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Kiyak C, Ijezie OA, Ackah JA, Armstrong M, Cowen J, Cetinkaya D, Burianová H, Akudjedu TN. Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion : A Systematic Literature Review. Clin Neuroradiol 2024; 34:13-31. [PMID: 37697012 PMCID: PMC10881816 DOI: 10.1007/s00062-023-01344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE This systematic review is aimed at synthesising the literature base to date on the frequency and topographical distribution of neuroanatomical changes seen on imaging following COVID-19 invasion with a focus on both the acute and chronic phases of the disease. METHODS In this study, 8 databases were systematically searched to identify relevant articles published from December 2019 to March 2022 and supplemented with a manual reference search. Data were extracted from the included studies and narrative synthesis was employed to integrate the findings. RESULTS A total of 110 studies met the inclusion criteria and comprised 119,307 participants (including 31,073 acute and 143 long COVID-19 patients manifesting neurological alterations) and controls. Considerable variability in both the localisation and nature of neuroanatomical abnormalities are noted along the continuum with a wide range of neuropathologies relating to the cerebrovascular/neurovascular system, (sub)cortical structures (including deep grey and white matter structures), brainstem, and predominant regional and/or global alterations in the cerebellum with varying degrees of spinal involvement. CONCLUSION Structural regional alterations on neuroimaging are frequently demonstrated in both the acute and chronic phases of SARS-CoV‑2 infection, particularly prevalent across subcortical, prefrontal/frontal and cortico-limbic brain areas as well as the cerebrovascular/neurovascular system. These findings contribute to our understanding of the acute and chronic effects of the virus on the nervous system and has the potential to provide information on acute and long-term treatment and neurorehabilitation decisions.
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Affiliation(s)
- Ceyda Kiyak
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
- School of Psychology, University of East Anglia, Norwich, UK
| | | | - Joseph A Ackah
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Sciences, Bournemouth University, 8 8GP, Bournemouth, UK
| | - Matthew Armstrong
- Department of Rehabilitation & Sports Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Jake Cowen
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Deniz Cetinkaya
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Hana Burianová
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Sciences, Bournemouth University, 8 8GP, Bournemouth, UK.
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Win KZ, Armstrong M, Steeds RP, Kalla M. Feasibility study of Glucagon-like peptide-1 analogues for the optimization of Outcomes in obese patients undergoing AbLation for Atrial Fibrillation (GOAL-AF) protocol. Pilot Feasibility Stud 2024; 10:36. [PMID: 38383462 PMCID: PMC10880291 DOI: 10.1186/s40814-024-01454-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Catheter ablation for atrial fibrillation is recommended for symptomatic patients after failed medical therapy. Ablation has a higher failure rate in obese patients, and both the prevalence of atrial fibrillation and obesity are increasingly globally. The outcome of ablation can be improved if obese patients can achieve goal-oriented weight reduction prior to ablation. Conventional weight loss strategies, however, can be difficult to access and can delay ablation, thereby risking a lower chance of maintaining sinus rhythm. Effective weight-loss medications, such as the glucagon-like peptide inhibitor-1 drugs, offer the potential for incremental impact on weight loss over a shorter period of time as a bridging therapy. The aim of this study is to assess the feasibility of using liraglutide, a glucagon-like peptide inhibitor-1, in producing weight loss in obese patients before catheter ablation. METHODS The study is an open-label, uncontrolled, prospective single-centre feasibility study of daily liraglutide injections in the treatment of obese patients for at least 13 weeks before and 52 weeks after AF ablation. Adult patients with symptomatic AF whose body mass index ≥ 30 will be recruited from those planning to undergo ablation. Feasibility will be determined based on the recruitment rate, adherence to the medication, and the amount of weight loss achieved over the study period. Exploratory outcomes include changes in atrial structure, function, and fibrosis with weight loss evaluated by cardiac magnetic resonance imaging, electroanatomic mapping, and patient-reported outcome measure. DISCUSSION This study will allow us to determine whether the use of liraglutide in obese patients with atrial fibrillation undergoing ablation is feasible with adequate recruitment. The additional information on adherence and average weight loss over the study period will inform the design of a future definitive randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov ( NCT05221229 ). Registered on 2 February 2022. TRIAL FUNDING Metchley Park Medical Society and University of Birmingham Starter Fellowship, British Heart Foundation Accelerator Grant, Abbott Investigator-Initiated Study Grant.
