick, Coventry, England
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Laura Kudrna
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Laura Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Kelly Ann Schmidtke
- University of Health Science and Pharmacy, St Louis, MO, United States of America
| | - James Yates
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | |
Collapse
|
5
|
Quinn L, Tryposkiadis K, Deeks J, De Vet HCW, Mallett S, Mokkink LB, Takwoingi Y, Taylor-Phillips S, Sitch A. Interobserver variability studies in diagnostic imaging: a methodological systematic review. Br J Radiol 2023:20220972. [PMID: 37399082 PMCID: PMC10392644 DOI: 10.1259/bjr.20220972] [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: 07/05/2023] Open
Abstract
OBJECTIVES To review the methodology of interobserver variability studies; including current practice and quality of conducting and reporting studies. METHODS Interobserver variability studies between January 2019 and January 2020 were included; extracted data comprised of study characteristics, populations, variability measures, key results, and conclusions. Risk of bias was assessed using the COSMIN tool for assessing reliability and measurement error. RESULTS Seventy-nine full-text studies were included covering various imaging tests and clinical areas. The median number of patients was 47 (IQR:23-88), and observers were 4 (IQR:2-7), with sample size justified in 12 (15%) studies. Most studies used static images (n = 75, 95%), where all observers interpreted images for all patients (n = 67, 85%). Intraclass correlation coefficients (ICC) (n = 41, 52%), Kappa (κ) statistics (n = 31, 39%) and percentage agreement (n = 15, 19%) were most commonly used. Interpretation of variability estimates often did not correspond with study conclusions. The COSMIN risk of bias tool gave a very good/adequate rating for 52 studies (66%) including any studies that used variability measures listed in the tool. For studies using static images, some study design standards were not applicable and did not contribute to the overall rating. CONCLUSIONS Interobserver variability studies have diverse study designs and methods, the impact of which requires further evaluation. Sample size for patients and observers was often small without justification. Most studies report ICC and κ values, which did not always coincide with the study conclusion. High ratings were assigned to many studies using the COSMIN risk of bias tool, with certain standards scored 'not applicable' when static images were used. ADVANCES IN KNOWLEDGE The sample size for both patients and observers was often small without justification.For most studies, observers interpreted static images and did not evaluate the process of acquiring the imaging test, meaning it was not possible to assess many COSMIN risk of bias standards for studies with this design.Most studies reported intraclass correlation coefficient and κ statistics; study conclusions often did not correspond with results.
Collapse
Affiliation(s)
- Laura Quinn
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Konstantinos Tryposkiadis
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Jon Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Henrica C W De Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Lidwine B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Sian Taylor-Phillips
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Alice Sitch
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
6
|
Davern M, Gaughan C, O’ Connell F, Moran B, Mylod E, Sheppard AD, Ramjit S, Yun-Tong Kung J, Phelan JJ, Davey MG, Ryan EJ, Butler C, Quinn L, Howard C, Tone E, Phoenix E, Butt WT, Lynam-Lennon N, Maher SG, Ravi N, Donohoe CL, Reynolds JV, Lysaght J, Donlon NE. PD-1 blockade attenuates surgery-mediated immunosuppression and boosts Th1 immunity perioperatively in oesophagogastric junctional adenocarcinoma. Front Immunol 2023; 14:1150754. [PMID: 37359545 PMCID: PMC10288841 DOI: 10.3389/fimmu.2023.1150754] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction This timely study assesses the immunosuppressive effects of surgery on cytotoxic Th1-like immunity and investigates if immune checkpoint blockade (ICB) can boost Th1-like immunity in the perioperative window in upper gastrointestinal cancer (UGI) patients. Methods PBMCs were isolated from 11 UGI patients undergoing tumour resection on post-operative days (POD) 0, 1, 7 and 42 and expanded ex vivo using anti-CD3/28 and IL-2 for 5 days in the absence/presence of nivolumab or ipilimumab. T cells were subsequently immunophenotyped via flow cytometry to determine the frequency of T helper (Th)1-like, Th1/17-like, Th17-like and regulatory T cell (Tregs) subsets and their immune checkpoint expression profile. Lymphocyte secretions were also assessed via multiplex ELISA (IFN-γ, granzyme B, IL-17 and IL-10). The 48h cytotoxic ability of vehicle-, nivolumab- and ipilimumab-expanded PBMCs isolated on POD 0, 1, 7 and 42 against radiosensitive and radioresistant oesophageal adenocarcinoma tumour cells (OE33 P and OE33 R) was also examined using a cell counting kit-8 (CCK-8) assay to determine if surgery affected the killing ability of lymphocytes and whether the use of ICB could enhance cytotoxicity. Results Th1-like immunity was suppressed in expanded PBMCs in the immediate post-operative setting. The frequency of expanded circulating Th1-like cells was significantly decreased post-operatively accompanied by a decrease in IFN-γ production and a concomitant increase in the frequency of expanded regulatory T cells with an increase in circulating levels of IL-10. Interestingly, PD-L1 and CTLA-4 immune checkpoint proteins were also upregulated on expanded Th1-like cells post-operatively. Additionally, the cytotoxic ability of expanded lymphocytes against oesophageal adenocarcinoma tumour cells was abrogated post-surgery. Of note, the addition of nivolumab or ipilimumab attenuated the surgery-mediated suppression of lymphocyte cytotoxicity, demonstrated by a significant increase in tumour cell killing and an increase in the frequency of Th1-like cells and Th1 cytokine production. Conclusion These findings support the hypothesis of a surgery-mediated suppression in Th1-like cytotoxic immunity and highlights a rationale for the use of ICB within the perioperative setting to abrogate tumour-promoting effects of surgery and ameliorate the risk of recurrence.
Collapse
Affiliation(s)
- Maria Davern
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Dublin, Ireland
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Caoimhe Gaughan
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Fiona O’ Connell
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Brendan Moran
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Eimear Mylod
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Andrew D. Sheppard
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Sinead Ramjit
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Jasmine Yun-Tong Kung
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - James J. Phelan
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Matthew G. Davey
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Eanna J. Ryan
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Christine Butler
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Laura Quinn
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Claudine Howard
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Emily Tone
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Eimear Phoenix
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Waqas T. Butt
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Niamh Lynam-Lennon
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Stephen G. Maher
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Narayanasamy Ravi
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Claire L. Donohoe
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - John V. Reynolds
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Joanne Lysaght
- Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Noel E. Donlon
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
7
|
Kudrna L, Bird P, Hemming K, Quinn L, Schmidtke K, Lilford R. Retrospective evaluation of an intervention based on training sessions to increase the use of control charts in hospitals. BMJ Qual Saf 2023; 32:100-108. [PMID: 35750493 PMCID: PMC9887349 DOI: 10.1136/bmjqs-2021-013514] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Statistical process control charts (SPCs) distinguish signal from noise in quality and safety metrics and thus enable resources to be targeted towards the most suitable actions for improving processes and outcomes. Nevertheless, according to a recent study, SPCs are not widely used by hospital boards in England. To address this, an educational training initiative with training sessions lasting less than one and a half days was established to increase uptake of SPCs in board papers. This research evaluated the impact of the training sessions on the inclusion of SPCs in hospital board papers in England. METHODS We used a non-randomised controlled before and after design. Use of SPCs was examined in 40 publicly available board papers across 20 hospitals; 10 intervention hospitals and 10 control hospitals matched using hospital characteristics and time-period. Zero-inflated negative binomial regression models and t-tests compared changes in usage by means of a difference in difference approach. RESULTS Across the 40 board papers in our sample, we found 6287 charts. Control hospitals had 9/1585 (0.6%) SPCs before the intervention period and 23/1900 (1.2%) after the intervention period, whereas intervention hospitals increased from 89/1235 (7%) before to 328/1567 (21%) after the intervention period; a relative risk ratio of 9 (95% CI 3 to 32). The absolute difference in use of SPCs was 17% (95% CI 6% to 27%) in favour of the intervention group. CONCLUSIONS The results suggest that a scalable educational training initiative to improve use of SPCs within organisations can be effective. Future research could aim to overcome the limitations of observational research with an experimental design or seek to better understand mechanisms, decision-making and patient outcomes.
Collapse
Affiliation(s)
- Laura Kudrna
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Bird
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,West Midlands Academic Health Science Network, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
8
|
Asamane EA, Quinn L, Watson SI, Lilford RJ, Hemming K, Sidibe C, Rego RT, Bensassi S, Diarra Y, Diop S, Gautam OP, Islam MS, Jackson L, Jolly K, Kayentao K, Koita O, Manjang B, Tebbs S, Gale N, Griffiths P, Cairncross S, Toure O, Manaseki-Holland S. Protocol for a parallel group, two-arm, superiority cluster randomised trial to evaluate a community-level complementary-food safety and hygiene and nutrition intervention in Mali: the MaaCiwara study (version 1.3; 10 November 2022). Trials 2023; 24:68. [PMID: 36717923 PMCID: PMC9885702 DOI: 10.1186/s13063-022-06984-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Diarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We describe a protocol for a cluster randomised trial to evaluate the effectiveness of a multi-faceted community-based educational intervention that aims to improve food safety and hygiene behaviours and enhance child nutrition. METHODS We describe a mixed-methods, parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures. One hundred twenty clusters comprising small urban and rural communities will be recruited in equal numbers and randomly allocated in a 1:1 ratio to either treatment or control arms. The community intervention will be focussed around an ideal mother concept involving all community members during campaign days with dramatic arts and pledging, and follow-up home visits. Participants will be mother-child dyads (27 per cluster period) with children aged 6 to 36 months. Data collection will comprise a day of observation and interviews with each participating mother-child pair and will take place at baseline and 4 and 15 months post-intervention. The primary analysis will estimate the effectiveness of the intervention on changes to complementary-food safety and preparation behaviours, food and water contamination, and diarrhoea. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. A additional structural equation analysis will be conducted to examine the causal relationships between the different outcomes. Qualitative and health economic analyses including process evaluation will be done. CONCLUSIONS The trial will provide evidence on the effectiveness of community-based behavioural change interventions designed to reduce the burden of diarrhoeal disease in the under-fives and how effectiveness varies across different contexts. TRIAL REGISTRATION ISRCTN14390796. Registration date December 13, 2021.
Collapse
Affiliation(s)
- Evans A. Asamane
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Quinn
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Samuel I. Watson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J. Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cheick Sidibe
- University of Science, Techniques and Technology Bamako, Bamako, Mali
| | - Ryan T. Rego
- grid.214458.e0000000086837370Center for Global Health Equity, University of Michigan, Ann Arbor, USA
| | - Sami Bensassi
- grid.6572.60000 0004 1936 7486Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Youssouf Diarra
- University of Science, Techniques and Technology Bamako, Bamako, Mali
| | - Samba Diop
- University of Science, Techniques and Technology Bamako, Bamako, Mali
| | | | - Mohammad Sirajul Islam
- grid.414142.60000 0004 0600 7174International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Louise Jackson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kassoum Kayentao
- University of Science, Techniques and Technology Bamako, Bamako, Mali
| | - Ousmane Koita
- University of Science, Techniques and Technology Bamako, Bamako, Mali
| | | | - Susan Tebbs
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- grid.6572.60000 0004 1936 7486School of Social Policy, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Paula Griffiths
- grid.6571.50000 0004 1936 8542School of Sport, Exercise and Health Sciences Loughborough University, London, UK ,grid.11951.3d0000 0004 1937 1135Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, University of the Witwatersr, Johannesburg, South Africa
| | - Sandy Cairncross
- grid.8991.90000 0004 0425 469XFaculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ousmane Toure
- University of Science, Techniques and Technology Bamako, Bamako, Mali
| | - Semira Manaseki-Holland
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
9
|
Quinn L, Nguyen B, Menard-Katcher C, Spencer L. IgG4+ cells are increased in the gastrointestinal tissue of pediatric patients with active eosinophilic gastritis and duodenitis and decrease in remission. Dig Liver Dis 2023; 55:53-60. [PMID: 36064648 PMCID: PMC9885790 DOI: 10.1016/j.dld.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recent studies have shown that IgG4 is increased in the esophageal tissue of eosinophilic esophagitis patients, including the presence of IgG4+ plasma cells. AIMS Our aim was to determine whether IgG4 is elevated in the gastric or duodenal tissue of pediatric patients with eosinophilic gastritis or duodenitis (EoG or EoD). METHODS This was a retrospective single center study. Pediatric patients were characterized as having active EoG, EoD, or as controls based on clinical symptoms and histologic features. Immunohistochemistry for IgG4 was performed in gastric and duodenal tissue, and peak IgG4+ cells were compared between groups and after treatment. RESULTS The frequency of IgG4+ cells was significantly higher in patients with EoG and EoD compared to controls in the stomach [EoG 6.5 cells/hpf (3.6-10.9), control 0 cells/hpf (0-0.7), p<0.0001] and duodenum [EoD 7.5 cells/hpf (2.8-37), control 0.5 cells/hpf (0.3-1.3), p<0.001)] respectively, and positively correlated with eosinophil counts (stomach: r 0.74, p<0.0001; duodenum: r 0.57, p<0.0001). The amount of tissue IgG4 was significantly decreased in patients in remission but not in persistently active disease. CONCLUSIONS These data suggest local tissue production of IgG4 may be a universal feature of eosinophilic gastrointestinal disease that tracks with disease activity.
