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Morris L, Shelton C. Widening the gap: could residential 'simulated altitude prehabilitation' exacerbate health inequalities? Anaesthesia 2024; 79:549-550. [PMID: 38330402 DOI: 10.1111/anae.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Affiliation(s)
- L Morris
- North West School of Anaesthesia, Manchester, UK
| | - C Shelton
- Wythenshawe Hospital, Manchester, UK
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Seymour M, Mase M, Rumints M, Neuendorf N, Newland J, Wuatai N, Bauri M, Morris L, Ilumi S, Toliman P, Kelly-Hanku A. Effect of COVID-19 on Routine Immunization During Health Outreach in Western Province, Papua New Guinea. Asia Pac J Public Health 2024:10105395241240803. [PMID: 38576394 DOI: 10.1177/10105395241240803] [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: 04/06/2024]
Affiliation(s)
- Mikaela Seymour
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Maggy Mase
- Sustainable Development Program, Health, Port Moresby, Papua New Guinea
| | - Maria Rumints
- Sustainable Development Program, Health, Port Moresby, Papua New Guinea
| | - Nalisa Neuendorf
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Jamee Newland
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Niko Wuatai
- Western Province Provincial Health Authority, Daru, Papua New Guinea
| | - Mathias Bauri
- Western Province Provincial Health Authority, Daru, Papua New Guinea
| | - Lucy Morris
- Western Province Provincial Health Authority, Daru, Papua New Guinea
| | - Suli Ilumi
- Western Province Provincial Health Authority, Daru, Papua New Guinea
- Middle Fly District Health, Balimo, Papua New Guinea
| | - Pamela Toliman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Dakulala P, Kal M, Honjepari A, Morris L, Rehan R, Akena SP, Codlin AJ, Jadambaa N, Islam T, Yanagawa M, Morishita F. Evaluation of a population-wide, systematic screening initiative for tuberculosis on Daru island, Western Province, Papua New Guinea. BMC Public Health 2024; 24:959. [PMID: 38575948 PMCID: PMC10993525 DOI: 10.1186/s12889-024-17918-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND A population-wide, systematic screening initiative for tuberculosis (TB) was implemented on Daru island in the Western Province of Papua New Guinea, where TB is known to be highly prevalent. The initiative used a mobile van equipped with a digital X-ray device, computer-aided detection (CAD) software to identify TB-related abnormalities on chest radiographs, and GeneXpert machines for follow-on diagnostic testing. We describe the results of the TB screening initiative, evaluate its population-level impact and examine risk factors associated with TB detection. METHODS Through a retrospective review of screening data, we assessed the effectiveness of the screening by examining the enrolment coverage and the proportion of people with TB among screened subjects. A cascade analysis was performed to illustrate the flow of participants in the screening algorithm. We conducted univariate and multivariate analyses to identify factors associated with TB. Furthermore, we estimated the number of additional cases detected by the project by examining the trend of routine TB case notifications during the intervention period, compared to the historical baseline cases and trend-adjusted expected cases. RESULTS Of the island's 18,854 residents, 8,085 (42.9%) were enrolled and 7,970 (98.6%) had chest X-ray interpreted by the CAD4TB software. A total of 1,116 (14.0%) participants were considered to have abnormal CXR. A total of 69 Xpert-positive cases were diagnosed, resulting in a detection rate of 853 per 100 000 population screened. 19.4% of people with TB had resistance to rifampicin. People who were in older age groups (aOR 6.6, 95%CI: 1.5-29.1 for the 45-59 age group), were severely underweight (aOR 2.5, 95%CI:1.0-6.1) or underweight (aOR 2.1, 95%CI: 1.1-3.8), lived in households < 5 people (aOR 3.4, 95%CI:1.8-6.6) and had a past history of TB (aOR 2.1, 95%CI: 1.2-3.6) were more likely to have TB. The number of bacteriologically confirmed TB notified during the intervention period was 79.3% and 90.8% higher than baseline notifications and forecasted notifications, respectively. CONCLUSION The screening project demonstrated its effectiveness with the high Xpert-positive TB prevalence among the participants and by successfully yielding additional cases of bacteriologically confirmed TB including rifampicin-resistant TB. The results and lessons learnt from the project should inform future TB screening initiatives in Papua New Guinea.
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Affiliation(s)
- Paison Dakulala
- National Department of Health, Port Moresby, Papua New Guinea
| | - Margaret Kal
- National Department of Health, Port Moresby, Papua New Guinea
| | | | - Lucy Morris
- Western Provincial Health Authority, Daru, Papua New Guinea
| | - Richard Rehan
- World Health Organization Representative Office for Papua New Guinea, Port Moresby, Papua, New, Guinea
| | - Simon Peter Akena
- World Vision International, Stop TB Programme, Daru, Papua New Guinea
| | - Andrew J Codlin
- Friends for International TB Relief (FIT), Ho Chi Minh City, Viet Nam
- Department of Global Public Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Narantuya Jadambaa
- World Health Organization Representative Office for Papua New Guinea, Port Moresby, Papua, New, Guinea
| | - Tauhid Islam
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Manami Yanagawa
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Fukushi Morishita
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines.
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Blake H, Adams EJ, Chaplin WJ, Morris L, Mahmood I, Taylor MG, Langmack G, Jones L, Miller P, Coffey F. Alcohol Prevention in Urgent and Emergency Care (APUEC): Development and Evaluation of Workforce Digital Training on Screening, Brief Intervention, and Referral for Treatment. Int J Environ Res Public Health 2023; 20:7028. [PMID: 37998259 PMCID: PMC10671475 DOI: 10.3390/ijerph20227028] [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] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach to identifying patients with excessive alcohol consumption and providing interventions to help them reduce their drinking. However, healthcare workers in urgent and emergency care settings do not routinely integrate SBIRT into clinical practice and raise a lack of training as a barrier to SBIRT delivery. Therefore, "Alcohol Prevention in Urgent and Emergency Care" (APUEC) training was developed, delivered, and evaluated. APUEC is a brief, stand-alone, multimedia, interactive digital training package for healthcare workers. The aim of APUEC is to increase positive attitudes, knowledge, confidence and skills related to SBIRT through the provision of (a) education on the impact of alcohol and the role of urgent and emergency care in alcohol prevention, and (b) practical guidance on patient assessment, delivery of brief advice and making referral decisions. Development involved collaborative-participatory design approaches and a rigorous six-step ASPIRE methodology (involving n = 28 contributors). APUEC was delivered to healthcare workers who completed an online survey (n = 18) and then participated in individual qualitative interviews (n = 15). Analysis of data was aligned with Levels 1-3 of the Kirkpatrick Model of Training Evaluation. Survey data showed that all participants (100%) found the training useful and would recommend it to others. Insights from the qualitative data showed that APUEC digital training increases healthcare workers' perceived knowledge, confidence and skills related to alcohol prevention in urgent and emergency care settings. Participants viewed APUEC to be engaging and relevant to urgent and emergency care workers. This digital training was perceived to be useful for workforce skills development and supporting the implementation of SBIRT in clinical practice. While the impact of APUEC on clinician behaviour and patient outcomes is yet to be tested, APUEC digital training could easily be embedded within education and continuing professional development programmes for healthcare workers and healthcare trainees of any discipline. Ultimately, this may facilitate the integration of SBIRT into routine care and contribute to population health improvement.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| | - Emma J. Adams
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Wendy J. Chaplin
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lucy Morris
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Ikra Mahmood
- General Surgery Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Michael G. Taylor
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Gillian Langmack
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lydia Jones
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Philip Miller
- Health Innovation East Midlands, Nottingham NG7 2TU, UK;
| | - Frank Coffey
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
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Harwood R, Bethell G, Eastwood MP, Hotonu S, Allin B, Boam T, Rees CM, Hall NJ, Rhodes H, Ampirska T, Arthur F, Billington J, Bough G, Burdall O, Burnand K, Chhabra S, Driver C, Ducey J, Engall N, Folaranmi E, Gracie D, Ford K, Fox C, Green P, Green S, Jawaid W, John M, Koh C, Lam C, Lewis S, Lindley R, Macafee D, Marks I, McNickle L, O’Sullivan BJ, Peeraully R, Phillips L, Rooney A, Thompson H, Tullie L, Vecchione S, Tyraskis A, Maldonado BN, Pissaridou M, Sanchez-Thompson N, Morris L, John M, Godse A, Farrelly P, Cullis P, McHoney M, Colvin D. The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres. Eur J Trauma Emerg Surg 2023; 49:2249-2256. [PMID: 35727342 PMCID: PMC10520113 DOI: 10.1007/s00068-022-01990-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance. METHODS UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres. RESULTS All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic. CONCLUSIONS UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.