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Affiliation(s)
- Kyaw Z Win
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Matthew Armstrong
- Department of Hepatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard P Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Manish Kalla
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
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Park J, Berman J, Dodson A, Liu Y, Armstrong M, Huang H, Kaber D, Ruiz J, Zahabi M. Assessing workload in using electromyography (EMG)-based prostheses. Ergonomics 2024; 67:257-273. [PMID: 37264794 DOI: 10.1080/00140139.2023.2221413] [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] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
Using prosthetic devices requires a substantial cognitive workload. This study investigated classification models for assessing cognitive workload in electromyography (EMG)-based prosthetic devices with various types of input features including eye-tracking measures, task performance, and cognitive performance model (CPM) outcomes. Features selection algorithm, hyperparameter tuning with grid search, and k-fold cross-validation were applied to select the most important features and find the optimal models. Classification accuracy, the area under the receiver operation characteristic curve (AUC), precision, recall, and F1 scores were calculated to compare the models' performance. The findings suggested that task performance measures, pupillometry data, and CPM outcomes, combined with the naïve bayes (NB) and random forest (RF) algorithms, are most promising for classifying cognitive workload. The proposed algorithms can help manufacturers/clinicians predict the cognitive workload of future EMG-based prosthetic devices in early design phases.Practitioner summary: This study investigated the use of machine learning algorithms for classifying the cognitive workload of prosthetic devices. The findings suggested that the models could predict workload with high accuracy and low computational cost and could be used in assessing the usability of prosthetic devices in the early phases of the design process.Abbreviations: 3d: 3 dimensional; ADL: Activities for daily living; ANN: Artificial neural network; AUC: Area under the receiver operation characteristic curve; CC: Continuous control; CPM: Cognitive performance model; CPM-GOMS: Cognitive-Perceptual-Motor GOMS; CRT: Clothespin relocation test; CV: Cross validation; CW: Cognitive workload; DC: Direct control; DOF: Degrees of freedom; ECRL: Extensor carpi radialis longus; ED: Extensor digitorum; EEG: Electroencephalogram; EMG: Electromyography; FCR: Flexor carpi radialis; FD: Flexor digitorum; GOMS: Goals, Operations, Methods, and Selection Rules; LDA: Linear discriminant analysis; MAV: Mean absolute value; MCP: Metacarpophalangeal; ML: Machine learning; NASA-TLX: NASA task load index; NB: Naïve Bayes; PCPS: Percent change in pupil size; PPT: Purdue Pegboard Test; PR: Pattern recognition; PROS-TLX: Prosthesis task load index; RF: Random forest; RFE: Recursive feature selection; SHAP: Southampton hand assessment protocol; SFS: Sequential feature selection; SVC: Support vector classifier.
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Affiliation(s)
- Junho Park
- Wm Michael Barnes '64 Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Joseph Berman
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
| | - Albert Dodson
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC, USA
| | - Yunmei Liu
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, USA
| | - Matthew Armstrong
- Intercollegiate School of Engineering Medicine, Texas A&M University, Houston, TX, USA
| | - He Huang
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC, USA
| | - David Kaber
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, USA
| | - Jaime Ruiz
- Department of Computer & Information Science & Engineering, University of Florida, Gainesville, FL, USA
| | - Maryam Zahabi
- Wm Michael Barnes '64 Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX, USA
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Buckey CR, Armstrong M, Chitsazzadeh S, Hobbis D, Clouser EL, Patel SH, Smetanick J, Pettit J, Rong Y. A Free, Open-Source Toolkit to Produce 3D Bolus in the Clinic. Int J Radiat Oncol Biol Phys 2023; 117:e646. [PMID: 37785922 DOI: 10.1016/j.ijrobp.2023.06.2062] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Tissue-equivalent, tissue-approximating and tissue-replacing bolus materials have been in use for decades in radiotherapy. Most frequently these materials are applied to a patient's skin to bring the highest dose region towards the surface of the skin-which is the location of the target. These materials can be applied at the time of simulation and included in a planning CT scan, or can be added during the planning process and first physically applied at the time of treatment. One of the most widely adopted materials for bolus has been sheets of a commercially available proprietary synthetic gel, which is uniform in thickness, and has some ability to match the curvature of the patient's body. Recently investigators have worked to create boluses using 3D printing technology, including several commercially available offerings. We hypothesized that we could create a bespoke, 3D bolus solution, using a series of open-source and free software products. MATERIALS/METHODS For an anthropomorphic phantom, a radiation treatment plan representative of skin cancer treatment was designed, this included a