Collapse
Affiliation(s)
- Laura Quinn
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology & Nutrition, Gastrointestinal Eosinophilic Diseases Program, and the Digestive Health Institute; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA.
| | - Brian Nguyen
- Department of Pathology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Calies Menard-Katcher
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology & Nutrition, Gastrointestinal Eosinophilic Diseases Program, and the Digestive Health Institute; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Lisa Spencer
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology & Nutrition, Gastrointestinal Eosinophilic Diseases Program, and the Digestive Health Institute; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
10
|
Quinn L, Veenith T, Bion J, Hemming K, Whitehouse T, Lilford R. Bayesian analysis of a systematic review of early versus late tracheostomy in ICU patients. Br J Anaesth 2022; 129:693-702. [PMID: 36163077 PMCID: PMC9642836 DOI: 10.1016/j.bja.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background A recent systematic review and meta-analysis of RCTs of early vs late tracheostomy in mechanically ventilated patients suggest that early tracheostomy reduces the duration of ICU stay and mechanical ventilation, but does not reduce short-term mortality or ventilator-associated pneumonia (VAP). Meta-analysis of randomised trials is typically performed using a frequentist approach, and although reporting confidence intervals, interpretation is usually based on statistical significance. To provide a robust basis for clinical decision-making, we completed the search used from the previous review and analysed the data using Bayesian methods to estimate posterior probabilities of the effect of early tracheostomy on clinical outcomes. Methods The search was completed for RCTS comparing early vs late tracheostomy in the databases PubMed, EMBASE, and Cochrane library in June 2022. Effect estimates and 95% confidence intervals were calculated for the outcomes short-term mortality, VAP, duration of ICU stay, and mechanical ventilation. A Bayesian meta-analysis was performed with uninformative priors. Risk ratios (RRs) and standardised mean differences (SMDs) with 95% credible intervals were reported alongside posterior probabilities for any benefit (RR<1; SMD<0), a small benefit (number needed to treat, 200; SMD<–0.5), or modest benefit (number needed to treat, 100; SMD<–1). Results Nineteen RCTs with 3508 patients were included. Comparing patients with early vs late tracheostomy, the posterior probabilities for any benefit, small benefit, and modest benefit, respectively, were: 99%, 99%, and 99% for short-term mortality; 94%, 78%, and 51% for VAP; 97%, 43%, and 1% for duration of mechanical ventilation; and 97%, 75%, and 27% and for length of ICU stay. Conclusions Bayesian meta-analysis suggests a high probability that early tracheostomy compared with delayed tracheostomy has at least some benefit across all clinical outcomes considered.
Collapse
Affiliation(s)
- Laura Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
| | - Tonny Veenith
- Department of Critical Care and Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Julian Bion
- Intensive Care Medicine, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tony Whitehouse
- Department of Critical Care and Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
11
|
Vitale S, Rampazzo E, Hiebner D, Devlin H, Quinn L, Prodi L, Casey E. Interaction between Engineered Pluronic Silica Nanoparticles and Bacterial Biofilms: Elucidating the Role of Nanoparticle Surface Chemistry and EPS Matrix. ACS Appl Mater Interfaces 2022; 14:34502-34512. [PMID: 35830504 DOI: 10.1021/acsami.2c10347] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nanoparticles (NPs) are considered a promising tool in the context of biofilm control. Many studies have shown that different types of NPs can interfere with the bacterial metabolism and cellular membranes, thus making them potential antibacterial agents; however, fundamental understanding is still lacking on the exact mechanisms involved in these actions. The development of NP-based approaches for effective biofilm control also requires a thorough understanding of how the chosen nanoparticles will interact with the biofilm itself, and in particular with the biofilm self-produced extracellular polymeric matrix (EPS). This work aims to provide advances in the understanding of the interaction between engineered fluorescent pluronic silica (PluS) nanoparticles and bacterial biofilms, with a main focus on the role of the EPS matrix in the accumulation and diffusion of the particles in the biofilm. It is demonstrated that particle surface chemistry has a key role in the different lateral distribution and specific affinity to the biofilm matrix components. The results presented in this study contribute to our understanding of biofilm-NP interactions and promote the principle of the rational design of smart nanoparticles as an important tool for antibiofilm technology.
Collapse
Affiliation(s)
- Stefania Vitale
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin 4, Ireland
| | - Enrico Rampazzo
- Dipartimento di Chimica "Giacomo Ciamician", Università degli Studi di Bologna, Via Selmi 2, Bologna 40126, Italy
| | - Dishon Hiebner
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin 4, Ireland
| | - Henry Devlin
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin 4, Ireland
| | - Laura Quinn
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin 4, Ireland
| | - Luca Prodi
- Dipartimento di Chimica "Giacomo Ciamician", Università degli Studi di Bologna, Via Selmi 2, Bologna 40126, Italy
| | - Eoin Casey
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
12
|
Quinn L, Ahmed T, Falk H, Miranda Altamirano A, Muganza A, Nakarmi K, Nawar A, Peck M, Man Rai S, Sartori J, Philipe Molina Vana L, Wabwire B, Moiemen N, Lilford R. Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey. J Burn Care Res 2022; 44:320-328. [PMID: 35802351 PMCID: PMC9981866 DOI: 10.1093/jbcr/irac096] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/12/2022]
Abstract
Burn injuries have decreased markedly in high-income countries while the incidence of burns remains high in Low- and Middle-Income Countries (LMICs) where more than 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional survey was completed for 2014 and 2019 in eight burn centers across Africa, Asia, and Latin America: Cairo, Nairobi, Ibadan, Johannesburg, Dhaka, Kathmandu, Sao Paulo, and Guadalajara. The information summarised included demographics of burn patients, location, cause, and outcomes of burns. In total, 15,344 patients were admitted across all centers, 37% of burns were women and 36% of burns were children. Burns occurred mostly in household settings (43-79%). In Dhaka and Kathmandu, occupational burns were also common (32 and 43%, respectively). Hot liquid and flame burns were most common while electric burns were also common in Dhaka and Sao Paulo. The type of flame burns varies by center and year, in Dhaka, 77% resulted from solid fuel in 2014 while 74% of burns resulted from Liquefied Petroleum Gas in 2019. In Nairobi, a large proportion (32%) of burns were intentional self-harm or assault. The average length of stay in hospitals decreased from 2014 to 2019. The percentage of deaths ranged from 5% to 24%. Our data provide important information on the causes of severe burns which can provide guidance in how to approach the development of burn injury prevention programs in LMIC.
Collapse
Affiliation(s)
- Laura Quinn
- Address correspondence to Laura Quinn, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B152TT, UK.
| | - Tanveer Ahmed
- Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Henry Falk
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Adelin Muganza
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Kiran Nakarmi
- Department of Burns, Plastic and Reconstructive Surgery, phect-NEPAL, Kirtipur Hospital, Kathmandu, Nepal
| | - Ahmed Nawar
- Plastic Surgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Michael Peck
- University of Arizona College of Medicine, Phoenix, USA
| | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, phect-NEPAL, Kirtipur Hospital, Kathmandu, Nepal,National Academy of Medical Science, Kathmandu, Nepal
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Luiz Philipe Molina Vana
- Department of Plastic Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK,University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| |
Collapse
|
13
|
McDevitt WM, Quinn L, Wimalachandra W, Carver E, Stendall C, Solanki GA, Lawley A. Amplitude-reduction alert criteria and intervention during complex paediatric cervical spine surgery. Clin Neurophysiol Pract 2022; 7:239-244. [PMID: 36043151 PMCID: PMC9420322 DOI: 10.1016/j.cnp.2022.07.003] [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] [Received: 03/24/2022] [Revised: 07/05/2022] [Accepted: 07/24/2022] [Indexed: 11/25/2022] Open
Abstract
Alert criteria breaches occur frequently and are reversed following intervention during complex paediatric cervical spine surgery. All patients with worsening sensorimotor function had irreversible alert criteria breaches. Evoked potential amplitude reduction may provide an early warning to worsening sensorimotor function.
Objective To determine the utility of widely used intraoperative neuromonitoring (IONM) alert criteria and intervention for predicting postoperative outcome following paediatric spinal surgery. Methods Retrospective analysis of somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) in consecutive cervical spine fixations. An intervention protocol followed amplitude-reductions in SSEPs (≥50 %) and/or MEPs (≥80 %). Alert breaches were reversed when SSEP/MEP amplitude was restored to > 50 %/20 % of baseline. Sensorimotor function was assessed preoperatively and 3-months postoperatively via the Modified McCormick Scale score (MMS). We explored associations between postoperative outcome, demographic/surgical and IONM variables. Results Forty-five procedures in 38 children (mean age:9 ± 4 years;55 % female) were monitored, 42 %of which breached alert criteria. Instrumentation (6/19,32 %) and hypotension (5/19,26 %) were common causes for alert and the majority (13/19,68 %) were reversed following intervention. There was an association between pre- and post-MMS and the type of breach (p = 0.002). All children with worse postoperative MMS (3/38,8%) had irreversible breaches. Conclusions IONM in this small sample accurately detected neurological injury. The majority of breaches reversed following an intervention protocol. Irreversible breaches frequently led to worse postoperative sensorimotor function. Significance An intervention protocol which reversed IONM alerts never resulted in postoperative worsening of sensorimotor function.
Collapse
Affiliation(s)
- William M. McDevitt
- Department of Neurophysiology, Birmingham Children’s Hospital, Birmingham, United Kingdom
- Corresponding author at: Department of Neurophysiology, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, West Midlands, B4 6NH, United Kingdom.
| | - Laura Quinn
- Institute of Applied Health Research, University of Birmingham, United Kingdom
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, United Kingdom
| | - W.S.B. Wimalachandra
- Department of Neurosurgery, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Edmund Carver
- Department of Anaesthesiology, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Catalina Stendall
- Department of Anaesthesiology, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Guirish A. Solanki
- Department of Neurosurgery, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Andrew Lawley
- Department of Neurophysiology, Birmingham Children’s Hospital, Birmingham, United Kingdom
| |
Collapse
|
14
|
Bhatnagar G, Mallett S, Quinn L, Beable R, Bungay H, Betts M, Greenhalgh R, Gupta A, Higginson A, Hyland R, Ilangovan R, Lambie H, Mainta E, Patel U, Pilcher J, Plumb A, Porté F, Sidhu H, Slater A, Tolan D, Zealley I, Halligan S, Taylor S. Interobserver variation in the interpretation of magnetic resonance enterography in Crohn's disease. Br J Radiol 2022; 95:20210995. [PMID: 35195444 DOI: 10.1259/bjr.20210995] [Citation(s) in RCA: 3] [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: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate interobserver variability for diagnosis of disease presence and extent of small bowel and colonic Crohn's disease using MR enterography (MRE). METHODS Data from the first 73 consecutive patients (mean age 32, 33F, 28 new diagnosis, 45 suspected relapse) recruited to a multicentre, prospective diagnostic accuracy trial evaluating MRE for small bowel Crohn's disease were each read independently by three (from a pool of 20) radiologists. Radiologists documented presence and segmental location of small bowel Crohn's disease and recorded morphological mural/extramural parameters for involved segments. Per patient percentage agreement for disease presence and extent were calculated against an outcome-based construct reference standard (averaged between pairs of readers). Prevalence-adjusted bias-adjusted κ (PABAK) was calculated. RESULTS Agreement for small bowel disease presence for new diagnosis/relapsed patients was 68%(κ = 0.36)/ 78% (κ = 0.56) and 43%(κ = 0.14)/ 53% for disease extent (κ = 0.07), respectively. For disease presence, all three radiologists agreed correctly with the reference standard in 41/59 (69%) of patients with small bowel involvement, and in 8/14 (57%) cases of without small bowel disease. Agreement was highest for multisegment disease, greater than 5 cm in length, with mural thickness>6 mm, and increased mural T2 signal. Agreement for colonic disease presence was 61% (κ = 0.21 fair agreement) for new diagnosis/ 60% (κ = 0.20, slight agreement) for relapsed patients. CONCLUSION There is a reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed Crohn's disease, and patients with suspected relapse, respectively. Agreement is lower for disease extent. ADVANCES IN KNOWLEDGE There is reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed (68%) Crohn's disease, and patients with suspected relapse (78%). Agreement is lower for disease extent (43% new diagnosis and 53% suspected relapse).