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Blake H, Yildirim M, Premakumar V, Morris L, Miller P, Coffey F. Attitudes and current practice in alcohol screening, brief intervention, and referral for treatment among staff working in urgent and emergency settings: An open, cross-sectional international survey. PLoS One 2023; 18:e0291573. [PMID: 37756359 PMCID: PMC10529549 DOI: 10.1371/journal.pone.0291573] [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: 04/13/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The aim of the study was to ascertain the views and experiences of those working in urgent and emergency care (UEC) settings towards screening, brief intervention, and referral to treatment (SBIRT) for alcohol, to inform future practice. OBJECTIVES To explore i) views towards health promotion, ii) views towards and practice of SBIRT, iii) facilitators and barriers to delivering SBIRT, iv) training needs to support future SBIRT practice, and v) comparisons in views and attitudes between demographic characteristics, geographical regions, setting and occupational groups. METHODS This was an open cross-sectional international survey, using an online self-administered questionnaire with closed and open-ended responses. Participants were ≥18 years of age, from any occupational group, working in urgent and emergency care (UEC) settings in any country or region. RESULTS There were 362 respondents (aged 21-65 years, 87.8% shift workers) from 7 occupational groups including physicians (48.6%), nurses (22.4%) and advanced clinical practitioners (18.5%). Most believed that health promotion is part of their role, and that SBIRT for alcohol prevention is needed and appropriate in UEC settings. SBIRT was seen to be acceptable to patients. 66% currently provide brief alcohol advice, but fewer screen for alcohol problems or make alcohol-related referrals. The most common barriers were high workload and lack of funding for prevention, lack of knowledge and training on SBIRT, lack of access to high-quality resources, lack of timely referral pathways, and concerns about patient resistance to advice. Some views and attitudes varied according to demographic characteristics, occupation, setting or region. CONCLUSIONS UEC workers are willing to engage in SBIRT for alcohol prevention but there are challenges to implementation in UEC environments and concerns about workload impacts on already-burdened staff, particularly in the context of global workforce shortages. UEC workers advocate for clear guidelines and policies, increased staff capacity and/or dedicated health promotion teams onsite, SBIRT education/training/resources, appropriate physical spaces for SBIRT conversations and improved alcohol referral pathways to better funded services. Implementation of SBIRT could contribute to improving population health and reducing service demand, but it requires significant and sustained commitment of time and resources for prevention across healthcare organisations.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Mehmet Yildirim
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Lucy Morris
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Philip Miller
- East Midlands Academic Health Sciences Network, Nottingham, United Kingdom
| | - Frank Coffey
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Fairman AD, Walko PF, Ding D, Morris L, Boateng J, Murphy K, Terhorst L. Reliability and validity testing of the ASSIST functional performance index. Assist Technol 2023:1-8. [PMID: 37552786 DOI: 10.1080/10400435.2023.2245004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
Reliability and validity testing of the ASSIST Functional Performance Index (AFPI) was conducted, focusing on persons with physical disabilities (PwPD). The AFPI was iteratively developed to assess persons' needs for Mainstream Smart Home Technologies (MSHT) as Assistive Technology (AT) and to measure the impact of a service delivery model for MSHT. The AFPI consists of 46 items organized by functional domains. A total of N = 22 PwPD completed the AFPI twice. The median response time between these two time points was four days. Test-retest reliability of overall scores was assessed using the Intraclass Correlation Coefficient model (ICC, 3.1). The weighted kappa coefficient was applied to conduct an item analysis, demonstrating moderate to substantial agreement in all but one of the items. During the second administration, validity was established by correlating the number of hours of assistance and total AFPI scores with the SCI-FI Self-Care and Basic Mobility Short Form Questionnaires. Results indicate that the AFPI demonstrates good to very good validity as an assessment tool and outcome measure in recommending and evaluating the impact of MSHT for PwPD. Future studies, including more participants and persons with cognitive and sensory disabilities, may further establish the clinical utility of the AFPI.
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Affiliation(s)
- A D Fairman
- Department of Occupational Therapy, Johnson & Wales University, Providence, Rhode Island, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - P Foschi Walko
- Department of Occupational Therapy, Johnson & Wales University, Providence, Rhode Island, USA
| | - D Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - L Morris
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J Boateng
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - K Murphy
- Department of Occupational Therapy, Johnson & Wales University, Providence, Rhode Island, USA
- Occupational Therapy Department, West Bay Collaborative, Warwick, Rhode Island, USA
| | - L Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Adams EJ, Morris L, Marshall G, Coffey F, Miller PD, Blake H. Effectiveness and implementation of interventions for health promotion in urgent and emergency care settings: an umbrella review. BMC Emerg Med 2023; 23:41. [PMID: 37024777 PMCID: PMC10080902 DOI: 10.1186/s12873-023-00798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Urgent and emergency care (UEC) settings provide an opportunity to prevent ill-health and promote healthy lifestyles with potential to screen and deliver interventions to under-served, at-risk populations. The aim of this study was to synthesise and summarise the evidence on the effectiveness and implementation of interventions for health promotion in UEC settings. METHODS PubMed and Embase (OVID) databases were used to search for studies published in English between January 2010 and January 2023. Systematic reviews and meta-analyses of studies that examined the effectiveness or implementation of face-to-face health promotion interventions for lifestyle behaviours delivered in UEC settings were eligible. Extracted data were synthesised and qualitatively summarised by lifestyle behaviour. Reviews were quality assessed using AMSTAR 2. RESULTS Eighteen reviews met the inclusion criteria; all included studies were conducted in emergency departments or trauma units. We identified 15 reviews on alcohol interventions (13 on effectiveness; 2 on implementation) and 3 on smoking interventions (effectiveness). There were no reviews of intervention studies targeting physical activity or diet and nutrition. There was heterogeneity across studies for study design, target populations, intervention design and content, comparator/control groups and outcomes assessed. The effectiveness of alcohol and smoking interventions in UEC settings varied but some reviews provided evidence of a significant decrease in alcohol consumption, alcohol-related outcomes and smoking in intervention groups, particularly in the short-term and in specific population groups. Research has focused on 'brief' interventions as part of screening, brief intervention and referral to treatment (SBIRT) approaches. Interventions are delivered by a wide range of staff with substantial variation in design. Alcohol brief interventions appear to be acceptable to UEC patients but clinicians face barriers in delivering them. CONCLUSIONS UEC settings have been under-researched and appear to be under-utilised for delivering health promotion activities, except for alcohol prevention. Review level evidence suggests alcohol and smoking interventions are warranted in some population groups. However, further research is needed to determine the optimal intervention design, content and delivery mode for lifestyle behaviours which are suitable for implementation in UEC settings and promote long-term intervention effectiveness. Changes in clinical practice may be needed, including increased training, integration into service delivery and supportive policy, to facilitate the implementation of SBIRT for lifestyle behaviours. Interventions may need to be delivered in the wider UEC system such as urgent care centres, minor injury units and walk-in centres, in addition to emergency departments and trauma units, to support and increase health promotion activities in UEC settings.
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Affiliation(s)
- Emma J Adams
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Lucy Morris
- DREEAM: Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Goolnora Marshall
- DREEAM: Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Frank Coffey
- School of Health Sciences, University of Nottingham, Nottingham, UK
- DREEAM: Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip D Miller
- East Midlands Academic Health Science Network, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Majumdar SS, Islam S, Huang GKL, Morris L, Bauri M, Chan G, Kama G, Keam T, Peacock-Smith A, Finch S, Marukutira T, Bhatt S, Drewett G, Wratten M, Murray A, Pank N, Masah C, Bala R, Umali S, Kalon S, Greig J, Chani K, Kal M, Graham SM. Contact screening and management in a high-transmission MDR-TB setting in Papua New Guinea: Progress, challenges and future directions. Front Trop Dis 2023. [DOI: 10.3389/fitd.2022.1085401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Daru, South Fly District, Papua New Guinea is a high transmission setting for multidrug-resistant tuberculosis (MDR-TB). An emergency response by the Government in 2014 established a high-quality model for treatment and care. Household contact screening and management commenced in 2016 with TB preventive treatment (TPT) for well young child (<5 years) contacts of people with drug-susceptible TB and later expanded to young child contacts of MDR-TB. The model of care is community-based and led by non-specialist health workers, under supervision. An electronic medical record system supports care, reporting and operational research. Community engagement and education has been central, with a concerted focus on peer-led counselling and patient-centred services to improve TPT uptake and completion. Challenges include the application of households as the unit of intervention for detection of active TB and TPT provision. Our implementation experience in Daru has highlighted significant population mixing dynamics with most transmission likely occurring outside the household. We propose a community-wide screening approach with the provision of TPT based on testing to include older children, adolescents, and young adults. As there is the possibility of MDR-TB infection irrespective of the drug susceptibility of the household index case, a novel option is a combination TPT regimen of 6 months of daily isoniazid and levofloxacin (6HLfx). A sensitive aged-related algorithm to detect and exclude active TB is being developed. Ongoing community engagement, quality data systems with operational research to evaluate approaches are critical in high transmission MDR-TB settings.
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Drovandi A, Smith D, Preston R, Morris L, Page P, Swain L, Biros E, Tremlett M, Loller H, Stephens M, Nugent A, Vaughan F, Couzos S. Enablers and barriers to non-dispensing pharmacist integration into the primary health care teams of Aboriginal community-controlled health services. Res Social Adm Pharm 2022; 18:3766-3774. [PMID: 35581127 DOI: 10.1016/j.sapharm.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/08/2022] [Accepted: 05/01/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The primary health care management of chronic disease affecting Aboriginal and Torres Strait Islander peoples requires healthcare quality and equity demands to be met, and systems that foster better team-based care. Non-dispensing pharmacists (NDPs) integrated within primary healthcare settings can enhance the quality of patient care, although factors that enable or challenge integration within these settings need to be better understood. OBJECTIVES To investigate enabling factors and barriers influencing integration of NDPs within Aboriginal community-controlled health services delivering primary health care. This was achieved through qualitative evaluation of the Integrating Pharmacists within Aboriginal Community Controlled Health Services (IPAC) Trial exploring the perceptions of NDPs, community pharmacists, healthcare staff, managers, and Aboriginal and Torres Strait Islander patients of these services. METHODS NDPs were employed across twenty urban, rural, and remote services in three Australian states and provided pre-defined medication-related roles to adult Aboriginal and Torres Strait Islander patients. Perceptions were elicited from online surveys, interviews, and focus groups. Transcripts were thematically analyzed using the constant comparison method to identify, compare, and refine emerging themes. RESULTS One hundred and four participants informed the findings, including 24 NDPs, 13 general practitioners, 12 service managers, 10 community pharmacists, 17 health service staff, and 17 patients. Enablers of integration included: personal (previous experience with Aboriginal and Torres Strait Islander peoples, cultural awareness, skills, individual attributes); health service-related (induction programs, Aboriginal Health Worker support, team-building initiatives); and community-related factors (engaged community elders, leaders, cultural mentors, community pharmacy champions). Barriers to NDP integration included a lack of systems supports for patients and staff to adapt to NDP roles, health service factors, travel requirements, a lack of community linkages, and time and budget constraints. CONCLUSIONS NDP integration within primary health care services has potential to enhance medication-related services to Aboriginal and Torres Strait Islander peoples if enabling factors are supported and health systems and adequate resources facilitate the integration of pharmacists within these settings.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Deborah Smith
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Robyn Preston
- College of Medicine and Dentistry, James Cook University, Townsville, Australia; School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Australia
| | - Lucy Morris
- Queensland Aboriginal and Islander Health Council, Cairns, Queensland, Australia
| | - Priscilla Page
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Lindy Swain
- Kimberley Rural Health Alliance, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Megan Tremlett
- Pharmaceutical Society of Australia, Canberra, Australian Capital Territory, Australia
| | - Hannah Loller
- Pharmaceutical Society of Australia, Canberra, Australian Capital Territory, Australia
| | - Mike Stephens
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Alice Nugent
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Fran Vaughan
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Sophia Couzos
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.