Collapse
Affiliation(s)
- Gauraang Bhatnagar
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard Beable
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Helen Bungay
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Margaret Betts
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Rebecca Greenhalgh
- Department of Radiology, St George's University Hospitals NHS Trust, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Anthony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel Hyland
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Hannah Lambie
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Evgenia Mainta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Uday Patel
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - James Pilcher
- Department of Radiology, St George's University Hospitals NHS Trust, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - François Porté
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Harbir Sidhu
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Stuart Taylor
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| |
Collapse
|
15
|
Osuh ME, Oke GA, Lilford RJ, Owoaje E, Harris B, Taiwo OJ, Yeboah G, Abiona T, Watson SI, Hemming K, Quinn L, Chen YF. Prevalence and determinants of oral health conditions and treatment needs among slum and non-slum urban residents: Evidence from Nigeria. PLOS Glob Public Health 2022; 2:e0000297. [PMID: 36962169 PMCID: PMC10021815 DOI: 10.1371/journal.pgph.0000297] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/06/2022] [Indexed: 11/19/2022]
Abstract
Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32-50) versus 38 (IQR:29-50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the "prompt and urgent" levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.
Collapse
Affiliation(s)
- Mary E Osuh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Faculty of Dentistry, Department of Periodontology and Community Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Gbemisola A Oke
- Faculty of Dentistry, Department of Periodontology and Community Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Richard J Lilford
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Eme Owoaje
- Institute of Applied Health Research, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, United Kingdom
| | - Bronwyn Harris
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Olalekan John Taiwo
- Faculty of Social Sciences, Department of Geography, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Godwin Yeboah
- Warwick Information and Digital Group, University of Warwick, Coventry, United Kingdom
| | - Taiwo Abiona
- Institute of Applied Health Research, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, United Kingdom
| | - Samuel I Watson
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Karla Hemming
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Laura Quinn
- Faculty of Public Health, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
16
|
Keane A, Regan SO, Quinn L, Murphy D, Kelly BO, Lynam A, Lyons F, Devitt E. Evaluation of the impact of human immunodeficiency virus pre-exposure prophylaxis on new human immunodeficiency virus diagnoses during the COVID-19 pandemic. Int J STD AIDS 2021; 33:99-102. [PMID: 34852685 DOI: 10.1177/09564624211054587] [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] [Indexed: 11/16/2022]
Abstract
AIMS The national PrEP programme launched in Ireland in November 2019 with tenofovir/emtricitabine free to those meeting eligibility criteria. We assessed the impact of the first year of the PrEP programme on new HIV diagnoses in the largest sexual health and HIV service in Ireland. METHODS A free PrEP service was established in November 2019. We reviewed the number of new diagnoses of HIV between November 2018-2019, before the introduction of the national PrEP programme and compared this with the number of new HIV diagnosis between November 2019-2020. RESULTS There were 95 new HIV diagnoses (63.3% MSM) between November 2018 and 2019 and 73 new HIV diagnoses (65.7% MSM) between November 2019 and 2020. There was a statistically significant decline in new HIV diagnoses between the 2 years (P = 0.0003). 546 patients were prescribed PrEP as of December 2020.106 patients (19.4%) changed their PrEP dosing regimen due to lockdown. 178 individuals (32.6%) had a rectal infection diagnosed. CONCLUSION There has been a reduction in new HIV diagnoses in our cohort (although this has occurred during a global pandemic). It is too early to say if PrEP reduces late presentations of HIV based on our findings. A significant number of rectal infections were identified in the PrEP clinic suggesting ongoing risk despite pandemic restrictions. Further research into sexual practices during COVID-19 is needed to assess if this had an impact on the lower rates of HIV acquisition.
Collapse
Affiliation(s)
- A Keane
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - S O Regan
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - L Quinn
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - D Murphy
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - B O Kelly
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - A Lynam
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - F Lyons
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| | - E Devitt
- Department of Genitourinary Medicine and Infectious Diseases, 58024GUIDE Clinic, St James Hospital, Dublin, Ireland
| |
Collapse
|
17
|
Karhan P, Ptáček J, Quinn L. Decision and detection thresholds for quantitative evaluation of the labeled leukocytes scan. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
18
|
Parker S, Mallet S, Quinn L, Wood C, Boulton R, Jamshaid S, Erotocritou M, Gowda S, Collier W, Plumb A, Windsor A, Archer L, Halligan S. O29 IDENTIFYING PREDICTORS OF VENTRAL HERNIA RECURRENCE: SYSTEMATIC REVIEW AND META-ANALYSIS. Br J Surg 2021. [DOI: 10.1093/bjs/znab396.028] [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]
Abstract
Abstract
Aim
Ventral hernias are increasing in prevalence and many recur despite attempted repair. To date, much of the literature is underpowered and divergent. As a result there is limited high quality evidence to inform surgeons succinctly which perioperative variables influence postoperative recurrence. This systematic review aimed to identify predictors of ventral hernia recurrence.
Material and Methods
PubMed was searched for studies reporting prognostic data of ventral hernia recurrence between 1 January 1995 and 1 January 2018. Extracted data described hernia type (primary/incisional), definitions of recurrence, methods used to detect recurrence, duration of follow-up, and co-morbidity. Data were extracted for all potential predictors, estimates and thresholds described. Random-effects meta-analysis was used. Bias was assessed with a modified PROBAST (Prediction model Risk Of Bias ASsessment Tool).
Results
Screening of 18 214 abstracts yielded 274 individual studies for inclusion. Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade III–IV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
Conclusions
This study summarized the current evidence base for predicting ventral hernia recurrence. Results should inform best practice and future research.
Collapse
Affiliation(s)
- Samuel Parker
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - Sue Mallet
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christopher Wood
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - Richard Boulton
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - Shiraz Jamshaid
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - Marios Erotocritou
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - Siri Gowda
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - William Collier
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | | | - Alastair Windsor
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - Lucinda Archer
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | | |
Collapse
|
19
|
Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 161 THE ROLE OF THE GERIATRIC DAY HOSPITAL DURING THE COVID 19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8690085 DOI: 10.1093/ageing/afab219.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
Collapse
Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Age Related Health Department, Tallaght University Hospital, Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
20
|
Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.163] [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: 02/25/2023] Open
Abstract
Abstract
Background
The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians.
Methods
Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH.
Results
One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p < 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p < 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p < 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p < 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468).
Conclusion
Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.
Collapse
Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Age Related Health Care Department, Tallaght University Hospital , Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| |
Collapse
|
21
|
Bouwman H, Pieters R, Polder A, Quinn L. Ten Bird Species, Six Guilds, Three Habitats, and 59 Chlorinated and Brominated POPs: What do 64 Eggs from the Largest Economic Hub of Southern Africa tell us? Arch Environ Contam Toxicol 2021; 81:347-366. [PMID: 34480207 DOI: 10.1007/s00244-021-00882-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/21/2021] [Indexed: 06/13/2023]
Abstract
There is little information on how POPs in eggs of different terrestrial, wetland, and aquatic birds share a large urban and rural landscape relate. We collected and analysed 64 eggs belonging to ten species of six feeding guilds, and compared organic chlorinated pesticide (OCP), polychlorinated biphenyl (PCB), and brominated flame retardants (BFR) residue concentrations and compositions. The eggs were collected in the Gauteng and the northern part of the Free Sate provinces of South Africa, one of the largest economic hubs in Africa. White-breasted Cormorant and African Darter eggs (at the highest trophic level as large aquatic predators) had the highest ΣOCP and ΣPCB concentrations, and Cape Sparrow and Southern Masked Weaver (granivores) eggs had the lowest concentrations, corresponding to the lowest trophic level in our collection. The highest percentage p,p'-DDT were in eggs of the terrestrial insectivore Crowned Lapwing (24%) and the scavenging African Sacred Ibis (17%), and the lowest in African Darter (1.0%) and White-breasted Cormorant (0.9%) eggs, suggesting that recency of DDT releases in a region cannot be gauged by this metric. African Sacred Ibis and Southern Masked Weaver eggs had the highest ΣBFR concentrations, with Crowned Lapwing, Cattle Egret, and White-breasted Cormorant eggs the least. Based on feeding guilds, the mean ΣPOP concentrations increased from granivore, aquatic omnivore, scavenger, terrestrial insectivore, small aquatic predator, to large aquatic predator. Mean ΣPOP concentrations in eggs increased from terrestrial, to wetland, to aquatic habitat birds. Interesting patterns were observed with multivariate analyses. There were no significant regressions between egg size and any summed POP classes. ΣBFR concentrations were not correlated with ΣOCPs or ΣPCBs. Eggshell thinning of African Darter eggs was associated with p,p'-DDE and ΣPCB suggesting risk. Other metrics also suggest risk. Therefore, different species of terrestrial and aquatic birds from the same area acquire and deposit POPs in different proportions and quantities in their eggs. Trophic levels and habitat explain the overall patterns, but detailed differences were found, some of which we are unable to explain. Based on POPs residues in terrestrial, wetland, and aquatic bird eggs, different POPs classes behave differently in a shared large inland industrial area, complicating deductions about POPs and associated risks based on one or few species.
Collapse
Affiliation(s)
- Hindrik Bouwman
- Research Unit, Environmental Sciences and Management, North-West University, Potchefstroom, 2520, South Africa.
| | - R Pieters
- Research Unit, Environmental Sciences and Management, North-West University, Potchefstroom, 2520, South Africa
| | - A Polder
- Research Unit, Environmental Sciences and Management, North-West University, Potchefstroom, 2520, South Africa
- Department of Paraclinical Sciences, Norwegian University of Life Sciences, Ås, Norway
| | - L Quinn
- National Metrology Institute of South Africa, Pretoria, South Africa
| |
Collapse
|
22
|
Schmidtke KA, Kudrna L, Quinn L, Vlaev I, Hemmings K, Lilford R. An online randomized controlled trial and survey of behavioural factors influencing patients' willingness to attend a video consultation. Br J Health Psychol 2021; 27:283-299. [PMID: 34184369 DOI: 10.1111/bjhp.12545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine whether the phrasing of a hospital appointment invitation influences patient preference to attend in person or by video. The study also explores patient capabilities, opportunities, and motivations to attend video consultations. DESIGN A randomized controlled trial followed by a cross-sectional survey. METHODS Participants (1,481 total, 780 females) were residents of the United Kingdom who self-identified as being diagnosed with a chronic disease. Participants considered one of three hypothetical invitations. In one group, participants were invited to attend in person. Those in another group were invited to attend by video. These participants could either accept the invitation or request the other option. In the final 'active choice' group, participants were asked to choose to attend either in-person or by video appointment. Then, all participants responded to open- and closed-ended items about attending video consultations. RESULTS When the default option was in person, 25% of participants chose video consultation, compared with 41% in the active choice group (RR = 1.65, 95% CI: 1.37-1.99, p < .001) and 65% in the default video group (RR = 2.60, 95% CI: 2.20-2.96, p < .001). Closed-ended responses suggested that younger patients and those with previous experience were more likely to prefer video consultations. Most open-ended responses contained themes about opportunities, followed by motivations and then capabilities. CONCLUSIONS Patients are more likely to express a preference to attend by video when video is the default option. The real-world effectiveness of this intervention is more likely to be realized where hospitals also support patient capabilities, opportunities, and motivations.
Collapse
|
23
|
Parker SG, Mallett S, Quinn L, Wood CPJ, Boulton RW, Jamshaid S, Erotocritou M, Gowda S, Collier W, Plumb AAO, Windsor ACJ, Archer L, Halligan S. Corrigendum to: Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis. BJS Open 2021; 5:6299993. [PMID: 34131707 PMCID: PMC8205854 DOI: 10.1093/bjsopen/zrab047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
24
|
Barros CHN, Hiebner DW, Fulaz S, Vitale S, Quinn L, Casey E. Synthesis and self-assembly of curcumin-modified amphiphilic polymeric micelles with antibacterial activity. J Nanobiotechnology 2021; 19:104. [PMID: 33849570 PMCID: PMC8045376 DOI: 10.1186/s12951-021-00851-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The ubiquitous nature of bacterial biofilms combined with the enhanced resistance towards antimicrobials has led to the development of an increasing number of strategies for biofilm eradication. Such strategies must take into account the existence of extracellular polymeric substances, which obstruct the diffusion of antibiofilm agents and assists in the maintenance of a well-defended microbial community. Within this context, nanoparticles have been studied for their drug delivery efficacy and easily customised surface. Nevertheless, there usually is a requirement for nanocarriers to be used in association with an antimicrobial agent; the intrinsically antimicrobial nanoparticles are most often made of metals or metal oxides, which is not ideal from ecological and biomedical perspectives. Based on this, the use of polymeric micelles as nanocarriers is appealing as they can be easily prepared using biodegradable organic materials. RESULTS In the present work, micelles comprised of poly(lactic-co-glycolic acid) and dextran are prepared and then functionalised with curcumin. The effect of the functionalisation in the micelle's physical properties was elucidated, and the antibacterial and antibiofilm activities were assessed for the prepared polymeric nanoparticles against Pseudomonas spp. cells and biofilms. It was found that the nanoparticles have good penetration into the biofilms, which resulted in enhanced antibacterial activity of the conjugated micelles when compared to free curcumin. Furthermore, the curcumin-functionalised micelles were efficient at disrupting mature biofilms and demonstrated antibacterial activity towards biofilm-embedded cells. CONCLUSION Curcumin-functionalised poly(lactic-co-glycolic acid)-dextran micelles are novel nanostructures with an intrinsic antibacterial activity tested against two Pseudomonas spp. strains that have the potential to be further exploited to deliver a secondary bioactive molecule within its core.
Collapse
Affiliation(s)
- Caio H N Barros
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
- National Institute for Bioprocessing Research and Training (NIBRT), Dublin, Ireland
| | - Dishon W Hiebner
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephanie Fulaz
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Stefania Vitale
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
- Université de Strasbourg, CNRS, ISIS, 8 allée Gaspard Monge, 67000, Strasbourg, France
| | - Laura Quinn
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Eoin Casey
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland.
| |
Collapse
|
25
|
Parker SG, Mallett S, Quinn L, Wood CPJ, Boulton RW, Jamshaid S, Erotocritou M, Gowda S, Collier W, Plumb AAO, Windsor ACJ, Archer L, Halligan S. Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis. BJS Open 2021; 5:6220253. [PMID: 33839749 PMCID: PMC8038271 DOI: 10.1093/bjsopen/zraa071] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/08/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Ventra hernias are increasing in prevalence and many recur despite attempted repair. To date, much of the literature is underpowered and divergent. As a result there is limited high quality evidence to inform surgeons succinctly which perioperative variables influence postoperative recurrence. This systematic review aimed to identify predictors of ventral hernia recurrence. METHODS PubMed was searched for studies reporting prognostic data of ventral hernia recurrence between 1 January 1995 and 1 January 2018. Extracted data described hernia type (primary/incisional), definitions of recurrence, methods used to detect recurrence, duration of follow-up, and co-morbidity. Data were extracted for all potential predictors, estimates and thresholds described. Random-effects meta-analysis was used. Bias was assessed with a modified PROBAST (Prediction model Risk Of Bias ASsessment Tool). RESULTS Screening of 18 214 abstracts yielded 274 individual studies for inclusion. Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade III-IV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence. CONCLUSION This study summarized the current evidence base for predicting ventral hernia recurrence. Results should inform best practice and future research.
Collapse
Affiliation(s)
- S G Parker
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - S Mallett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - L Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,University College London Medical School, London, UK
| | - C P J Wood
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - R W Boulton
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - S Jamshaid
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - M Erotocritou
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - S Gowda
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - W Collier
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - A A O Plumb
- Centre of Medical Imaging, University College Hospital, London, UK
| | - A C J Windsor
- Abdominal Wall Unit, Department of Surgery, University College Hospital, London, UK
| | - L Archer
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - S Halligan
- Centre of Medical Imaging, University College Hospital, London, UK
| |
Collapse
|
26
|
McDevitt WM, Quinn L, Bill PR, Morris KP, Scholefield BR, Seri S. Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest. Clin Neurophysiol 2021; 132:765-769. [PMID: 33571884 DOI: 10.1016/j.clinph.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/15/2020] [Accepted: 12/06/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To measure inter- and intra-rater agreement in the interpretation of cortical somatosensory evoked potential (SSEP) components following paediatric cardiac arrest (CA) in multi-professional neurophysiology teams. METHODS Thirteen professionals blinded to patient outcome interpreted 96 SSEPs in paediatric patients 24-/48-/72-hours following CA. Of these, 34 were duplicates used to assess intra-rater agreement. Consistent interpretations (absent/present/indeterminate) between scientists (who record/identify SSEP components) and neurophysiologists (who provide prognostic SSEP interpretation) were expressed as percentages. Rates of agreement were calculated using Fleiss' kappa coefficient (K). RESULTS Unanimous agreement between professionals was present in 40% (95%CI: 28-54%) of the interpreted SSEPs, with a K value of 0.62 (95%CI: 0.55-0.70) based on average agreement. Agreement was similar between neurophysiologists (K = 0.67; 95%CI: 0.57-0.77) and scientists (K = 0.62; 95%CI: 0.54-0.70) but lower in patients < 2 years old (K = 0.23; 95%CI: 0.14-0.33) and in those with poor outcome (K = 0.21; 95%CI: 0.07-0.35). No SSEP was unanimously interpreted as absent and 92% (95%CI: 89-95%) of duplicate SSEPs were interpreted consistently. CONCLUSION Despite substantial agreement when interpreting prognostic SSEPs, this was significantly lower in children with poor outcome and of younger age. SIGNIFICANCE Clinicians using SSEPs in the intensive care unit should be aware of the inter-rater variability when interpreting SSEPs as absent.
Collapse
Affiliation(s)
- William M McDevitt
- Department of Neurophysiology, Birmingham Women's and Children's NHS Foundation Trust, UK.
| | - Laura Quinn
- Institute of Applied Health Research, University of Birmingham, UK; Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
| | - Peter R Bill
- Department of Neurophysiology, Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Kevin P Morris
- Institute of Applied Health Research, University of Birmingham, UK; Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Barnaby R Scholefield
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, UK; Birmingham Acute Care Research Group, University of Birmingham, UK
| | - Stefano Seri
- Department of Neurophysiology, Birmingham Women's and Children's NHS Foundation Trust, UK; Aston Brain Centre, College of Health and Life Sciences, Aston University, UK
| |
Collapse
|
27
|
Koriath C, Kenny J, Adamson G, Druyeh R, Taylor W, Beck J, Quinn L, Mok TH, Dimitriadis A, Norsworthy P, Bass N, Carter J, Walker Z, Kipps C, Coulthard E, Polke JM, Bernal-Quiros M, Denning N, Thomas R, Raybould R, Williams J, Mummery CJ, Wild EJ, Houlden H, Tabrizi SJ, Rossor MN, Hummerich H, Warren JD, Rowe JB, Rohrer JD, Schott JM, Fox NC, Collinge J, Mead S. Predictors for a dementia gene mutation based on gene-panel next-generation sequencing of a large dementia referral series. Mol Psychiatry 2020; 25:3399-3412. [PMID: 30279455 PMCID: PMC6330090 DOI: 10.1038/s41380-018-0224-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 11/09/2022]
Abstract
Next-generation genetic sequencing (NGS) technologies facilitate the screening of multiple genes linked to neurodegenerative dementia, but there are few reports about their use in clinical practice. Which patients would most profit from testing, and information on the likelihood of discovery of a causal variant in a clinical syndrome, are conspicuously absent from the literature, mostly for a lack of large-scale studies. We applied a validated NGS dementia panel to 3241 patients with dementia and healthy aged controls; 13,152 variants were classified by likelihood of pathogenicity. We identified 354 deleterious variants (DV, 12.6% of patients); 39 were novel DVs. Age at clinical onset, clinical syndrome and family history each strongly predict the likelihood of finding a DV, but healthcare setting and gender did not. DVs were frequently found in genes not usually associated with the clinical syndrome. Patients recruited from primary referral centres were compared with those seen at higher-level research centres and a national clinical neurogenetic laboratory; rates of discovery were comparable, making selection bias unlikely and the results generalisable to clinical practice. We estimated penetrance of DVs using large-scale online genomic population databases and found 71 with evidence of reduced penetrance. Two DVs in the same patient were found more frequently than expected. These data should provide a basis for more informed counselling and clinical decision making.
Collapse
Affiliation(s)
- C Koriath
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J Kenny
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - G Adamson
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - R Druyeh
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - W Taylor
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J Beck
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - L Quinn
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - T H Mok
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - A Dimitriadis
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - P Norsworthy
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - N Bass
- UCL Division of Psychiatry, Maple House, University College London, London, UK
| | - J Carter
- UCL Division of Psychiatry, Maple House, University College London, London, UK
| | - Z Walker
- UCL Division of Psychiatry, Maple House, University College London, London, UK
- Essex Partnership University NHS Foundation Trust, Essex, SS11 7XX, UK
| | - C Kipps
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Coulthard
- Institute of Clinical Neuroscience, University of Bristol, Level 1 Learning and Research Building, Bristol, BS10 5NB, UK
| | - J M Polke
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - M Bernal-Quiros
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - N Denning
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - R Thomas
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - R Raybould
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - J Williams
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - C J Mummery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - E J Wild
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - H Houlden
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - S J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - M N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - H Hummerich
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - J D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - N C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J Collinge
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - S Mead
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK.
| |
Collapse
|
28
|
Hiebner DW, Barros C, Quinn L, Vitale S, Casey E. Surface functionalization-dependent localization and affinity of SiO 2 nanoparticles within the biofilm EPS matrix. Biofilm 2020; 2:100029. [PMID: 33447814 PMCID: PMC7798476 DOI: 10.1016/j.bioflm.2020.100029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022] Open
Abstract
The contribution of the biofilm extracellular polymeric substance (EPS) matrix to reduced antimicrobial susceptibility in biofilms is widely recognised. As such, the direct targeting of the EPS matrix is a promising biofilm control strategy that allows for the disruption of the matrix, thereby allowing a subsequent increase in susceptibility to antimicrobial agents. To this end, surface-functionalized nanoparticles (NPs) have received considerable attention. However, the fundamental understanding of the interactions occurring between engineered NPs and the biofilm EPS matrix has not yet been fully elucidated. An insight into the underlying mechanisms involved when a NP interacts with the EPS matrix will aid in the design of more efficient NPs for biofilm control. Here we demonstrate the use of highly specific fluorescent probes in confocal laser scanning microscopy (CLSM) to illustrate the distribution of EPS macromolecules within the biofilm. Thereafter, a three-dimensional (3D) colocalization analysis was used to assess the affinity of differently functionalized silica NPs (SiNPs) and EPS macromolecules from Pseudomonas fluorescens biofilms. Results show that both the charge and surface functional groups of SiNPs dramatically affected the extent to which SiNPs interacted and localized with EPS macromolecules, including proteins, polysaccharides and DNA. Hypotheses are also presented about the possible physicochemical interactions which may be dominant in EPS matrix-NP interactions. This research not only develops an innovative CLSM-based methodology for elucidating biofilm-nanoparticle interactions but also provides a platform on which to build more efficient NP systems for biofilm control.
Collapse
Affiliation(s)
- Dishon Wayne Hiebner
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| | - Caio Barros
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| | - Laura Quinn
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| | - Stefania Vitale
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| | - Eoin Casey
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| |
Collapse
|
29
|
Abstract
In the midst of the COVID-19 pandemic, health care providers have had to rapidly
change how they deliver care to patients. We discuss how we are delivering a
virtual HIV pre-exposure prophylaxis (PrEP) service during this time; challenges
faced; challenges expected and goals for the coming months.