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Lam A, Jankovic L, Aharonyan L, McGroarty K, Prince M, Morris L, Stang C, Berdahl C, Torbati S. 95 A Tender-Loving-Care Volunteer Program to Provide Non-Clinical, Supportive Interventions to Older Adults in the Emergency Department. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Pampaloni I, Marriott S, Pessina E, Fisher C, Govender A, Mohamed H, Chandler A, Tyagi H, Morris L, Pallanti S. The global assessment of OCD. Compr Psychiatry 2022; 118:152342. [PMID: 36007341 DOI: 10.1016/j.comppsych.2022.152342] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022] Open
Abstract
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
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Affiliation(s)
- Ilenia Pampaloni
- South West London and St Georges Mental Health Trust, London, UK.
| | - Sabina Marriott
- South West London and St Georges Mental Health Trust, London, UK
| | | | - Claire Fisher
- South West London and St Georges Mental Health Trust, London, UK
| | - Anusha Govender
- South West London and St Georges Mental Health Trust, London, UK
| | - Heba Mohamed
- South West London and St Georges Mental Health Trust, London, UK
| | - Augusta Chandler
- South West London and St Georges Mental Health Trust, London, UK
| | - Himanshu Tyagi
- University College London Hospital NHS foundation Trust, London, UK
| | - Lucy Morris
- South West London and St Georges Mental Health Trust, London, UK
| | - Stefano Pallanti
- Albert Einstein Institute, New York, USA; Istututo di Neuroscienze, Firenze, Italy
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13
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Heine M, Fruet G, Courtin S, Jenkins D, Adsley P, Brown A, Canavan R, Catford W, Charon E, Curien D, Della Negra S, Duprat J, Hammache F, Lesrel J, Lotay G, Meyer A, Monpribat E, Montanari D, Morris L, Moukaddam M, Nippert J, Podolyák Z, Regan P, Ribaud I, Richer M, Rudigier M, Shearman R, de Séréville N, Stodel C. Direct Measurement of Carbon Fusion at Astrophysical Energies with Gamma-Particle Coincidences. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202226001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present 12C+12C direct fusion measurements with STELLA UKFATIMA, that reach into the region of astrophysics interest relevant to massive stars (M⊙ ≈ 25) using self-supporting thin rotating carbon foils [1]. We demonstrate that detecting gammas and light charged particles in coincidence with nanosecond timing is key for effective background reduction achieving reliable measurements in the sub-nanobarn range. We give details about core developments of the detection apparatus as well as the coincidence-analysis procedure of low count statistics. The present data largely follows the phenomenological hindrance interpolation and shows indication for resonant behaviour at the lowest energy explored.
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14
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Morris L, Patrick R, Ali B, Tarazi M. EP.TU.734Rectal mesh erosion post pelvic gynaecological surgery: A literature review. Br J Surg 2021. [DOI: 10.1093/bjs/znab311.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Surgical mesh has long been used for the repair of pelvic organ prolapse. In recent years high rates of serious complications have been reported and the US has withdrawn it from use, while the UK advises extreme caution. Here, we present a review of the literature with a focus on causative factors.
Methods
Twenty-three articles were included in the review: 21 cases of rectal mesh erosion and three cases of sigmoid mesh erosion. Causative factors were subdivided into patient-related, mesh-related and procedure-related.
Results
Main patient related risk factors included pre-existing intestinal diseases (reported in 4 cases) and an older age (median 65.5). Risk factors that were mesh related included increased porosity. 11 cases were reported with a macroporous (>75µm) mesh, whereas only 1 case had used a microporous (<10µM) mesh. 9 cases with partial/ no details of the mesh. The main risk factor that was procedure related was concomitant hysterectomy with 7 cases of mesh erosion had concomitant hysterectomy, 11 cases without concomitant hysterectomy, with a further 5 being unclear.
Conclusion
Pre-existing bowel disease, mesh type and mechanical factors associated with surgical technique all influenced the risk of mesh erosion into the bowels. A lack of reported information regarding the original surgical mesh and operation hindered the ability to draw conclusions. A step into rectifying this in the future would be the provision of medical device cards directly to the patient detailing the mesh.
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Affiliation(s)
- Lucy Morris
- North Manchester General Hospital, Department of General Surgery
| | - Robyn Patrick
- Medway Maritime Hospital, Department of Obstetrics and Gynaecology
| | - Bakar Ali
- North Manchester General Hospital, Department of General Surgery
| | - Munir Tarazi
- North Manchester General Hospital, Department of General Surgery
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15
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Morris L, Tarazi M, Waugh C, Foster K, Shah J, Mansour M. TP8.2.21 Two Teams, One Patient: Identifying Barriers to Patients’ Flow from Emergency Departments to Surgical Wards. Br J Surg 2021. [DOI: 10.1093/bjs/znab362.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
The transfer of responsibility for patient care across the Emergency Department (ED)/ inpatient interface has always been recognised as a challenging process. Current research focuses on qualitative data and is based occasionally on anecdotal information. The aim of this study was to identify barriers to efficient patient flow with a specific focus on type and quality of referrals and logistics involved.
Methods
Quantitative retrospective data was collected on referrals received by the surgical team from ED (n = 83). The outcome of the referral was recorded. Quality of referrals was assessed on clinical information, examination and investigations performed as well as working diagnoses. Further data was collected on location and time to review referred patients.
Results
Outcome of referral: 14.5% were discharged directly from ED, 16.9% were admitted for <24 hours, 4.8% were referred to another speciality within 24 hours and 63.9% were admitted for > 24 hours. Quality of referral: 18.1% patients were referred without working diagnosis. 31% of patients presenting with upper abdominal pain did not have amylase checked prior to referral and 20% of patients with suspected PR bleeding lacked a PR examination. Logistics: 57% of patients were seen in ED. 15.7% were reviewed within 1 hour (median: 133mins).
Conclusions
Referrals often failed to meet the needs/criteria of the speciality team. Combining the above with high volume of referrals and logistical challenges of working across multiple areas leads to potential delays in timely patients’ review. Intense workloads create stressful environments which eventually breed interpersonal discord.
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Affiliation(s)
- Lucy Morris
- North Manchester General Hospital, Department of Upper GI/ Emergency General Surgery
| | - Munir Tarazi
- North Manchester General Hospital, Department of Upper GI/ Emergency General Surgery
| | - Christopher Waugh
- North Manchester General Hospital, Department of Upper GI/ Emergency General Surgery
| | - Karl Foster
- North Manchester General Hospital, Department of Upper GI/ Emergency General Surgery
| | - Jigar Shah
- North Manchester General Hospital, Department of Upper GI/ Emergency General Surgery
| | - Moustafa Mansour
- North Manchester General Hospital, Department of Upper GI/ Emergency General Surgery
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16
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Foster K, Shah J, Bandyopadhyay S, Waugh C, Fawzy S, Morris L, Mansour M. 721 Imaging for Suspected Bowel Obstruction in Pennine Acute Trust (PAT): A Comparison with the National Audit of Small Bowel Obstruction’s (NASBO) recommendations. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.479] [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
Background
NASBO recommends Computed Topography (CT) over plain abdominal X-ray (AXR) for the investigation of bowel obstruction (BO). AXR is routinely used within PAT for investigation of BO which may be exposing patients to unnecessary radiation and adding unnecessary cost to the service.
Method
A retrospective audit collected data on patients with CT confirmed BO between July 2019 and February 2020. This looked at the percentage of patients who had both CT and AXR to investigate BO. The cost of these AXRs and the percentage of these AXRs that were normal were also calculated.
Results
A search identified 141 patients with CT proven BO. 81/141(57.4%) patients had both AXR and CT as a part of their initial investigations. Of those patients 26/81(32.1%) had no AXR features suggestive of BO. Only 12/81(14.8%) of those patients had serial AXRs following initial imaging. The cost for one AXR is £34.15 which means £2766.15 was spent on potentially unnecessary AXRs within this period.
Conclusions
PAT is performing potentially unnecessary AXRs which is exposing patients to unnecessary radiation and costing the trust. Plain AXRs do not rule out BO. We have recommended an investigation flowchart to PAT A&E departments to reduce unnecessary AXRs being performed.
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Affiliation(s)
- K Foster
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - J Shah
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - S Bandyopadhyay
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - C Waugh
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - S Fawzy
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - L Morris
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - M Mansour
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
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17
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Ranti D, Balchandani P, Morris L. Stress is associated with larger perivascular spaces in depression: A 7-tesla MRI study. Eur Psychiatry 2021. [PMCID: PMC9471385 DOI: 10.1192/j.eurpsy.2021.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Emerging evidence in depressive phenotypes suggests that the breakdown of the blood brain barrier (BBB) andhigh levels of inflammatory cytokines in states of persistent stress or traumatic experiences may contribute to its pathophysiology. Ultra-high field MRI may aid in the radiological detection of maladaptations of the glymphatic system related to BBB integrity that may not be visualized at lower field strengths. Objectives We aimed to investigate the link between glymphatic neuroanatomy in the form of perivascular spaces (PVS) and trauma experience in patients with major depressive disorder. Methods We examined PVS’s in patients with major depressive disorder and in healthy controls using 7-Tesla MRI and a semi-automated segmentation algorithm. Results After controlling for age and gender, we found that the number of traumatic life events experienced was positively correlated with total PVS volume in MDD patients (r= 0.50, p= 0.028) and the overall population (r= 0.34, p= 0.024). Furthermore, the number of traumatic events eliciting fear, helplessness, or horror was positively correlated with total PVS volume in MDD patients (r= 0.50, p= 0.030) and the overall population (r= 0.32, p= 0.023). As expected, age correlated positively with PVS count (r= 0.37, p= 0.013), PVS total volume (r= 0.53, p< 0.001), and PVS density (r= 0.68, p< 0.001 in all participants. Conclusions These results suggest a relationship between glymphatic dysfunction potentially related to BBB integrity and psychological trauma in patients with depression, and suggest that glymphatic impairment may play a role in trauma-related symptomatology.