Collapse
Affiliation(s)
- Siobhan Quirke
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James's Hospital, Dublin, Ireland
| | - Laura Quinn
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James's Hospital, Dublin, Ireland
| | - Deborah Hegarty
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James's Hospital, Dublin, Ireland
| | - Aisling Loy
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James's Hospital, Dublin, Ireland
| | - Fiona Lyons
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James's Hospital, Dublin, Ireland
| | - Fiona Mulcahy
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James's Hospital, Dublin, Ireland
| | - Emma Devitt
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James's Hospital, Dublin, Ireland
| |
Collapse
|
30
|
Taylor SA, Mallett S, Bhatnagar G, Morris S, Quinn L, Tomini F, Miles A, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Murray CD, Plumb AA, Pollok RC, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study. Health Technol Assess 2020; 23:1-162. [PMID: 31432777 DOI: 10.3310/hta23420] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Magnetic resonance enterography and enteric ultrasonography are used to image Crohn's disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn's disease was compared. OBJECTIVE To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn's disease. DESIGN Prospective multicentre cohort study. SETTING Eight NHS hospitals. PARTICIPANTS Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn's disease or with established Crohn's disease and suspected relapse. INTERVENTIONS Magnetic resonance enterography and ultrasonography. MAIN OUTCOME MEASURES The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn's disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease extent, and sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. RESULTS Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn's disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn's disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn's disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn's disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn's disease presence and extent were similar in the two cohorts. For colonic Crohn's disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn's disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. LIMITATIONS Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. CONCLUSIONS Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn's disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn's disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN03982913. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Florian Tomini
- Applied Health Research, University College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Peter John Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Ilan Jacobs
- Independent patient representative, c/o Centre for Medical Imaging, University College London, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Ao Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew Slater
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
31
|
Barros CHN, Fulaz S, Vitale S, Casey E, Quinn L. Interactions between functionalised silica nanoparticles and Pseudomonas fluorescens biofilm matrix: A focus on the protein corona. PLoS One 2020; 15:e0236441. [PMID: 32701973 PMCID: PMC7377396 DOI: 10.1371/journal.pone.0236441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/31/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022] Open
Abstract
Biofilms are microbial communities embedded in an extracellular polymeric matrix and display an enhanced tolerance to the action of antimicrobials. The emergence of novel functionalised nanoparticles is considered a promising avenue for the development of biofilm-specific antimicrobial technologies. However, there is a gap in the understanding of interactions between nanoparticles and the biofilm matrix. Particularly, questions are raised on how nanoparticle charge and surface groups play a role in aggregation when in contact with biofilm components. Herein we present the synthesis of four types of silica nanoparticles and undertake an analysis of their interactions with Pseudomonas fluorescens biofilm matrix. The effect of the biofilm matrix components on the charge and aggregation of the nanoparticles was assessed. Additionally, the study focused on the role of matrix proteins, with the in-depth characterisation of the protein corona of each nanoparticle by Liquid Chromatography with Tandem Mass Spectrometry experiments. The protein corona composition is dependent on the nanoparticle type; non-functionalised nanoparticles show less protein selectivity, whereas carboxylate-functionalised nanoparticles prefer proteins with a higher isoelectric point. These outcomes provide insights into the field of biofilm-nanoparticle interactions that can be valuable for the design of new nano-based targeting systems in future anti-biofilm applications.
Collapse
Affiliation(s)
- Caio H. N. Barros
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Stephanie Fulaz
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Stefania Vitale
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Eoin Casey
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Laura Quinn
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
- * E-mail:
| |
Collapse
|
32
|
Fulaz S, Devlin H, Vitale S, Quinn L, O'Gara JP, Casey E. Tailoring Nanoparticle-Biofilm Interactions to Increase the Efficacy of Antimicrobial Agents Against Staphylococcus aureus. Int J Nanomedicine 2020; 15:4779-4791. [PMID: 32753866 PMCID: PMC7354952 DOI: 10.2147/ijn.s256227] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Considering the timeline required for the development of novel antimicrobial drugs, increased attention should be given to repurposing old drugs and improving antimicrobial efficacy, particularly for chronic infections associated with biofilms. Methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) are common causes of biofilm-associated infections but produce different biofilm matrices. MSSA biofilm cells are typically embedded in an extracellular polysaccharide matrix, whereas MRSA biofilms comprise predominantly of surface proteins and extracellular DNA (eDNA). Nanoparticles (NPs) have the potential to enhance the delivery of antimicrobial agents into biofilms. However, the mechanisms which influence the interactions between NPs and the biofilm matrix are not yet fully understood. Methods To investigate the influence of NPs surface chemistry on vancomycin (VAN) encapsulation and NP entrapment in MRSA and MSSA biofilms, mesoporous silica nanoparticles (MSNs) with different surface functionalization (bare-B, amine-D, carboxyl-C, aromatic-A) were synthesised using an adapted Stöber method. The antibacterial efficacy of VAN-loaded MSNs was assessed against MRSA and MSSA biofilms. Results The two negatively charged MSNs (MSN-B and MSN-C) showed a higher VAN loading in comparison to the positively charged MSNs (MSN-D and MSN-A). Cellular binding with MSN suspensions (0.25 mg mL−1) correlated with the reduced viability of both MSSA and MRSA biofilm cells. This allowed the administration of low MSNs concentrations while maintaining a high local concentration of the antibiotic surrounding the bacterial cells. Conclusion Our data suggest that by tailoring the surface functionalization of MSNs, enhanced bacterial cell targeting can be achieved, leading to a novel treatment strategy for biofilm infections.
Collapse
Affiliation(s)
- Stephanie Fulaz
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Henry Devlin
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Stefania Vitale
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Laura Quinn
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - James P O'Gara
- Department of Microbiology, School of Natural Sciences, National University of Ireland, Galway, Ireland
| | - Eoin Casey
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| |
Collapse
|
33
|
Devlin H, Hiebner D, Barros C, Fulaz S, Quinn L, Vitale S, Casey E. A high throughput method to investigate nanoparticle entrapment efficiencies in biofilms. Colloids Surf B Biointerfaces 2020; 193:111123. [PMID: 32450504 DOI: 10.1016/j.colsurfb.2020.111123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/23/2020] [Accepted: 05/07/2020] [Indexed: 01/30/2023]
Abstract
The commercial use of nanoparticles has increased in recent years due to their unique characteristics, including high surface area, modifiable shape and surface charge and size-dependent properties. Consequently, a greater number of nanomaterials are now being released into the environment and inevitably interact with the natural ecosystem. Bacterial biofilms have the potential to capture and retain nanoparticles, however the factors determining the specific nanoparticle entrapment efficiencies of biofilms are not yet fully understood. Based on fluorescent intensity measurements we developed a simple and straightforward method that allowed the entrapment of different silica nanoparticles by two Pseudomonas strains to be quantified. It was determined that, regardless of nanoparticle size or surface functionalisation, Pseudomonas putida biofilms showed enhanced entrapment efficiencies compared to Pseudomonas fluorescens biofilms. It was also noted that both biofilms showed a higher entrapment capacity towards positively charged NPs. The method developed has the potential to be utilized for high throughput biofilm screening studies in order to develop a new understating of the relationship between nanoparticle characteristics and its uptake by bacterial biofilms.
Collapse
Affiliation(s)
- Henry Devlin
- School of Chemical and Bioprocess Engineering, University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Dishon Hiebner
- School of Chemical and Bioprocess Engineering, University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Caio Barros
- School of Chemical and Bioprocess Engineering, University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Stephanie Fulaz
- School of Chemical and Bioprocess Engineering, University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Laura Quinn
- School of Chemical and Bioprocess Engineering, University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Stefania Vitale
- School of Chemical and Bioprocess Engineering, University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Eoin Casey
- School of Chemical and Bioprocess Engineering, University College Dublin (UCD), Belfield, Dublin 4, Ireland.
| |
Collapse
|
34
|
Barros CHN, Devlin H, Hiebner DW, Vitale S, Quinn L, Casey E. Enhancing curcumin's solubility and antibiofilm activity via silica surface modification. Nanoscale Adv 2020; 2:1694-1708. [PMID: 36132306 PMCID: PMC9418611 DOI: 10.1039/d0na00041h] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/19/2020] [Indexed: 06/15/2023]
Abstract
Bacterial biofilms are microbial communities in which bacterial cells in sessile state are mechanically and chemically protected against foreign agents, thus enhancing antibiotic resistance. The delivery of active compounds to the inside of biofilms is often hindered due to the existence of the biofilm extracellular polymeric substances (EPS) and to the poor solubility of drugs and antibiotics. A possible strategy to overcome the EPS barrier is the incorporation of antimicrobial agents into a nanocarrier, able to penetrate the matrix and deliver the active substance to the cells. Here, we report the synthesis of antimicrobial curcumin-conjugated silica nanoparticles (curc-NPs) as a possibility for dealing with these issues. Curcumin is a known antimicrobial agent and to overcome its low solubility in water it was grafted onto the surface of silica nanoparticles, the latter functioning as nanocarrier for curcumin into the biofilm. Curc-NPs were able to impede the formation of model P. putida biofilms up to 50% and disrupt mature biofilms up to 54% at 2.5 mg mL-1. Cell viability of sessile cells in both cases was also considerably affected, which is not observed for curcumin delivered as a free compound at the same concentration. Furthermore, proteomics of extracted EPS matrix of biofilms grown in the presence of free curcumin and curc-NPs revealed differences in the expression of key proteins related to cell detoxification and energy production. Therefore, curc-NPs are presented here as an alternative for curcumin delivery that can be exploited not only to other bacterial strains but also to further biological applications.
Collapse
Affiliation(s)
- Caio H N Barros
- School of Chemical and Bioprocess Engineering, University College Dublin Ireland
| | - Henry Devlin
- School of Chemical and Bioprocess Engineering, University College Dublin Ireland
| | - Dishon W Hiebner
- School of Chemical and Bioprocess Engineering, University College Dublin Ireland
| | - Stefania Vitale
- School of Chemical and Bioprocess Engineering, University College Dublin Ireland
| | - Laura Quinn
- School of Chemical and Bioprocess Engineering, University College Dublin Ireland
| | - Eoin Casey
- School of Chemical and Bioprocess Engineering, University College Dublin Ireland
| |
Collapse
|
35
|
Quinn L, Davis K, Yee A, Snyder H. Understanding genetic learning needs of people affected by rare disease. J Genet Couns 2020; 29:1050-1058. [PMID: 32128950 DOI: 10.1002/jgc4.1233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/10/2022]
Abstract
Nearly 350 million people worldwide are affected by a rare disease (RD) and ~80% of RDs have a genetic type, underscoring the need for access to reliable genomics education. Patient assistance in resource development can help ensure content is appropriate. The aim of this study was to define the needs and practical usage of the RD community to inform the scope and content of an online genetic course targeted toward the entire RD ecosystem. A high-level online survey (OS) was disseminated to 586 RD patients and family members/caregivers. A total of 251 individuals responded to the OS. Eight respondents were invited to participate in a follow-up focus group (FG). Nearly 87% of OS respondents have made efforts previously to learn more about genetics and 95.6% indicated a current interest in genetic education. Navigating healthcare systems, information sharing, and advocacy support were driving factors for this desire. Respondents indicated difficulty finding information on gene function, genetic testing, disease pathogenesis, and scientific advances. FG outcomes dove deeper into psychological needs including reducing emotional burden, alleviating fear of the unknown and seeking hope. Research identified high levels of interest in genetic education across all stages of the RD journey. Key themes identified in this study may help guide genetic counselors as they create their own patient and family-facing content.
Collapse
Affiliation(s)
| | - Kendall Davis
- Patient Advocacy, PRA Health Sciences Center for Rare Diseases, Pittsburgh, PA, USA
| | - Ashley Yee
- Patient Engagement, Global Genes, Aliso Viejo, CA, USA
| | | |
Collapse
|
36
|
Taylor SA, Mallett S, Miles A, Morris S, Quinn L, Clarke CS, Beare S, Bridgewater J, Goh V, Janes S, Koh DM, Morton A, Navani N, Oliver A, Padhani A, Punwani S, Rockall A, Halligan S. Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health Technol Assess 2019; 23:1-270. [PMID: 31855148 PMCID: PMC6936168 DOI: 10.3310/hta23660] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN The design was a prospective multicentre cohort study. SETTING The setting was 16 NHS hospitals. PARTICIPANTS Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. LIMITATIONS Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. CONCLUSIONS In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment. TRIAL REGISTRATION Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Susan Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, and Priment Clinical Trials Unit, University College London, London, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Sutton, UK
| | - Alison Morton
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Alfred Oliver
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Anwar Padhani
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Andrea Rockall
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
37
|
Fulaz S, Vitale S, Quinn L, Casey E. Nanoparticle–Biofilm Interactions: The Role of the EPS Matrix. Trends Microbiol 2019; 27:915-926. [DOI: 10.1016/j.tim.2019.07.004] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/19/2019] [Accepted: 07/18/2019] [Indexed: 01/09/2023]
|
38
|
Fulaz S, Hiebner D, Barros CHN, Devlin H, Vitale S, Quinn L, Casey E. Ratiometric Imaging of the in Situ pH Distribution of Biofilms by Use of Fluorescent Mesoporous Silica Nanosensors. ACS Appl Mater Interfaces 2019; 11:32679-32688. [PMID: 31418546 DOI: 10.1021/acsami.9b09978] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Biofilms are communities of microorganisms enclosed in a self-generated matrix of extracellular polymeric substances. While biofilm recalcitrance and persistence are caused by several factors, a reduction in antimicrobial susceptibility has been closely associated with the generation of pH gradients within the biofilm structure. Cells embedded within the biofilm create a localized acidic microenvironment, which is unaffected by the external pH. Therefore, pH monitoring is a promising approach for understanding the complexities of a three-dimensional heterogeneous biofilm. A fluorescent pH nanosensor was designed through the synthesis of mesoporous silica nanoparticles (47 ± 5 nm diameter) conjugated to a pH-sensitive dye (fluorescein) and a pH-insensitive dye (rhodamine B) as an internal standard (dye-MSNs). The fluorescence intensity of fluorescein (IF) reduced significantly as the pH was decreased from 8.5 to 3.5. In contrast, the fluorescence intensity of rhodamine B (IR) remained constant at any pH. The ratio of IF/IR produced a sigmoidal curve with respect to the pH, in a working pH range between 4.5 and 7.5. Dye-MSNs enabled the measurement of pH gradients within Pseudomonas fluorescens WCS 365 biofilm microcolonies. The biofilms showed spatially distinct low-pH regions that were enclosed into large clusters corresponding to high-cell-density areas. Also present were small low-pH areas that spread indistinctly throughout the microcolony caused by the mass transfer effect. The lowest detected pH within the inner core of the microcolonies was 5.1, gradually increasing to a neutral pH toward the exterior of the microcolonies. The dye-MSNs were able to fully penetrate the biofilm matrix and allowed a quantitative ratiometric analysis of pH gradients and distribution throughout the biofilm, which was independent of the nanoparticle concentration.
Collapse
Affiliation(s)
- Stephanie Fulaz
- UCD School of Chemical and Bioprocess Engineering , University College Dublin , Belfield, Dublin 4 Dublin , Ireland
| | - Dishon Hiebner
- UCD School of Chemical and Bioprocess Engineering , University College Dublin , Belfield, Dublin 4 Dublin , Ireland
| | - Caio H N Barros
- UCD School of Chemical and Bioprocess Engineering , University College Dublin , Belfield, Dublin 4 Dublin , Ireland
| | - Henry Devlin
- UCD School of Chemical and Bioprocess Engineering , University College Dublin , Belfield, Dublin 4 Dublin , Ireland
| | - Stefania Vitale
- UCD School of Chemical and Bioprocess Engineering , University College Dublin , Belfield, Dublin 4 Dublin , Ireland
| | - Laura Quinn
- UCD School of Chemical and Bioprocess Engineering , University College Dublin , Belfield, Dublin 4 Dublin , Ireland
| | - Eoin Casey
- UCD School of Chemical and Bioprocess Engineering , University College Dublin , Belfield, Dublin 4 Dublin , Ireland
| |
Collapse
|
39
|
Anderson VE, Weber AM, Wiedermann GE, Pachnio A, Dauleh S, Ahmed T, Docta RY, Quattrini A, Pope G, Quinn L, Ashton TM, Tunbridge HM, Sanderson JP, Gerry AB. Abstract 2313: Enhanced activity of second-generation MAGE-A4 SPEAR T-cells through co-expression of a CD8α homodimer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-2313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Affinity enhanced T-cell receptors (TCRs) have shown promise in the clinic. Second-generation strategies that enhance T-cell function alongside the TCR may improve the depth and durability of anti-tumor responses. In this second-generation TCR study, we added a CD8α homodimer to our MAGE-A4c1032TCR, a first-generation TCR currently being tested in a clinical trial (NCT03132922). Transduction of HLA class I-restricted, specific peptide enhanced affinity receptor (SPEAR) TCRs into peripheral blood lymphocytes creates both cytotoxic (CD8+) and helper (CD4+) T-cells of the same specificity; however, the lack of CD8 co-receptors on CD4+ T-cells may affect binding avidity of the engineered TCR. The addition of CD8α co-receptor into CD4+ T-cells alongside the engineered TCR (CD8α_MAGE-A4c1032) is anticipated to increase TCR binding avidity and enhance the polyfunctional response of CD4+ T-cells against tumor antigens, thereby widening the immune response to the tumor through dendritic cell (DC) activation and enhanced cytotoxicity. The effect of co-expressing the CD8α co-receptor on the MAGE-A4c1032TCR was assessed by in vitro assays addressing proof of concept for increased potency, focusing on CD4+ function, in parallel with assessment of potential safety issues. In assays involving antigen-positive tumor cell lines co-cultured with T-cells, we demonstrated improved T-cell engagement, as measured by increased CD40L on the T-cell surface in response to antigen. There were modest improvements in T-cell proliferation and cytokine production in response to tumor cells, particularly when isolated CD4+ cells were analyzed. However, when immature DCs were added to the co-culture, a more marked improvement with the second-generation T-cells was seen. DCs and T-cells in conditions containing CD8α_MAGE-A4c1032T-cells produced higher levels of cytokines and chemokines (e.g. IL-12, MIG for DCs, IFNγ, IL-2 for T-cells) than in conditions that contained MAGE-A4c1032T-cells without the CD8α co-receptor. Flow cytometry analyses illustrated T-cell-driven maturation of the DCs during the course of the co-culture. We also saw that second-generation CD4+ T-cells expressing the CD8α homodimer were able to kill antigen-expressing 3D tumor line microspheres, an additional benefit to the improvement of CD4+ helper functions. No changes in TCR specificity, sensitivity, or aberrant cytokine release arose from co-expressing the CD8α co-receptor in T-cells transduced with the MAGE-A4c1032TCR, suggesting no change to the existing safety profile. These data illustrate improved engagement and function in the CD4+ T-cells transduced with CD8α_MAGE-A4c1032, without additional off-target reactivity. The second generation CD8α_MAGE-A4 SPEAR T-cells are expected to improve long term T-cell functions as well as immediate anti-tumor activity in vivo.
Citation Format: Victoria E. Anderson, Anika M. Weber, Guy E. Wiedermann, Anette Pachnio, Sumaya Dauleh, Tina Ahmed, Roslin Y. Docta, Adriano Quattrini, George Pope, Laura Quinn, Thomas M. Ashton, Helen M. Tunbridge, Joseph P. Sanderson, Andrew B. Gerry. Enhanced activity of second-generation MAGE-A4 SPEAR T-cells through co-expression of a CD8α homodimer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2313.
Collapse
|
40
|
Taylor SA, Mallett S, Beare S, Bhatnagar G, Blunt D, Boavida P, Bridgewater J, Clarke CS, Duggan M, Ellis S, Glynne-Jones R, Goh V, Groves AM, Hameeduddin A, Janes SM, Johnston EW, Koh DM, Miles A, Morris S, Morton A, Navani N, O'Donohue J, Oliver A, Padhani AR, Pardoe H, Patel U, Punwani S, Quinn L, Rafiee H, Reczko K, Rockall AG, Shahabuddin K, Sidhu HS, Teague J, Thaha MA, Train M, van Ree K, Wijeyekoon S, Halligan S. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol 2019; 4:529-537. [PMID: 31080095 PMCID: PMC6547166 DOI: 10.1016/s2468-1253(19)30056-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer. METHODS The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete. FINDINGS Between March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways, a difference in sensitivity of 4% (-5 to 13, p=0·51). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (95% [95% CI 92-97]) and standard pathways (93% [90-96], p=0·48). Agreement with the multidisciplinary team's final treatment decision was 96% for WB-MRI and 95% for the standard pathway. Time to complete staging was shorter for WB-MRI (median, 8 days [IQR 6-9]) than for the standard pathway (13 days [11-15]); a 5-day (3-7) difference. WB-MRI required fewer tests (median, one [95% CI 1 to 1]) than did standard pathways (two [2 to 2]), a difference of one (1 to 1). Mean per-patient staging costs were £216 (95% CI 211-221) for WB-MRI and £285 (260-310) for standard pathways. INTERPRETATION WB-MRI staging pathways have similar accuracy to standard pathways and reduce the number of tests needed, staging time, and cost. FUNDING UK National Institute for Health Research.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK.
| | - Sue Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Dominic Blunt
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Boavida
- Department of Radiology, Homerton Hospital, London, UK
| | | | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Marian Duggan
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Steve Ellis
- Department of Radiology, Barts Health NHS Trust, London, UK
| | - Robert Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Alison Morton
- Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | - John O'Donohue
- Department of Gastroenterology, Lewisham Hospital, London, UK
| | - Alfred Oliver
- Centre for Medical Imaging, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Helen Pardoe
- Department of Surgery, Homerton Hospital, London, UK
| | - Uday Patel
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hameed Rafiee
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Krystyna Reczko
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Andrea G Rockall
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Cancer and Surgery, Imperial College London, London, UK
| | | | - Harbir S Sidhu
- Centre for Medical Imaging, University College London, London, UK
| | - Jonathan Teague
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Mohamed A Thaha
- Blizard Institute, National Bowel Research Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Surgery, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Matthew Train
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Katherine van Ree
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
41
|
Taylor SA, Mallett S, Ball S, Beare S, Bhatnagar G, Bhowmik A, Boavida P, Bridgewater J, Clarke CS, Duggan M, Ellis S, Glynne-Jones R, Goh V, Groves AM, Hameeduddin A, Janes SM, Johnston EW, Koh DM, Lock S, Miles A, Morris S, Morton A, Navani N, Oliver A, O'Shaughnessy T, Padhani AR, Prezzi D, Punwani S, Quinn L, Rafiee H, Reczko K, Rockall AG, Russell P, Sidhu HS, Strickland N, Tarver K, Teague J, Halligan S. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed non-small-cell lung cancer: the prospective Streamline L trial. Lancet Respir Med 2019; 7:523-532. [PMID: 31080129 PMCID: PMC6529610 DOI: 10.1016/s2213-2600(19)30090-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Whole-body magnetic resonance imaging (WB-MRI) could be an alternative to multi-modality staging of non-small-cell lung cancer (NSCLC), but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in NSCLC. METHODS The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed NSCLC that was potentially radically treatable on diagnostic chest CT (defined as stage IIIb or less). Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or histologies other than NSCLC. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs) and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN50436483, and is complete. FINDINGS Between Feb 26, 2013, and Sept 5, 2016, 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial; 52 (28%) had metastasis at baseline. Pathway sensitivity was 50% (95% CI 37-63) for WB-MRI and 54% (41-67) for standard pathways, a difference of 4% (-7 to 15, p=0·73). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (93% [88-96]) and standard pathways (95% [91-98], p=0·45). Agreement with the multidisciplinary team's final treatment decision was 98% for WB-MRI and 99% for the standard pathway. Time to complete staging was shorter for WB-MRI (13 days [12-14]) than for the standard pathway (19 days [17-21]); a 6-day (4-8) difference. The number of tests required was similar WB-MRI (one [1-1]) and standard pathways (one [1-2]). Mean per-patient costs were £317 (273-361) for WBI-MRI and £620 (574-666) for standard pathways. INTERPRETATION WB-MRI staging pathways have similar accuracy to standard pathways, and reduce the staging time and costs. FUNDING UK National Institute for Health Research.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK.
| | - Sue Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Simon Ball
- Barking, Havering, and Redbridge NHS Trust, Romford, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Angshu Bhowmik
- Department of Respiratory Medicine, Homerton University Hospital, London, UK
| | - Peter Boavida
- Department of Radiology, Homerton University Hospital, London, UK
| | | | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Marian Duggan
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Steve Ellis
- Department of Radiology, Barts Health NHS Trust, London, UK
| | - Robert Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Sara Lock
- Department of Respiratory Medicine, Whittington Hospital, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Alison Morton
- Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | - Alfred Oliver
- Centre for Medical Imaging, University College London, London, UK
| | | | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - David Prezzi
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hameed Rafiee
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Krystyna Reczko
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Andrea G Rockall
- Department of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Cancer and Surgery, Imperial College London, London, UK
| | - Peter Russell
- Department of Respiratory Medicine, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Harbir S Sidhu
- Centre for Medical Imaging, University College London, London, UK
| | - Nicola Strickland
- Department of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Jonathan Teague
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
42
|
Devlin H, Barros C, Fulaz S, Hiebner D, Quinn L, Vitale S, Casey E. Fundamental nanoparticle interactions with biofilms of Pseudomonas species. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Eoin Casey
- University College Dublin, Dublin, Ireland
| |
Collapse
|
43
|
Quinn L, Barros C, Vitale S, Casey E. Extraction and identification of components of the biofilm matrix in Pseudomonas species biofilms. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | | | - Eoin Casey
- University College Dublin, Dublin, Ireland
| |
Collapse
|
44
|
Gazzola G, Habimana O, Quinn L, Casey E, Murphy CD. Population dynamics of a dual Pseudomonas putida- Pseudomonas fluorescens biofilm in a capillary bioreactor. Biofouling 2019; 35:299-307. [PMID: 31025575 DOI: 10.1080/08927014.2019.1598397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/12/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Most biofilm studies employ single species, yet in nature biofilms exist as mixed cultures, with inevitable effects on growth and development of each species present. To investigate how related species of bacteria interact in biofilms, two Pseudomonas spp., Pseudomonas fluorescens and Pseudomonas putida, were cultured in capillary bioreactors and their growth measured by confocal microscopy and cell counting. When inoculated in pure culture, both bacteria formed healthy biofilms within 72 h with uniform coverage of the surface. However, when the bioreactors were inoculated with both bacteria simultaneously, P. putida was completely dominant after 48 h. Even when the inoculation by P. putida was delayed for 24 h, P. fluorescens was eliminated from the capillary within 48 h. It is proposed that production of the lipopeptide putisolvin by P. putida is the likely reason for the reduction of P. fluorescens. Putisolvin biosynthesis in the dual-species biofilm was confirmed by mass spectrometry.