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18
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Morris L, Thiruthaneeswaran N, O'Donovan A, Simcock R, Cree A, Turner S, Agar M. PO-1263: What every radiation oncologist should know about geriatric oncology: A global expert consensus. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Oh J, Katsoulakis E, Riaz N, Yu Y, Apte A, Leeman J, Katabi N, Morris L, Chan T, Hatzoglou V, Lee N, Deasy J. PO-1550: Radiomics characteristics correlate with immune activation and HPV status in head and neck cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Swanton T, Beswick JA, Hammadi H, Morris L, Williams D, de Cesco S, El-Sharkawy L, Yu S, Green J, Davis JB, Lawrence CB, Brough D, Freeman S. Selective inhibition of the K + efflux sensitive NLRP3 pathway by Cl - channel modulation. Chem Sci 2020; 11:11720-11728. [PMID: 34094411 PMCID: PMC8162947 DOI: 10.1039/d0sc03828h] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The NLRP3 inflammasome regulates production of the pro-inflammatory cytokines interleukin-1β (IL-1β) and IL-18, and contributes to inflammation exacerbating disease. Fenamate non-steroidal anti-inflammatory drugs (NSAIDs) were recently described as NLRP3 inflammasome inhibitors via chloride channel inhibition. Fenamate NSAIDs inhibit cyclooxygenase (COX) enzymes, limiting their potential as therapeutics for NLRP3-associated diseases due to established side effects. The aim here was to develop properties of the fenamates that inhibit NLRP3, and at the same time to reduce COX inhibition. We synthesised a library of analogues, with feedback from in silico COX docking potential, and IL-1β release inhibitory activity. Through iterative screening and rational chemical design, we established a collection of chloride channel inhibiting active lead molecules with potent activity at the canonical NLRP3 inflammasome and no activity at COX enzymes, but only in response to stimuli that activated NLRP3 by a K+ efflux-dependent mechanism. This study identifies a model for the isolation and removal of unwanted off-target effects, with the enhancement of desired activity, and establishes a new chemical motif for the further development of NLRP3 inflammasome inhibitors. The NLRP3 inflammasome regulates production of the pro-inflammatory cytokines interleukin-1β (IL-1β) and IL-18, and contributes to inflammation exacerbating disease.![]()
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Affiliation(s)
- Tessa Swanton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester AV Hill Building, Oxford Road Manchester M13 9PT UK .,Lydia Becker Institute of Immunology and Inflammation, University of Manchester Manchester M13 9PT UK
| | - James A Beswick
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester Stopford Building, Oxford Road Manchester M13 9PT UK
| | - Halah Hammadi
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester Stopford Building, Oxford Road Manchester M13 9PT UK
| | - Lucy Morris
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester AV Hill Building, Oxford Road Manchester M13 9PT UK .,Lydia Becker Institute of Immunology and Inflammation, University of Manchester Manchester M13 9PT UK
| | - Daniel Williams
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester AV Hill Building, Oxford Road Manchester M13 9PT UK .,Lydia Becker Institute of Immunology and Inflammation, University of Manchester Manchester M13 9PT UK
| | - Stephane de Cesco
- Alzheimer's Research UK Oxford Drug Discovery Institute, Target Discovery Institute NDM Building, Roosevelt Drive Oxford OX3 7FZ UK
| | - Lina El-Sharkawy
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester Stopford Building, Oxford Road Manchester M13 9PT UK
| | - Shi Yu
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester AV Hill Building, Oxford Road Manchester M13 9PT UK .,Lydia Becker Institute of Immunology and Inflammation, University of Manchester Manchester M13 9PT UK
| | - Jack Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester AV Hill Building, Oxford Road Manchester M13 9PT UK .,Lydia Becker Institute of Immunology and Inflammation, University of Manchester Manchester M13 9PT UK
| | - John B Davis
- Alzheimer's Research UK Oxford Drug Discovery Institute, Target Discovery Institute NDM Building, Roosevelt Drive Oxford OX3 7FZ UK
| | - Catherine B Lawrence
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester AV Hill Building, Oxford Road Manchester M13 9PT UK .,Lydia Becker Institute of Immunology and Inflammation, University of Manchester Manchester M13 9PT UK
| | - David Brough
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester AV Hill Building, Oxford Road Manchester M13 9PT UK .,Lydia Becker Institute of Immunology and Inflammation, University of Manchester Manchester M13 9PT UK
| | - Sally Freeman
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester Stopford Building, Oxford Road Manchester M13 9PT UK
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21
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McHugo VS, Nolke L, Delassus P, MaCarthy E, McMahon CJ, Morris L. The impact of compliance on Stage 2 uni-ventricular heart circulation: An experimental assessment of the Bidirectional Glenn. Med Eng Phys 2020; 84:184-192. [PMID: 32977917 DOI: 10.1016/j.medengphy.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/11/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Abstract
The Bidirectional Glenn (BDG) or cavopulmonary connection is typically undertaken to volume unload the single ventricle in an effort to preserve ventricular and atrioventricular valve function. The geometry of this surgical palliation has been shown to influence the fluid energy loss as well as the distribution of flow that enters through the superior vena cava. In-vitro and in-silico studies to date have been performed on rigid wall models, while this investigation looks at the impact of flexible thin walled models versus rigid walls. Rigid and compliant models of two patient-specific Glenn geometries were fabricated and tested under various flow conditions, within a biosimulator capable of replicating patient specific flow conditions. It was found that the compliant models exhibit greater levels of energy loss compared to the rigid models. Along with these findings greater levels of turbulence was found in both compliant models compared to their rigid counterparts under ultrasound examinations. This shows that vessel compliance has a significant impact on the hemodynamics within hypoplastic left heart syndrome.
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Affiliation(s)
- V S McHugo
- Department of Mechanical and Industrial Engineering (GMIT), Galway Medical Technology Centre, Ireland.
| | - L Nolke
- Department of Pediatric Cardiology Our Lady's Children's Hospital Crumlin, Dublin, Ireland; University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - P Delassus
- Department of Mechanical and Industrial Engineering (GMIT), Galway Medical Technology Centre, Ireland
| | - E MaCarthy
- Department of Mechanical and Industrial Engineering (GMIT), Galway Medical Technology Centre, Ireland
| | - C J McMahon
- Department of Pediatric Cardiology Our Lady's Children's Hospital Crumlin, Dublin, Ireland; University College Dublin School of Medicine, Belfield, Dublin, Ireland.
| | - L Morris
- Department of Mechanical and Industrial Engineering (GMIT), Galway Medical Technology Centre, Ireland.
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22
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O'Donovan A, Morris L. Palliative Radiation Therapy in Older Adults With Cancer: Age-Related Considerations. Clin Oncol (R Coll Radiol) 2020; 32:766-774. [PMID: 32641244 DOI: 10.1016/j.clon.2020.06.011] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed 'frailty', and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and perhaps require a different approach. Frailty assessment also presents an important opportunity for intervention, when followed by Comprehensive Geriatric Assessment (CGA) in those who require it. Generally, a two-step approach, with a short initial screening, followed by CGA, is advocated in geriatric oncology guidelines. This has the potential to optimise care of the older person, and may also reverse or slow the development of frailty. It therefore has an important impact on the patient's quality of life, which is especially valued in the context of palliative care. Frailty assessment also allows a more informed discussion of treatment outcomes and a shared decision-making approach. With regards to the radiotherapy regimen itself, there are many adaptations that can better facilitate the older person, from positioning and immobilisation, to treatment prescriptions. Treatment courses should be as short as possible and take into account the older person's unique circumstances. The additional burden of travel to treatment for the patient, caregiver or family/support network should also be considered. Reducing treatments to single fractions may be appropriate, or alternatively, hypofractionated regimens. In order to enhance care and meet the demands of a rapidly ageing population, future radiation oncology professionals require education on the basic principles of geriatric medicine, as many aspects remain poorly understood.
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Affiliation(s)
- A O'Donovan
- Applied Radiation Therapy Trinity (ARTT) research group, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland.
| | - L Morris
- Department of Radiation Oncology, St George Hospital, Sydney, NSW 2217, Australia
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23
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Fruet G, Courtin S, Heine M, Jenkins DG, Adsley P, Brown A, Canavan R, Catford WN, Charon E, Curien D, Della Negra S, Duprat J, Hammache F, Lesrel J, Lotay G, Meyer A, Montanari D, Morris L, Moukaddam M, Nippert J, Podolyák Z, Regan PH, Ribaud I, Richer M, Rudigier M, Shearman R, de Séréville N, Stodel C. Advances in the Direct Study of Carbon Burning in Massive Stars. Phys Rev Lett 2020; 124:192701. [PMID: 32469543 DOI: 10.1103/physrevlett.124.192701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/27/2019] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
The ^{12}C+^{12}C fusion reaction plays a critical role in the evolution of massive stars and also strongly impacts various explosive astrophysical scenarios. The presence of resonances in this reaction at energies around and below the Coulomb barrier makes it impossible to carry out a simple extrapolation down to the Gamow window-the energy regime relevant to carbon burning in massive stars. The ^{12}C+^{12}C system forms a unique laboratory for challenging the contemporary picture of deep sub-barrier fusion (possible sub-barrier hindrance) and its interplay with nuclear structure (sub-barrier resonances). Here, we show that direct measurements of the ^{12}C+^{12}C fusion cross section may be made into the Gamow window using an advanced particle-gamma coincidence technique. The sensitivity of this technique effectively removes ambiguities in existing measurements made with gamma ray or charged-particle detection alone. The present cross-section data span over 8 orders of magnitude and support the fusion-hindrance model at deep sub-barrier energies.