Collapse
Affiliation(s)
- Giulio Gazzola
- a UCD School of Chemical and Bioprocess Engineering , University College Dublin , Dublin , Ireland
| | - Olivier Habimana
- a UCD School of Chemical and Bioprocess Engineering , University College Dublin , Dublin , Ireland
| | - Laura Quinn
- a UCD School of Chemical and Bioprocess Engineering , University College Dublin , Dublin , Ireland
| | - Eoin Casey
- a UCD School of Chemical and Bioprocess Engineering , University College Dublin , Dublin , Ireland
| | - Cormac D Murphy
- b UCD School of Biomolecular and Biomedical Science , University College Dublin , Dublin , Ireland
| |
Collapse
|
45
|
Hiebner D, Barros C, Devlin H, Fulaz S, Quinn L, Vitale S, Casey E. Investigation into the physicochemical interactions of silica nanoparticles and EPS biomolecules within the biofilm matrix of Pseudomonas spp. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dishon Hiebner
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Caio Barros
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Henry Devlin
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Stephanie Fulaz
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Laura Quinn
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Stefania Vitale
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Eoin Casey
- School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| |
Collapse
|
46
|
Albert A, André M, Anghinolfi M, Anton G, Ardid M, Aubert JJ, Aublin J, Avgitas T, Baret B, Barrios-Martít J, Basa S, Belhorma B, Bertin V, Biagi S, Bormuth R, Boumaaza J, Bourret S, Bouwhuis MC, Brânzaş H, Bruijn R, Brunner J, Busto J, Capone A, Caramete L, Carr J, Celli S, Chabab M, Moursli RCE, Chiarusi T, Circella M, Coelho JAB, Coleiro A, Colomer M, Coniglione R, Costantini H, Coyle P, Creusot A, Díaz AF, Deschamps A, Distefano C, Palma ID, Domi A, Donzaud C, Dornic D, Drouhin D, Eberl T, Bojaddaini IE, Khayati NE, Elsässer D, Enzenhöfer A, Ettahiri A, Fassi F, Felis I, Fermani P, Ferrara G, Fusco LA, Gay P, Glotin H, Grégoire T, Ruiz RG, Graf K, Hallmann S, van Haren H, Heijboer AJ, Hello Y, Hernández-Rey JJ, Hößl J, Hofestädt J, Illuminati G, de Jong M, Jongen M, Kadler M, Kalekin O, Katz U, Khan-Chowdhury NR, Kouchner A, Kreter M, Kreykenbohm I, Kulikovskiy V, Lachaud C, Lahmann R, Lefèvre D, Leonora E, Levi G, Lotze M, Loucatos S, Marcelin M, Margiotta A, Marinelli A, Martínez-Mora JA, Mele R, Melis K, Migliozzi P, Moussa A, Navas S, Nezri E, Nuñez A, Organokov M, Păvălaş GE, Pellegrino C, Piattelli P, Popa V, Pradier T, Quinn L, Racca C, Randazzo N, Riccobene G, Sánchez-Losa A, Saldaña M, Salvadori I, Samtleben DFE, Sanguineti M, Sapienza P, Schüssler F, Spurio M, Stolarczyk T, Taiuti M, Tayalati Y, Trovato A, Vallage B, Van Elewyck V, Versari F, Vivolo D, Wilms J, Zaborov D, Zornoza JD, Zúñiga J. The cosmic ray shadow of the Moon observed with the ANTARES neutrino telescope. Eur Phys J C Part Fields 2018; 78:1006. [PMID: 30872956 PMCID: PMC6383875 DOI: 10.1140/epjc/s10052-018-6451-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
One of the main objectives of the ANTARES telescope is the search for point-like neutrino sources. Both the pointing accuracy and the angular resolution of the detector are important in this context and a reliable way to evaluate this performance is needed. In order to measure the pointing accuracy of the detector, one possibility is to study the shadow of the Moon, i.e. the deficit of the atmospheric muon flux from the direction of the Moon induced by the absorption of cosmic rays. Analysing the data taken between 2007 and 2016, the Moon shadow is observed with 3.5 σ statistical significance. The detector angular resolution for downward-going muons is 0 . 73 ∘ ± 0 . 14 ∘ . The resulting pointing performance is consistent with the expectations. An independent check of the telescope pointing accuracy is realised with the data collected by a shower array detector onboard of a ship temporarily moving around the ANTARES location.
Collapse
Affiliation(s)
- A. Albert
- Université de Strasbourg, CNRS, IPHC UMR 7178, 67000 Strasbourg, France
| | - M. André
- Laboratory of Applied Bioacoustics, Technical University of Catalonia, Rambla Exposició, 08800 Vilanova i la Geltrú, Barcelona Spain
| | - M. Anghinolfi
- INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - G. Anton
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - M. Ardid
- Institut d’Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC), Universitat Politècnica de València. C/ Paranimf 1, 46730 Gandia, Spain
| | - J. -J. Aubert
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - J. Aublin
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | - T. Avgitas
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | - B. Baret
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | - J. Barrios-Martít
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - S. Basa
- LAM - Laboratoire d’Astrophysique de Marseille, Pôle de l’Étoile Site de Château-Gombert, rue Frédéric Joliot-Curie 38, 13388 Marseille Cedex 13, France
| | - B. Belhorma
- National Center for Energy Sciences and Nuclear Techniques, B.P.1382, 10001 Rabat, Morocco
| | - V. Bertin
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - S. Biagi
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | - R. Bormuth
- Nikhef, Science Park, Amsterdam, The Netherlands
- Huygens-Kamerlingh Onnes Laboratorium, Universiteit Leiden, Leiden, The Netherlands
| | - J. Boumaaza
- Faculty of Sciences, University Mohammed V in Rabat, 4 av. Ibn Battouta, B.P. 1014, 10000 Rabat, Morocco
| | - S. Bourret
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | | | - H. Brânzaş
- Institute of Space Science, RO-077125 Măgurele, Bucharest, Romania
| | - R. Bruijn
- Nikhef, Science Park, Amsterdam, The Netherlands
- Universiteit van Amsterdam, Instituut voor Hoge-Energie Fysica, Science Park 105, 1098 XG Amsterdam, The Netherlands
| | - J. Brunner
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - J. Busto
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - A. Capone
- INFN, Sezione di Roma, P.le Aldo Moro 2, 00185 Rome, Italy
- Dipartimento di Fisica dell’Università La Sapienza, P.le Aldo Moro 2, 00185 Rome, Italy
| | - L. Caramete
- Institute of Space Science, RO-077125 Măgurele, Bucharest, Romania
| | - J. Carr
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - S. Celli
- INFN, Sezione di Roma, P.le Aldo Moro 2, 00185 Rome, Italy
- Dipartimento di Fisica dell’Università La Sapienza, P.le Aldo Moro 2, 00185 Rome, Italy
- Gran Sasso Science Institute, Viale Francesco Crispi 7, 00167 L’Aquila, Italy
| | - M. Chabab
- LPHEA, Faculty of Science, Semlali, Cadi Ayyad University, P.O.B. 2390, Marrakech, Morocco
| | - R. Cherkaoui El Moursli
- Faculty of Sciences, University Mohammed V in Rabat, 4 av. Ibn Battouta, B.P. 1014, 10000 Rabat, Morocco
| | - T. Chiarusi
- INFN, Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy
| | - M. Circella
- INFN, Sezione di Bari, Via E. Orabona 4, 70126 Bari, Italy
| | - J. A. B. Coelho
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | - A. Coleiro
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - M. Colomer
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - R. Coniglione
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | - H. Costantini
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - P. Coyle
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - A. Creusot
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | - A. F. Díaz
- Department of Computer Architecture and Technology/CITIC, University of Granada, 18071 Granada, Spain
| | - A. Deschamps
- Géoazur, UCA, CNRS, IRD, Observatoire de la Côte d’Azur, Sophia Antipolis, France
| | - C. Distefano
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | - I. Di Palma
- INFN, Sezione di Roma, P.le Aldo Moro 2, 00185 Rome, Italy
- Dipartimento di Fisica dell’Università La Sapienza, P.le Aldo Moro 2, 00185 Rome, Italy
| | - A. Domi
- INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
- Dipartimento di Fisica dell’Università, Via Dodecaneso 33, 16146 Genova, Italy
| | - C. Donzaud
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- Université Paris-Sud, 91405 Orsay Cedex, France
| | - D. Dornic
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - D. Drouhin
- Université de Strasbourg, CNRS, IPHC UMR 7178, 67000 Strasbourg, France
| | - T. Eberl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - I. El Bojaddaini
- Laboratory of Physics of Matter and Radiations, University Mohammed I, B.P.717, 6000 Oujda, Morocco
| | - N. El Khayati
- Faculty of Sciences, University Mohammed V in Rabat, 4 av. Ibn Battouta, B.P. 1014, 10000 Rabat, Morocco
| | - D. Elsässer
- Institut für Theoretische Physik und Astrophysik, Universität Würzburg, Emil-Fischer Str. 31, 97074 Würzburg, Germany
| | - A. Enzenhöfer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - A. Ettahiri
- Faculty of Sciences, University Mohammed V in Rabat, 4 av. Ibn Battouta, B.P. 1014, 10000 Rabat, Morocco
| | - F. Fassi
- Faculty of Sciences, University Mohammed V in Rabat, 4 av. Ibn Battouta, B.P. 1014, 10000 Rabat, Morocco
| | - I. Felis
- Institut d’Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC), Universitat Politècnica de València. C/ Paranimf 1, 46730 Gandia, Spain
| | - P. Fermani
- INFN, Sezione di Roma, P.le Aldo Moro 2, 00185 Rome, Italy
- Dipartimento di Fisica dell’Università La Sapienza, P.le Aldo Moro 2, 00185 Rome, Italy
| | - G. Ferrara
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | - L. A. Fusco
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- Dipartimento di Fisica e Astronomia dell’Università, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - P. Gay
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- Laboratoire de Physique Corpusculaire, Clermont Université, Université Blaise Pascal, CNRS/IN2P3, BP 10448, 63000 Clermont-Ferrand, France
| | - H. Glotin
- LIS, UMR Université de Toulon, Aix Marseille Université, CNRS, 83041 Toulon, France
| | - T. Grégoire
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | - R. Gracia Ruiz
- Université de Strasbourg, CNRS, IPHC UMR 7178, 67000 Strasbourg, France
| | - K. Graf
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - S. Hallmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - H. van Haren
- Royal Netherlands Institute for Sea Research (NIOZ) and Utrecht University, Landsdiep 4, 1797 SZ ’t Horntje (Texel), The Netherlands
| | | | - Y. Hello
- Géoazur, UCA, CNRS, IRD, Observatoire de la Côte d’Azur, Sophia Antipolis, France
| | - J. J. Hernández-Rey
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - J. Hößl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - J. Hofestädt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - G. Illuminati
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - M. de Jong
- Nikhef, Science Park, Amsterdam, The Netherlands
- Huygens-Kamerlingh Onnes Laboratorium, Universiteit Leiden, Leiden, The Netherlands
| | - M. Jongen
- Nikhef, Science Park, Amsterdam, The Netherlands
| | - M. Kadler
- Institut für Theoretische Physik und Astrophysik, Universität Würzburg, Emil-Fischer Str. 31, 97074 Würzburg, Germany
| | - O. Kalekin
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - U. Katz
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - N. R. Khan-Chowdhury
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - A. Kouchner
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- Institut Universitaire de France, 75005 Paris, France
| | - M. Kreter
- Institut für Theoretische Physik und Astrophysik, Universität Würzburg, Emil-Fischer Str. 31, 97074 Würzburg, Germany
| | - I. Kreykenbohm
- Dr. Remeis-Sternwarte and ECAP, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - V. Kulikovskiy
- INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
- Skobeltsyn Institute of Nuclear Physics, Leninskie gory, Moscow State University, 119991 Moscow, Russia
| | - C. Lachaud
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
| | - R. Lahmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, Erlangen, Germany
| | - D. Lefèvre
- Mediterranean Institute of Oceanography (MIO), Aix-Marseille University, 13288 Marseille, Cedex 9, France
- Université du Sud Toulon-Var, CNRS-INSU/IRD UM 110, 83957 La Garde Cedex, France
| | - E. Leonora
- INFN, Sezione di Catania, Via S. Sofia 64, 95123 Catania, Italy
| | - G. Levi
- INFN, Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy
- Dipartimento di Fisica e Astronomia dell’Università, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - M. Lotze
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - S. Loucatos
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- IRFU, CEA, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | - M. Marcelin
- LAM - Laboratoire d’Astrophysique de Marseille, Pôle de l’Étoile Site de Château-Gombert, rue Frédéric Joliot-Curie 38, 13388 Marseille Cedex 13, France
| | - A. Margiotta
- INFN, Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy
- Dipartimento di Fisica e Astronomia dell’Università, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - A. Marinelli
- INFN, Sezione di Pisa, Largo B. Pontecorvo 3, 56127 Pisa, Italy
- Dipartimento di Fisica dell’Università, Largo B. Pontecorvo 3, 56127 Pisa, Italy
| | - J. A. Martínez-Mora
- Institut d’Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC), Universitat Politècnica de València. C/ Paranimf 1, 46730 Gandia, Spain
| | - R. Mele
- INFN, Sezione di Napoli, Via Cintia, 80126 Napoli, Italy
- Dipartimento di Fisica dell’Università Federico II di Napoli, Via Cintia, 80126 Napoli, Italy
| | - K. Melis
- Nikhef, Science Park, Amsterdam, The Netherlands
- Universiteit van Amsterdam, Instituut voor Hoge-Energie Fysica, Science Park 105, 1098 XG Amsterdam, The Netherlands
| | - P. Migliozzi
- INFN, Sezione di Napoli, Via Cintia, 80126 Napoli, Italy
| | - A. Moussa
- Laboratory of Physics of Matter and Radiations, University Mohammed I, B.P.717, 6000 Oujda, Morocco
| | - S. Navas
- Dpto. de Física Teórica y del Cosmos & C.A.F.P.E., University of Granada, 18071 Granada, Spain
| | - E. Nezri
- LAM - Laboratoire d’Astrophysique de Marseille, Pôle de l’Étoile Site de Château-Gombert, rue Frédéric Joliot-Curie 38, 13388 Marseille Cedex 13, France
| | - A. Nuñez
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
- LAM - Laboratoire d’Astrophysique de Marseille, Pôle de l’Étoile Site de Château-Gombert, rue Frédéric Joliot-Curie 38, 13388 Marseille Cedex 13, France
| | - M. Organokov
- Université de Strasbourg, CNRS, IPHC UMR 7178, 67000 Strasbourg, France
| | - G. E. Păvălaş
- Institute of Space Science, RO-077125 Măgurele, Bucharest, Romania
| | - C. Pellegrino
- INFN, Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy
- Dipartimento di Fisica e Astronomia dell’Università, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - P. Piattelli
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | - V. Popa
- Institute of Space Science, RO-077125 Măgurele, Bucharest, Romania
| | - T. Pradier
- Université de Strasbourg, CNRS, IPHC UMR 7178, 67000 Strasbourg, France
| | - L. Quinn
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - C. Racca
- GRPHE, Université de Haute Alsace - Institut universitaire de technologie de Colmar, 34 rue du Grillenbreit, BP 50568, 68008 Colmar, France
| | - N. Randazzo
- INFN, Sezione di Catania, Via S. Sofia 64, 95123 Catania, Italy
| | - G. Riccobene
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | | | - M. Saldaña
- Institut d’Investigació per a la Gestió Integrada de les Zones Costaneres (IGIC), Universitat Politècnica de València. C/ Paranimf 1, 46730 Gandia, Spain
| | - I. Salvadori
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - D. F. E. Samtleben
- Nikhef, Science Park, Amsterdam, The Netherlands
- Huygens-Kamerlingh Onnes Laboratorium, Universiteit Leiden, Leiden, The Netherlands
| | - M. Sanguineti
- INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
- Dipartimento di Fisica dell’Università, Via Dodecaneso 33, 16146 Genova, Italy
| | - P. Sapienza
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | - F. Schüssler
- IRFU, CEA, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | - M. Spurio
- INFN, Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy
- Dipartimento di Fisica e Astronomia dell’Università, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - Th. Stolarczyk
- IRFU, CEA, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | - M. Taiuti
- INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
- Dipartimento di Fisica dell’Università, Via Dodecaneso 33, 16146 Genova, Italy
| | - Y. Tayalati
- Faculty of Sciences, University Mohammed V in Rabat, 4 av. Ibn Battouta, B.P. 1014, 10000 Rabat, Morocco
| | - A. Trovato
- INFN, Laboratori Nazionali del Sud (LNS), Via S. Sofia 62, 95123 Catania, Italy
| | - B. Vallage
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- IRFU, CEA, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | - V. Van Elewyck
- APC, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, Paris, France
- Institut Universitaire de France, 75005 Paris, France
| | - F. Versari
- INFN, Sezione di Bologna, Viale Berti-Pichat 6/2, 40127 Bologna, Italy
- Dipartimento di Fisica e Astronomia dell’Università, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - D. Vivolo
- INFN, Sezione di Napoli, Via Cintia, 80126 Napoli, Italy
- Dipartimento di Fisica dell’Università Federico II di Napoli, Via Cintia, 80126 Napoli, Italy
| | - J. Wilms
- Dr. Remeis-Sternwarte and ECAP, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - D. Zaborov
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - J. D. Zornoza
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| | - J. Zúñiga
- IFIC, Instituto de Física Corpuscular (CSIC, Universitat de València) c/ Catedrático José Beltrán, 2 E-46980 Paterna, Valencia, Spain
| |
Collapse
|
47
|
Quinn L, Miljevic A, Rurak BK, Marinovic W, Vallence AM. Differential plasticity of extensor and flexor motor cortex representations following visuomotor adaptation. Exp Brain Res 2018; 236:2945-2957. [PMID: 30088021 DOI: 10.1007/s00221-018-5349-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/28/2018] [Indexed: 12/20/2022]
Abstract
Representations within the primary motor cortex (M1) are capable of rapid functional changes following motor learning, known as use-dependent plasticity. GABAergic inhibition plays a role in use-dependent plasticity. Evidence suggests a different capacity for plasticity of distal and proximal upper limb muscle representations. However, it is unclear whether the motor cortical representations of forearm flexor and extensor muscles also have different capacities for plasticity. The current study used transcranial magnetic stimulation to investigate motor cortex excitability and inhibition of forearm flexor and extensor representations before and after performance of a visuomotor adaptation task that primarily targeted flexors and extensors separately. There was a decrease in extensor and flexor motor-evoked potential (MEP) amplitude after performing the extensor adaptation, but no change in flexor and extensor MEP amplitude after performing the flexor adaptation. There was also a decrease in motor cortical inhibition in the extensor following extensor adaptation, but no change in motor cortical inhibition in the flexor muscle following flexor adaptation or either of the non-prime mover muscles. Findings suggest that the forearm extensor motor cortical representation exhibits plastic change following adaptive motor learning, and broadly support the distinct neural control of forearm flexor and extensor muscles.
Collapse
Affiliation(s)
- L Quinn
- School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - A Miljevic
- School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - B K Rurak
- School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - W Marinovic
- School of Psychology, Curtin University, Perth, Australia
| | - Ann-Maree Vallence
- School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia.
| |
Collapse
|
48
|
Taylor SA, Mallett S, Bhatnagar G, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Miles A, Murray CD, Plumb AA, Pollok RC, Punwani S, Quinn L, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol 2018; 3:548-558. [PMID: 29914843 PMCID: PMC6278907 DOI: 10.1016/s2468-1253(18)30161-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Magnetic resonance enterography (MRE) and ultrasound are used to image Crohn's disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue. METHODS We recruited patients from eight UK hospitals. Eligible patients were 16 years or older, with newly diagnosed Crohn's disease or with established disease and suspected relapse. Consecutive patients had MRE and ultrasound in addition to standard investigations. Discrepancy between MRE and ultrasound for the presence of small bowel disease triggered an additional investigation, if not already available. The primary outcome was difference in per-patient sensitivity for small bowel disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). This trial is registered with the International Standard Randomised Controlled Trial, number ISRCTN03982913, and has been completed. FINDINGS 284 patients completed the trial (133 in the newly diagnosed group, 151 in the relapse group). Based on the reference standard, 233 (82%) patients had small bowel Crohn's disease. The sensitivity of MRE for small bowel disease extent (80% [95% CI 72-86]) and presence (97% [91-99]) were significantly greater than that of ultrasound (70% [62-78] for disease extent, 92% [84-96] for disease presence); a 10% (95% CI 1-18; p=0·027) difference for extent, and 5% (1-9; p=0·025) difference for presence. The specificity of MRE for small bowel disease extent (95% [85-98]) was significantly greater than that of ultrasound (81% [64-91]); a difference of 14% (1-27; p=0·039). The specificity for small bowel disease presence was 96% (95% CI 86-99) with MRE and 84% (65-94) with ultrasound (difference 12% [0-25]; p=0·054). There were no serious adverse events. INTERPRETATION Both MRE and ultrasound have high sensitivity for detecting small bowel disease presence and both are valid first-line investigations, and viable alternatives to ileocolonoscopy. However, in a national health service setting, MRE is generally the preferred radiological investigation when available because its sensitivity and specificity exceed ultrasound significantly. FUNDING National Institute of Health and Research Health Technology Assessment.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London (UCL), London, UK.
| | - Susan Mallett
- Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK
| | - Peter J Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew A Plumb
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Holborn, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London (UCL), London, UK
| |
Collapse
|
49
|
Quinn L, Ailsworth M, Matthews E, Kellams A, Shirley DA. Serratia marcescens Colonization Causing Pink Breast Milk and Pink Diapers: A Case Report and Literature Review. Breastfeed Med 2018; 13:388-394. [PMID: 29708771 DOI: 10.1089/bfm.2018.0002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Serratia marcescens is an opportunistic pathogen and common cause of infectious outbreaks in pediatric units, leading to both significant morbidity and mortality in immunocompromised hosts. Environmental and some clinical strains may produce a characteristic red pigment, prodigiosin. Colonization can hence turn breast milk and fecally-soiled diapers pink, which can lead otherwise unaffected patients to present to their physicians and also interrupt breastfeeding. No clear guidance exists regarding the outpatient management of breastfeeding mothers and infants colonized with S. marcescens. METHODS Our aim was to understand the significance of pigment-producing S. marcescens colonization of breast milk and stools in healthy infants in the community setting. We describe the case of a healthy 9-week-old infant presenting with pink soiled diapers secondary to S. marcescens colonization and systematically review previously reported cases of infants diagnosed with pink diapers or milk published in PubMed between 1958 and 2017. RESULTS Six publications describing seven additional mother-infant cases were selected for inclusion. In all, 8 mother-infant groups of colonization were reviewed, involving 10 infants (there were 2 sets of twins). Good clinical outcomes were reported in all cases regardless of whether antibiotic treatment was prescribed. CONCLUSION Providers evaluating mother-infant dyads with S. marcescens colonization causing pink milk or pink infant soiled diapers should assess for manifestations of systemic infection. In the absence of evidence of clinical infection, expectant management is appropriate and continued breastfeeding can be supported.
Collapse
Affiliation(s)
- Laura Quinn
- 1 Department of Pediatrics, University of Virginia School of Medicine , Charlottesville, Virginia
| | | | - Elizabeth Matthews
- 1 Department of Pediatrics, University of Virginia School of Medicine , Charlottesville, Virginia
| | - Ann Kellams
- 1 Department of Pediatrics, University of Virginia School of Medicine , Charlottesville, Virginia
| | - Debbie-Ann Shirley
- 1 Department of Pediatrics, University of Virginia School of Medicine , Charlottesville, Virginia
| |
Collapse
|
50
|
Kim I, Park C, Collins E, Horswill C, Quinn L, Bronas U, Kapella M. 0901 Sleep Patterns in People with Chronic Obstructive Pulmonary Disease. Sleep 2018. [DOI: 10.1093/sleep/zsy061.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Kim
- University of Illinois at Chicago, Chicago, IL
| | - C Park
- University of Illinois at Chicago, Chicago, IL
| | - E Collins
- University of Illinois at Chicago, Chicago, IL
| | - C Horswill
- University of Illinois at Chicago, Chicago, IL
| | - L Quinn
- University of Illinois at Chicago, Chicago, IL
| | - U Bronas
- University of Illinois at Chicago, Chicago, IL
| | - M Kapella
- University of Illinois at Chicago, Chicago, IL
| |
Collapse
|