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Affiliation(s)
- G Fruet
- IPHC, Université de Strasbourg, Strasbourg F-67037, France
- CNRS, UMR7178, Strasbourg F-67037, France
| | - S Courtin
- IPHC, Université de Strasbourg, Strasbourg F-67037, France
- CNRS, UMR7178, Strasbourg F-67037, France
- USIAS/Université de Strasbourg, Strasbourg F-67083, France
| | - M Heine
- IPHC, Université de Strasbourg, Strasbourg F-67037, France
- CNRS, UMR7178, Strasbourg F-67037, France
| | - D G Jenkins
- University of York, York YO10 5DD, United Kingdom
| | - P Adsley
- Institut de Physique Nucléaire, CNRS/IN2P3, Université Paris-Sud, Université Paris-Saclay, 91406 Orsay Cedex, France
| | - A Brown
- University of York, York YO10 5DD, United Kingdom
| | - R Canavan
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
- National Physical Laboratory, Teddington, Middlesex TW110 LW, United Kingdom
| | - W N Catford
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - E Charon
- NIMBE, CEA, CNRS, Université Paris-Saclay, CEA Saclay F-91191 Gif sur Yvette, France
| | - D Curien
- IPHC, Université de Strasbourg, Strasbourg F-67037, France
- CNRS, UMR7178, Strasbourg F-67037, France
| | - S Della Negra
- Institut de Physique Nucléaire, CNRS/IN2P3, Université Paris-Sud, Université Paris-Saclay, 91406 Orsay Cedex, France
| | - J Duprat
- Centre de Sciences Nucléaires et de Sciences de la Matière (CSNSM), Université Paris Sud, UMR 8609-CNRS/IN2P3, 91405 Orsay, France
| | - F Hammache
- Institut de Physique Nucléaire, CNRS/IN2P3, Université Paris-Sud, Université Paris-Saclay, 91406 Orsay Cedex, France
| | - J Lesrel
- Institut de Physique Nucléaire, CNRS/IN2P3, Université Paris-Sud, Université Paris-Saclay, 91406 Orsay Cedex, France
| | - G Lotay
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - A Meyer
- Institut de Physique Nucléaire, CNRS/IN2P3, Université Paris-Sud, Université Paris-Saclay, 91406 Orsay Cedex, France
| | - D Montanari
- IPHC, Université de Strasbourg, Strasbourg F-67037, France
- CNRS, UMR7178, Strasbourg F-67037, France
- USIAS/Université de Strasbourg, Strasbourg F-67083, France
| | - L Morris
- University of York, York YO10 5DD, United Kingdom
| | - M Moukaddam
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - J Nippert
- IPHC, Université de Strasbourg, Strasbourg F-67037, France
- CNRS, UMR7178, Strasbourg F-67037, France
| | - Zs Podolyák
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - P H Regan
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
- National Physical Laboratory, Teddington, Middlesex TW110 LW, United Kingdom
| | - I Ribaud
- Institut de Physique Nucléaire, CNRS/IN2P3, Université Paris-Sud, Université Paris-Saclay, 91406 Orsay Cedex, France
| | - M Richer
- IPHC, Université de Strasbourg, Strasbourg F-67037, France
- CNRS, UMR7178, Strasbourg F-67037, France
| | - M Rudigier
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - R Shearman
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
- National Physical Laboratory, Teddington, Middlesex TW110 LW, United Kingdom
| | - N de Séréville
- Institut de Physique Nucléaire, CNRS/IN2P3, Université Paris-Sud, Université Paris-Saclay, 91406 Orsay Cedex, France
| | - C Stodel
- GANIL, CEA/DSM-CNRS/IN2P3, Caen F-14076, France
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Fan D, Fan M, Wang H, Lee A, Yu Y, Chen L, Tsai C, McBride S, Riaz N, Bernstein M, Mueller B, Gelblum D, Fetten J, Dunn L, Michel L, Pfister D, Ho A, Boyle J, Cohen M, Roman B, Cracchiolo J, Morris L, Ganly I, Singh B, Shaha A, Patel S, Shah J, Wong R, Sherman E, Lee N, Kang J. Last-line Local Treatment with the Quad Shot Regimen for Previously Irradiated Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Preston JA, Bewley MA, Marriott HM, McGarry Houghton A, Mohasin M, Jubrail J, Morris L, Stephenson YL, Cross S, Greaves DR, Craig RW, van Rooijen N, Bingle CD, Read RC, Mitchell TJ, Whyte MKB, Shapiro SD, Dockrell DH. Alveolar Macrophage Apoptosis-associated Bacterial Killing Helps Prevent Murine Pneumonia. Am J Respir Crit Care Med 2020; 200:84-97. [PMID: 30649895 DOI: 10.1164/rccm.201804-0646oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rationale: Antimicrobial resistance challenges therapy of pneumonia. Enhancing macrophage microbicidal responses would combat this problem but is limited by our understanding of how alveolar macrophages (AMs) kill bacteria. Objectives: To define the role and mechanism of AM apoptosis-associated bacterial killing in the lung. Methods: We generated a unique CD68.hMcl-1 transgenic mouse with macrophage-specific overexpression of the human antiapoptotic Mcl-1 protein, a factor upregulated in AMs from patients at increased risk of community-acquired pneumonia, to address the requirement for apoptosis-associated killing. Measurements and Main Results: Wild-type and transgenic macrophages demonstrated comparable ingestion and initial phagolysosomal killing of bacteria. Continued ingestion (for ≥12 h) overwhelmed initial killing, and a second, late-phase microbicidal response killed viable bacteria in wild-type macrophages, but this response was blunted in CD68.hMcl-1 transgenic macrophages. The late phase of bacterial killing required both caspase-induced generation of mitochondrial reactive oxygen species and nitric oxide, the peak generation of which coincided with the late phase of killing. The CD68.hMcl-1 transgene prevented mitochondrial reactive oxygen species but not nitric oxide generation. Apoptosis-associated killing enhanced pulmonary clearance of Streptococcus pneumoniae and Haemophilus influenzae in wild-type mice but not CD68.hMcl-1 transgenic mice. Bacterial clearance was enhanced in vivo in CD68.hMcl-1 transgenic mice by reconstitution of apoptosis with BH3 mimetics or clodronate-encapsulated liposomes. Apoptosis-associated killing was not activated during Staphylococcus aureus lung infection. Conclusions: Mcl-1 upregulation prevents macrophage apoptosis-associated killing and establishes that apoptosis-associated killing is required to allow AMs to clear ingested bacteria. Engagement of macrophage apoptosis should be investigated as a novel, host-based antimicrobial strategy.
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Affiliation(s)
- Julie A Preston
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Martin A Bewley
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Helen M Marriott
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - A McGarry Houghton
- 3 Clinical Research Division, Fred Hutchinson Cancer Research Center, and.,4 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Mohammed Mohasin
- 5 Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | | | - Lucy Morris
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Yvonne L Stephenson
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Simon Cross
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom.,7 Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - David R Greaves
- 8 Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Ruth W Craig
- 9 Department of Pharmacology and Toxicology, Geissel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Nico van Rooijen
- 10 Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, the Netherlands
| | - Colin D Bingle
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Robert C Read
- 11 University of Southampton Medical School, Southampton, United Kingdom.,12 National Institute for Health Research Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Timothy J Mitchell
- 13 Institute of Microbiology and Infection, School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom; and
| | - Moira K B Whyte
- 6 MRC Centre for Inflammation Research.,14 Department of Respiratory Medicine, and
| | - Steven D Shapiro
- 15 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David H Dockrell
- 6 MRC Centre for Inflammation Research.,16 Infection Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Kelley WN, Andrews J, Appelt AW, Barber R, Barnett J, Barta L, Bass B, Bone E, Breske L, Bryant HH, Case RA, Coleman K, Cyr R, Dewald SK, Dombroski P, Dubs EL, Feldstein FF, Gay BE, Ginn RE, Gottomoller C, Grant H, Heady J, Hills DG, Jerrod L, Jones K, Kaus C, Lane AL, Leslie JE, Marchette D, Misup M, Morris L, Mullen RN, Payton C, Schmidt J, Schneider D, Share R, Sierck M, Wehr HM, Williams R. Qualitative Ampule and Multitest for Beta-Lactam Residues in Fluid Milk Products: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/65.5.1193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was performed on a rapid Bacillus stearothermophilus agar diffusion ampule method to detect low levels of penicillin G in 7 types of fluid milk products. A multitest technique for processing a large number of samples simultaneously was also studied. Slight modifications were made in the original method to establish more uniformity and to eliminate doubtful responses by specifying a confirmation procedure. Twenty samples spiked with penicillin G (0.000 to 0.008 IU/mL) and tetracycline hydrochloride were frozen and sent to 20 laboratories in the ampule test, and 16 laboratories in the multitest. Each analyst was asked to do a screening run and a confirmation run. Results were reported by color reaction and also as positive or negative for β-lactam inhibitors. The concentrations (penicillin G) where percent positive results equal 100 or not significantly less than 100 (α = 0.05) ranged from 0.005 to 0.007 IU/mi in the ampule test and from 0.004 to 0.007 IU/mL in the multitest. Both techniques have been adopted official first action.
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Growcott EJ, Cariaga TA, Morris L, Zang X, Lopez S, Ansaldi DA, Gold J, Gamboa L, Roth T, Simmons RL, Osborne CS. Pharmacokinetics and pharmacodynamics of the novel monobactam LYS228 in a neutropenic murine thigh model of infection. J Antimicrob Chemother 2020; 74:108-116. [PMID: 30325447 DOI: 10.1093/jac/dky404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives The neutropenic murine thigh infection model and a dose-fractionation approach were used to determine the pharmacokinetic/pharmacodynamic (PK/PD) relationship of LYS228, a novel monobactam antibiotic with activity against Enterobacteriaceae including carbapenem-resistant strains. Methods Mice (n = 4 per group) were inoculated with Enterobacteriaceae strains via intramuscular injection. Two hours post-bacterial inoculation, treatment with LYS228 was initiated. Animals were euthanized with CO2 24 h after the start of therapy and bacterial counts (log10 cfu) per thigh were determined. PK parameters were calculated using free (f) plasma drug levels. Results Following a dose-fractionation study, non-linear regression analysis determined that the predominant PK/PD parameter associated with antibacterial efficacy of LYS228 was the percentage of the dosing interval that free drug concentrations remained above the MIC (%fT>MIC). In a dose-dependent manner, LYS228 reduced the thigh bacterial burden in models established with Enterobacteriaceae producing β-lactamase enzymes of all classes (e.g. ESBLs, NDM-1, KPC, CMY-2 and OXA-48). The range of the calculated static dose was 86-649 mg/kg/day for the isolates tested, and the magnitude of the driver of efficacy was 37-83 %fT>MIC. %fT>MIC was confirmed as the parameter predominantly driving efficacy as evidenced by a strong coefficient of determination (r2 = 0.68). Neutrophils had minimal impact on the effect of LYS228 in the murine thigh infection model. Conclusions LYS228 is efficacious in murine thigh infection models using β-lactamase-producing strains of Enterobacteriaceae, including those expressing metallo-β-lactamases, ESBLs and serine carbapenemases, with the PK/PD driver of efficacy identified as %T>MIC.
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Affiliation(s)
- E J Growcott
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - T A Cariaga
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - L Morris
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - X Zang
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - S Lopez
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - D A Ansaldi
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - J Gold
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - L Gamboa
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - T Roth
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - R L Simmons
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - C S Osborne
- Novartis Institutes for BioMedical Research, Emeryville, CA, USA
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28
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Stavrakis S, Elkholey K, Morris L, Li Y, Po SS. P3512Sex differences in rats with heart failure with preserved ejection fraction and the effect of autonomic modulation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0376] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for 50% of HF and sudden death is the leading cause of mortality. There are considerable sex differences in cardiac structure and function, which may be related to outcomes in HFpEF. Transcutaneous vagus nerve stimulation (tVNS) is antiarrhythmic.
Purpose
To describe sex differences in mortality, autonomic tone and ECG parameters in rats with HFpEF and examine the effect of tVNS on these outcomes.
Methods
Dahl salt sensitive (DS) rats of either sex were randomized into high salt (HS, 8% NaCl) or low salt (LS) diet (0.3% NaCl) at 7 weeks of age. After 6 weeks of LS or HS diets, HS rats were randomized to receive active or sham tVNS, 30min daily (20Hz, 3mA) for 4 weeks. The rats were monitored daily for 4 weeks for the development of HFpEF. ECG and echocardiogram were performed at 13 weeks (baseline) and 17 weeks (endpoint). Heart rate variability (HRV) was calculated at the respective time points. ECG and HRV parameters were analyzed in a blinded fashion. Logistic regression analysis was performed to identify independent predictors of mortality.
Results
A total of 58 rats were included (5 male LS, 6 female LS, 22 male HS and 25 female HS). HS rats developed significant hypertension and signs of HFpEF, while 24% of females and 53% of males died (P=0.004). There were 4 sudden cardiac deaths in males (with ventricular tachycardia documented in 1 rat), whereas all the females died of HF or stroke. Corrected QT (QTc) at baseline significantly prolonged in HS compared to LS rats (250.5±14.4ms vs. 226.8±13.9ms, respectively, p=0.0007), while all other ECG parameters did not differ significantly between groups. In HS rats, QTc prolongation was significantly more pronounced in males compared to females (259.4±20.6ms vs. 243.8±14.5ms, respectively, P=0.002). In univariate analysis, prolonged baseline QTc (OR=1.04; 95% CI 1.01–1.06, p=0.003) and male sex (OR=3.21, 95% CI 1.19–8.66, p=0.016) predicted mortality. However, in multivariate analysis, QTc was the only significant predictor of mortality (OR=1.04; 95% CI 1.01–1.06, p=0.003). After 4 weeks of treatment, active tVNS significantly decreased QTc compared to sham (244.6±13.8ms vs. 255.8±14.0ms, respectively, p=0.017) in both male and female rats in a similar manner. The low frequency to high frequency ratio (LF/HF) of HRV, which reflects sympathovagal balance, was significantly decreased in active tVNS rats compared to sham (0.21±0.13 vs. 0.54±0.14, respectively; p=0.001) in both male and female rats in a similar manner.
Conclusions
Male rats with HFpEF exhibit worse survival compared to females and are at higher risk for sudden death. QTc prolongation accounts for the increased risk of sudden death in males compared to females. Autonomic modulation with tVNS attenuates the unfavorable changes in QTc and HRV induced by HS diet and may be used to prevent ventricular arrhythmias in patients with HFpEF.
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Affiliation(s)
- S Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - K Elkholey
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - L Morris
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Y Li
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - S S Po
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
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29
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Taune M, Ustero P, Hiashiri S, Huang K, Aia P, Morris L, Main S, Chan G, du Cros P, Majumdar SS. Successful implementation of bedaquiline for multidrug-resistant TB treatment in remote Papua New Guinea. Public Health Action 2019; 9:S73-S79. [PMID: 31579654 PMCID: PMC6735455 DOI: 10.5588/pha.18.0071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Bedaquiline (BDQ) was introduced in the multi-drug-resistant tuberculosis (MDR-TB) programme in Daru in remote Papua New Guinea in 2015, along with a core package of active drug-safety monitoring (aDSM). OBJECTIVE To assess interim results and safety of BDQ for the treatment of MDR-TB from 1 July 2015 to 31 December 2017. DESIGN A retrospective cohort analysis of routine programme data. RESULTS Of 277 MDR-TB patients, 77 (39%) received BDQ with a total of 8 serious adverse events including 5 (6.5%) deaths, of which 1 (1.3% QTcF prolongation, grade 3) was attributable to BDQ. Of 200 (61%) patients who did not receive BDQ, there were 17 (9%) deaths. Completeness of monitoring for the BDQ group was 90% for >5 electrocardiograms and 79% for ⩾2 cultures. In the interim result indicator analysis at month 6 in the BDQ and non-BDQ groups, there were respectively 0% and 1% lost to follow-up; 6.5% and 8.5% who died; 94% and 91% in care; and 92% and 96% with negative culture among those monitored. CONCLUSION Early experience in Daru shows BDQ is safe and feasible to implement with aDSM with good interim effectiveness supporting the rapid adoption and scale-up of the 2019 WHO MDR-TB treatment guidelines in the programme and in similar remote settings.
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Affiliation(s)
- M Taune
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - P Ustero
- Burnet Institute, Melbourne, Victoria, Australia
| | - S Hiashiri
- Burnet Institute, Melbourne, Victoria, Australia
| | - K Huang
- Burnet Institute, Melbourne, Victoria, Australia
| | - P Aia
- National TB Program, Port Moresby, Papua New Guinea
| | - L Morris
- Provincial Health Office, Daru, Western Province, Papua New Guinea
| | - S Main
- Burnet Institute, Melbourne, Victoria, Australia
| | - G Chan
- Burnet Institute, Melbourne, Victoria, Australia
| | - P du Cros
- Burnet Institute, Melbourne, Victoria, Australia
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia
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30
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Adepoyibi T, Keam T, Kuma A, Haihuie T, Hapolo M, Islam S, Akumu B, Chani K, Morris L, Taune M. A pilot model of patient education and counselling for drug-resistant tuberculosis in Daru, Papua New Guinea. Public Health Action 2019; 9:S80-S82. [PMID: 31579655 PMCID: PMC6735450 DOI: 10.5588/pha.18.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
Education and counselling for people with drug-resistant tuberculosis (DR-TB) is recommended by the World Health Organization, given the arduous treatment journey. A model of education and counselling involving counsellors and peer counsellors, standard sessions and novel education tools was piloted in the high DR-TB burden context of Daru, Papua New Guinea. The pilot contributed to high retention in care, highlighting the need for investment in scalable models. Future models will need to be adapted as better tolerated regimens are introduced. A focus on patient-centred care requires prioritisation in order to meet the End TB Strategy targets.
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Affiliation(s)
- T Adepoyibi
- Burnet Institute, Melbourne, Victoria, Australia
| | - T Keam
- Burnet Institute, Melbourne, Victoria, Australia
| | - A Kuma
- Burnet Institute, Melbourne, Victoria, Australia
| | - T Haihuie
- Daru General Hospital, Daru, Western Province, Papua New Guinea (PNG)
| | - M Hapolo
- Daru General Hospital, Daru, Western Province, Papua New Guinea (PNG)
| | - S Islam
- Burnet Institute, Melbourne, Victoria, Australia
| | - B Akumu
- Burnet Institute, Melbourne, Victoria, Australia
| | - K Chani
- Burnet Institute, Melbourne, Victoria, Australia
| | - L Morris
- Western Province Health Department, Daru, Western Province, PNG
| | - M Taune
- Daru General Hospital, Daru, Western Province, Papua New Guinea (PNG)
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31
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Morris L, Hiasihri S, Chan G, Honjepari A, Tugo O, Taune M, Aia P, Dakulala P, Majumdar SS. The emergency response to multidrug-resistant tuberculosis in Daru, Western Province, Papua New Guinea, 2014-2017. Public Health Action 2019; 9:S4-S11. [PMID: 31580333 PMCID: PMC6735456 DOI: 10.5588/pha.18.0074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING A response to an outbreak of multidrug-resistant tuberculosis (MDR-TB) on Daru Island, South Fly District (SFD), Western Province, Papua New Guinea (PNG) was implemented by a national emergency response taskforce. OBJECTIVE To describe programmatic interventions for TB in SFD and evaluate characteristics of TB case notifications, drug resistance and treatment outcomes. DESIGN This was a retrospective cohort study based on routine programmatic data for all patients enrolled on TB treatment at Daru General Hospital from 2014 to 2017. RESULTS The response involved high-level political commitment, joint planning, resource mobilisation, community engagement and strengthening TB case detection and treatment. Of 1548 people enrolled on TB treatment, 1208 (78%) had drug-susceptible TB (DS-TB) and 333 (21.5%) had MDR-TB. There was an increase in MDR-TB as a proportion of all TB. Treatment success rates increased over the study period from 55% to 86% for DS-TB, and from 70% to 81% for MDR-TB from 2014 to 2015. The 2014 case notification rate for TB in SFD was 1031/100 000, decreasing to 736/100 000 in 2017. CONCLUSION The outbreak was stabilised through the response from the national and provincial governments and international partners. Additional interventions are needed to decrease the TB burden in Daru.
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Affiliation(s)
- L Morris
- Western Province Health Department, Daru, Western Province, Papua New Guinea (PNG)
| | - S Hiasihri
- Burnet Institute, Melbourne, Victoria, Australia
| | - G Chan
- Burnet Institute, Melbourne, Victoria, Australia
| | - A Honjepari
- Western Province Health Department, Daru, Western Province, Papua New Guinea (PNG)
| | - O Tugo
- Daru General Hospital, Daru, Western Province, PNG
| | - M Taune
- Daru General Hospital, Daru, Western Province, PNG
| | - P Aia
- National Department of Health, Port Morseby, PNG
| | - P Dakulala
- National Department of Health, Port Morseby, PNG
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia
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32
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Kama G, Huang GKL, Taune M, Arura R, Morris L, Kombuk B, Marome A, O'Brien DP. Tuberculosis treatment unmasking leprosy: management of drug-resistant tuberculosis and leprosy co-infection. Public Health Action 2019; 9:S83-S85. [PMID: 31579656 DOI: 10.5588/pha.18.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/13/2019] [Indexed: 11/10/2022] Open
Abstract
Co-infection with tuberculosis (TB) and leprosy is thought to occur infrequently, but has been reported in settings highly endemic for both infectious diseases. We report for the first time a case where treatment for multidrug-resistant TB (MDR-TB) led to the 'unmasking' of clinically silent leprosy through the precipitation of a type-1 immunological reaction. Current treatment regimens for MDR-TB may contain a number of drugs, such as levo-floxacin and clofazimine, which also have activity against M. leprae. A treatment regimen containing drugs active against both mycobacterial species may be used to achieve cure. Individual considerations on drug-drug interactions, potential additive toxicities and other comorbidities should be taken into account.
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Affiliation(s)
- G Kama
- Daru General Hospital, Daru, Western Province, Papua New Guinea (PNG)
| | - G K L Huang
- Burnet Institute, Melbourne, Victoria, Australia
| | - M Taune
- Daru General Hospital, Daru, Western Province, Papua New Guinea (PNG)
| | - R Arura
- Daru General Hospital, Daru, Western Province, Papua New Guinea (PNG)
| | - L Morris
- Western Province Health Department, Daru, PNG
| | - B Kombuk
- Daru General Hospital, Daru, Western Province, Papua New Guinea (PNG)
| | - A Marome
- National Department of Health, Public Health Division, Port Moresby, PNG
| | - D P O'Brien
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
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33
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Kitchin D, Bhiman J, Mvududu D, Oosthuysen B, Lambson B, Madzorera S, Anthony C, Abdool Karim SS, Garrett NJ, Doria-Rose NA, Mascola JR, Morris L, Moore PL. A1 The role of virus-antibody co-evolution in the development of a V3-glycan-directed HIV-1 broadly neutralizing antibody lineage. Virus Evol 2019. [PMCID: PMC6736059 DOI: 10.1093/ve/vez002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Broadly neutralizing antibodies (bNAbs) are essential for a preventative HIV-1 vaccine but have not been elicited through vaccination. bNAbs develop in 20–30 per cent of HIV-1 infections and often target the V3-glycan epitope of the HIV envelope protein (Env). In these individuals, virus-antibody co-evolution is thought to drive the maturation of antibody lineages to neutralization breadth. We used deep sequencing of env genes and antibody transcripts from fourteen time points spanning the first 3 years of infection to characterize the virus-antibody co-evolution in donor CAP255 who developed V3-glycan-specific bNAbs. Sequencing and cloning of env genes, followed by neutralization assays, were used to identify Env mutations associated with neutralization escape from two bNAbs (CAP255.G3 and CAP255.C5) isolated at 149 weeks post-infection (wpi). Sequencing data indicated that CAP255 was co-infected by three related viral variants, all of which had an intact N332 glycan, which persisted in > 90 per cent of later viruses. A recombinant V3-region became fixed from 8 wpi, conferring slight neutralization resistance to CAP255.G3/C5 and other V3-glycan bNAbs. Later, T415R/K substitutions in V4 emerged by 51 wpi and were associated with complete viral escape from CAP255.G3/C5, though not from the polyclonal plasma response. All 93-week and later Envs were resistant to CAP255.G3/C5 and V3-glycan bNAb PGT135. Viral escape by 51 wpi suggested that the CAP255 bNAbs arose earlier, driving escape, but persisted to 149 weeks. This was supported by preliminary deep sequencing of the antibody repertoire that indicated bNAb lineage members were already present in the plasma at 39 wpi. Escape from V3-glycan bNAbs via T415R/K mutations have not previously been shown, suggesting a novel mode of recognition within the V3-glycan supersite. Further work will focus on identifying the bNAb-initiating Env and intermediate bNAb lineage members that were capable of engaging contemporaneous Env neutralization escape mutants. Characterization of Envs that engaged bNAb precursors, as well as those that selected for broader members of the bNAb lineage, will inform the design of immunogens capable of eliciting V3-glycan bNAbs in a novel HIV-1 vaccine regimen.
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Affiliation(s)
- D Kitchin
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | - J Bhiman
- The Scripps Research Institute, La Jolla, CA, USA
| | - D Mvududu
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), South Africa
| | - B Oosthuysen
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), South Africa
| | - B Lambson
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), South Africa
| | - S Madzorera
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | - C Anthony
- Institute of Infectious Disease and Molecular Medicine and Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - S S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu Natal, Durban, South Africa
| | - N J Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu Natal, Durban, South Africa
| | - N A Doria-Rose
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - J R Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - L Morris
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | - P L Moore
- National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), South Africa
- University of the Witwatersrand, Johannesburg, South Africa
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Malone F, McCarthy E, Delassus P, Buhk JH, Fiehler J, Morris L. Embolus Analog Trajectory Paths Under Physiological Flowrates Through Patient-Specific Aortic Arch Models. J Biomech Eng 2019; 141:2734765. [DOI: 10.1115/1.4043832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Indexed: 01/10/2023]
Abstract
Atrial fibrillation (AF) is the most common irregular heartbeat among the world's population and is a major contributor to cardiogenic embolisms and acute ischemic stroke (AIS). However, the role AF flow plays in the trajectory paths of cardiogenic emboli has not been experimentally investigated. A physiological simulation system was designed to analyze the trajectory patterns of bovine embolus analogs (EAs) (n = 720) through four patient-specific models, under three flow conditions: steady flow, normal pulsatile flow, and AF pulsatile flow. It was seen that EA trajectory paths were proportional to the percentage flowrate split of 25–31% along the branching vessels. Overall, AF flow conditions increased trajectories through the left- (LCCA) and right (RCCA)-common carotid artery by 25% with respect to normal pulsatile flow. There was no statistical difference in the distribution of clot trajectories when the clot was released from the right, left, or anterior positions. Significantly, more EAs traveled through the brachiocephalic trunk (BCT) than through the LCCA or the left subclavian. Yet of the EAs that traveled through the common carotid arteries, there was a greater affiliation toward the LCCA compared to the RCCA (p < 0.05).
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Affiliation(s)
- F. Malone
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland e-mail:
| | - E. McCarthy
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland
| | - P. Delassus
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland
| | - J. H. Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - J. Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - L. Morris
- GMedTech, Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway H91 T8NW, Ireland e-mail:
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Morris L, Turner S, Thiruthaneeswaran N, O'Donovan A, Agar M, Simcock R. EP-1646 Radiation Oncology for the Older Person: Defining international standards for trainee education. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32066-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nguyen H, Butow P, Dhillon H, Morris L, Brown A, West K, Sundaresan P. OC-0198 Using PROs and PROMs in routine head and neck cancer care: what do RTs perceive as barriers? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30618-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wheeler JA, Vaghefi H, Liu F, Owens V, Morris L, Denham F, Coody L. Abstract P5-18-12: Effectiveness of Oncotype DX DCIS scoring in a community setting. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-18-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The Oncotype DX DCIS Score was developed to assist in determining a low risk for recurrence subgroup of patients who can avoid radiation therapy following breast conserving surgery. We sought to evaluate our experience using the Oncotype DX DCIS Score and to see if a greater number of patients who did not receive radiation therapy were experiencing a local recurrence than the score predicted.
Between February 23, 2011 and November 29, 2017, 145 women were diagnosed with ductal carcinoma in situ (DCIS) without an invasive component. 126 (87%) underwent breast conserving surgery. Thirty-five underwent Oncotype DX DCIS Score, of whom 26 (74%) were low risk, four were intermediate risk (11%), and five were high risk (14%).
The scores ranged from 0 (7 patients) to 100 (1 patient). Of the 26 patients with low risk scores, one chose to undergo mastectomy, three received radiation therapy, 20 chose observation without radiation therapy, and two patients were unknown because they had no further treatment or follow-up at our facility. Two of the four intermediate risk patients underwent radiation therapy and two did not. Four of the five high risk patients underwent radiation therapy, but one did not.
Twenty-two of the 35 patients who underwent Oncotype DX Score met the criteria for size (based on grade) and margins (at least 3 mm). Ten patients had margins that were less than 3 mm but met the size criteria. Two patients did not meet the size criteria but had at least 3 mm margins. One patient did not meet either the size or margin criteria. None of our 20 patients with low risk Oncotype DX DCIS Score and who met both the size and margin criteria recurred.
With the median follow-up of approximately 2-1/2 years, three of the 21 patients (14%) with low or intermediate risk scores who underwent Oncotype DX DCIS Score and did not receive radiation therapy suffered a local recurrence. The predicted average recurrence risk for these patients based on their Oncotype DX DCIS Score was 12%. Two of these patients who recurred had margins less than 3 mm, and one patient met the size and margin criteria, but had an intermediate risk score.
By comparison, five of 61 (8%) of patients who underwent breast conserving surgery and adjuvant radiation therapy had a local recurrence.
Twenty of the 23 (87%) low risk Oncotype DX DCIS Score patients did not receive radiation therapy and overall 20/35 (57%) of the patients undergoing Oncotype DX DCIS Score did not receive radiation therapy.
Although the follow-up is still relatively short, Oncotype DX DCIS Score allows a considerable number of women to avoid adjuvant radiation therapy.
Citation Format: Wheeler JA, Vaghefi H, Liu F, Owens V, Morris L, Denham F, Coody L. Effectiveness of Oncotype DX DCIS scoring in a community setting [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-18-12.
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Affiliation(s)
- JA Wheeler
- Goshen Center for Cancer Care, Goshen, IN; University of Notre Dame, Notre Dame, IN
| | - H Vaghefi
- Goshen Center for Cancer Care, Goshen, IN; University of Notre Dame, Notre Dame, IN
| | - F Liu
- Goshen Center for Cancer Care, Goshen, IN; University of Notre Dame, Notre Dame, IN
| | - V Owens
- Goshen Center for Cancer Care, Goshen, IN; University of Notre Dame, Notre Dame, IN
| | - L Morris
- Goshen Center for Cancer Care, Goshen, IN; University of Notre Dame, Notre Dame, IN
| | - F Denham
- Goshen Center for Cancer Care, Goshen, IN; University of Notre Dame, Notre Dame, IN
| | - L Coody
- Goshen Center for Cancer Care, Goshen, IN; University of Notre Dame, Notre Dame, IN
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Growcott EJ, Cariaga TA, Morris L, Zang X, Lopez S, Ansaldi DA, Gold J, Gamboa L, Roth T, Simmons RL, Osborne CS. Pharmacokinetics and pharmacodynamics of the novel monobactam LYS228 in a neutropenic murine thigh model of infection. J Antimicrob Chemother 2019; 74:280. [PMID: 30412250 DOI: 10.1093/jac/dky478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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LaPorte J, Leone K, Zhang X, Holland K, Morris L, Bashey A, Solh M, Solomon S. A unique schedule of palonosetron, ondansetron, and dexamethasone for the prevention of delayed nausea and vomiting in patients receiving myeloablative chemotherapy. J Oncol Pharm Pract 2018; 25:1336-1342. [PMID: 30058442 DOI: 10.1177/1078155218790345] [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
Myeloablative chemotherapy administered prior to autologous stem cell transplantation (auto-SCT) is associated with a significant amount of chemotherapy-induced nausea and vomiting (CINV). We conducted a phase II trial to assess the safety, efficacy, and impact on quality of life when palonosetron (PAL) 0.25 mg combined with dexamethasone were given on the final or only day of myeloablative chemotherapy for auto-SCT. The primary end point of this study was the incidence of achieving a delayed CINV complete response defined as no emetic episode and no use of rescue medications during the 24-120 h period post chemotherapy. Eighty-five patients were enrolled in the study and received PAL. A delayed CINV complete response was achieved in 15% of patients. A multivariate analysis demonstrated no associated differences between age, gender, diagnosis, or regimen. By day 5 after PAL, the mean nausea severity was 0.91 ± 2.45 vs. 0.09 ± 1.58 at baseline (p = 0.012). Quality of life measurements demonstrated similar quality of life between baseline and day 3. By day 6 however, nausea alone had a statistically significant impact on quality of life. In our study, PAL controlled nausea severity and sustained quality of life, but further strategies are needed to control delayed CINV associated with the auto-SCT process.
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Affiliation(s)
- J LaPorte
- 1 Northside Hospital, Department of Pharmacy, Atlanta, GA, USA
| | - K Leone
- 1 Northside Hospital, Department of Pharmacy, Atlanta, GA, USA
| | - X Zhang
- 2 The University of Texas School of Public Health, Houston, TX, USA
| | - K Holland
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - L Morris
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - A Bashey
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - M Solh
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - S Solomon
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
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Morris L, Horne M, McEvoy P, Williamson T. Communication training interventions for family and professional carers of people living with dementia: a systematic review of effectiveness, acceptability and conceptual basis. Aging Ment Health 2018; 22:863-880. [PMID: 29125324 DOI: 10.1080/13607863.2017.1399343] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To update previous reviews and provide a more detailed overview of the effectiveness, acceptability and conceptual basis of communication training-interventions for carers of people living with dementia. METHOD We searched CINAHL Plus, MEDLINE and PsycINFO using a specific search and extraction protocol, and PRISMA guidelines. Two authors conducted searches and extracted studies that reported effectiveness, efficacy or acceptability data regarding a communication training-intervention for carers of people living with dementia. Risk of bias was assessed using the Cochrane Collaboration guidelines. Quality of qualitative studies was also systematically assessed. RESULTS Searches identified 450 studies (after de-duplication). Thirty-eight studies were identified for inclusion in the review. Twenty-two studies focused on professional carers; 16 studies focused mainly on family carers. Training-interventions were found to improve communication and knowledge. Overall training-interventions were not found to significantly improve behaviour that challenges and caregiver burden. Acceptability levels were high overall, but satisfaction ratings were found to be higher for family carers than professional carers. Although many interventions were not supported by a clear conceptual framework, person-centred care was the most common framework described. CONCLUSION This review indicated that training-interventions were effective in improving carer knowledge and communication skills. Effective interventions involved active participation by carers and were generally skills based (including practicing skills and discussion). However, improvements to quality of life and psychological wellbeing of carers and people living with dementia may require more targeted interventions.
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Affiliation(s)
- L Morris
- a Six Degrees Social Enterprise , Salford , UK.,b Institute of Dementia , University of Salford , Salford , M6 6PU , UK
| | - M Horne
- a Six Degrees Social Enterprise , Salford , UK.,c School of Health and Society , University of Salford , Salford , M6 6PU , UK
| | - P McEvoy
- a Six Degrees Social Enterprise , Salford , UK
| | - T Williamson
- b Institute of Dementia , University of Salford , Salford , M6 6PU , UK.,c School of Health and Society , University of Salford , Salford , M6 6PU , UK
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Malda Castillo J, Smith I, Morris L, Perez-Algorta G. Violent incidents in a secure service for individuals with learning disabilities: Incident types, circumstances and staff responses. J Appl Res Intellect Disabil 2018; 31:1164-1173. [PMID: 29953700 DOI: 10.1111/jar.12490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/09/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The issue of violence in secure services has long been recognized both in the UK and worldwide. However, there is currently scarce literature available about violence within learning disability (LD) secure settings. METHODS Secondary data analysis was conducted on violent incidents, using information routinely collected by the staff over a 1-year period. RESULTS Physical assaults were the most frequent type of incident, and the distribution in terms of days or months was homogenous and incidents were concentrated in the corridors, lounges and dining rooms of secure facilities. Antipsychotic medication was not regularly prescribed. Generalized linear modelling analyses revealed significant predictors that increased the chances of seclusion and physical restraint, such as being female or directing the violence towards staff. CONCLUSIONS These findings can inform staff training on violence prevention and suggest that increased ward-based supervision and enhanced use of psychological formulations may help in reducing violence within this service context.
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Affiliation(s)
- Javier Malda Castillo
- Furness College, Lancaster University, Lancaster, England.,Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
| | - Ian Smith
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
| | - Lucy Morris
- Mersey Care NHS Foundation Trust, Lancaster, England
| | - Guillermo Perez-Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
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Ashton RA, Morris L, Smith I. A qualitative meta-synthesis of emergency department staff experiences of violence and aggression. Int Emerg Nurs 2018; 39:13-19. [PMID: 29326038 DOI: 10.1016/j.ienj.2017.12.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/22/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patient and visitor violence or aggression against healthcare workers in the Emergency Department (ED) is a significant issue worldwide. This review synthesises existing qualitative studies exploring the first-hand experiences of staff working in the ED to provide insight into preventing this issue. METHOD A meta-ethnographic approach was used to review papers. RESULTS Four concepts were identified: 'The inevitability of violence and aggression'; 'Staff judgments about why they face violence and aggression'; 'Managing in isolation'; and 'Wounded heroes'. DISCUSSION Staff resigned themselves to the inevitability of violence and aggression, doing this due to a perceived lack of support from the organisation. Staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor. Staff often felt isolated when managing violence and aggression. Key recommendations included: Staff training in understanding violence and aggression and clinical supervision. CONCLUSION Violence and aggression in the ED can often be an overwhelming yet inevitable experience for staff. A strong organisational commitment to reducing violence and aggression is imperative.
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Affiliation(s)
| | - Lucy Morris
- Merseycare NHS Foundation Trust, Whalley, Lancashire BB7 9PE, UK
| | - Ian Smith
- Furness College, Lancaster University, Lancaster LA1 4YG, UK.
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Stein M, Morris L, Martin M. MA 06.07 JAK Pseudokinase Domain Variants Highlight nRTK nsSNPs Identified with Next-Generation Sequencing in NSCLC Patients. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Riaz N, Sherman E, Katabi N, Leeman J, Higginson D, Boyle J, Singh B, Morris L, Wong R, Tsai C, Schupak K, Gelblum D, McBride S, Hatzoglou V, Baxi S, Pfister D, Dave A, Humm J, Schoder H, Lee N. A Personalized Approach Using Hypoxia Resolution to Guide Curative-Intent Radiation Therapy Dose-Reduction to 30 Gy: A Novel De-escalation Paradigm for HPV-Associated Oropharynx Cancers Treated With Concurrent Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Morris L, Smirnov A, Kvassay A, Leslie E, Kavanagh R, Alexander N, Davey G, Williams O, Gilks C, Najman J. P40 Initial outcomes of integrated community-based hepatitis C treatment for people who inject drugs: findings from the Queensland injectors’ health network. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Morris L, Thiruthaneeswaran N, Lehman M, Hasselburg G, Turner S. EP-1407: Are future radiation oncologists equipped with the knowledge to manage elderly cancer patients? Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Anderson M, Morris L, Tang D, Batsides G, Kirtane A, Hanson I, Meraj P, Kapur N, O'Neill W. Impella RP Post Approval Study: First Multi-Center, Prospective Post Market Approval Results for the Impella RP in Patients with Right Ventricular Failure. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mabvakure B, Scheepers C, Nonyane M, Lambson B, Madzorera S, Kitchin D, Bhiman J, Wibmer K, Abdool Karim S, Williamson C, Morris L, Moore PL. A38 Diversity analyses of HIV-1 envelope glycoproteins in HIV-infected individuals with and without broadly neutralizing antibodies. Virus Evol 2017; 3:vew036.037. [PMID: 28845277 PMCID: PMC5565991 DOI: 10.1093/ve/vew036.037] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Mabvakure
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - C Scheepers
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - M Nonyane
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - B Lambson
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - S Madzorera
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - D Kitchin
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - J Bhiman
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - K Wibmer
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Kwa-Zulu Natal
| | - C Williamson
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Kwa-Zulu Natal
| | - L Morris
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
| | - P L Moore
- National Health Laboratory Service, Center for HIV and STIs, National Institute for Communicable Diseases, Johannesburg
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Voon V, Droux F, Morris L, Chabardes S, Bougerol T, David O, Krack P, Polosan M. Decisional impulsivity and the associative-limbic subthalamic nucleus in obsessive-compulsive disorder: subthalamic stimulation and intrinsic functional connectivity. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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