superficial target. The DICOM CT and structure set were imported into 3D Slicer, which is a free, open-source software for visualization, processing, segmentation, and registration. Using 3D Slicer, the bolus structure was saved as an STL file. Meshmixer, a free software for working with triangle meshes, was used to complete a mold design, and the mold parts were then printed using a rigid filament on a 3D printer. The mold parts were glued together, and small spring clamps were used secure the walls to the shells to ensure mold integrity. The mold was then filled with a thinned and degassed silicone. After appropriate curing, demolding was completed by removing the clamps and separating the walls. After QA, the bolus was applied to the anthropomorphic phantom and CTs were taken to compare a commercial sheet bolus with the in-house 3D printed product. RESULTS The bolus made via the in-house 3D printing process fit even complicated patient geometries well, and had both an obvious visual/goodness of fit advantage over the commercial sheet bolus and a nuanced dosimetric improvement as the air gaps present in the commercial sheet bolus were not desirable nor reproducible. The overall in-house workflow was efficient, and clinically reasonable (an estimated time of 72 hours was presented to the physician team, but in testing less than 24 hours was needed from export to delivery of the finished product). CONCLUSION In this work we explored whether motivated groups and departments could produce dosimetrically accurate and clinically reasonable custom boluses for patients undergoing radiotherapy to a superficial area of the body, using a test case on an anthropomorphic phantom. We found that this was absolutely achievable and could be implemented with no funds spent on software or licenses. Provided that a 3D printer, filament and silicone are available, any thoughtful practice can join the bespoke-bolus-club.
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Armstrong M, Hume E, McNeillie L, Chambers F, Wakenshaw L, Burns G, Heslop Marshall K, Vogiatzis I. Cognitive behavioural therapy combined with physical activity behavioural modification strategies during pulmonary rehabilitation in patients with COPD. ERJ Open Res 2023; 9:00074-2023. [PMID: 37701362 PMCID: PMC10493712 DOI: 10.1183/23120541.00074-2023] [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: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction Patients with COPD who exhibit elevated levels of anxiety and/or depression are typically less able to improve symptoms and physical activity levels following a programme of pulmonary rehabilitation (PR). The objective of the present study was to provide proof of concept that offering an intervention comprising cognitive behavioural therapy (CBT) alongside physical activity behavioural modification strategies (BPA) during PR is more effective in improving physical activity outcomes compared to PR and CBT alone. Methods 32 patients with COPD (mean±sd forced expiratory volume in 1 s 42±14% predicted) were assigned 1:1 to receive PR+CBT+BPA or PR+CBT. BPA comprised motivational interviews, step-count monitoring, feedback using a pedometer and goal setting. Assessments included accelerometer-derived steps per day, movement intensity, 6-min walk distance (6MWD) and Hospital Anxiety and Depression Scale (HADS) scores. Results The magnitude of improvement across physical activity outcomes was greater for the PR+CBT+BPA compared to the PR+CBT intervention (by 829 steps per day (p=0.029) and by 80±39 vector magnitude units (p=0.042), respectively). Compared to PR and CBT alone, the PR+CBT+BPA intervention induced greater clinically meaningful improvements in HADS anxiety scores (by -2 units, 95% CI -4-1 units) and 6MWD (by 33±20 m). Conclusions Providing anxious and/or depressed patients with COPD with a combined intervention of CBT and BPA during PR presents more favourable improvements in physical activity outcome measures compared to CBT alone during PR.
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Affiliation(s)
- Matthew Armstrong
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Laura McNeillie
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Francesca Chambers
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Lynsey Wakenshaw
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Graham Burns
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK
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Sim BZ, Aaron L, Coulter C, Parkes-Smith J, Badrick T, May K, Armstrong M, Hendry S, Sundac L, Dang L, Ho J, Hanson J, Smith S, Choong K, Henderson AH, Bursle E. A multi-centre retrospective study of Nocardia speciation and antimicrobial susceptibility in Queensland, Australia. Eur J Clin Microbiol Infect Dis 2023; 42:339-345. [PMID: 36720769 DOI: 10.1007/s10096-022-04542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/15/2022] [Indexed: 02/02/2023]
Abstract
The study aims to characterise the species identification and antimicrobial susceptibility testing (AST) results of Nocardial isolates from adult patients across major public hospitals in Queensland, Australia, over a 15-year period. A multi-centre retrospective observational study of Nocardia sp. isolates was conducted from 7 major public hospitals in Queensland, Australia, over a 15-year period. Clinical samples from patients aged ≥ 18 years that isolated Nocardia sp. were included. Demographic and clinical data were collected, along with species identification and AST results. Overall, 484 Nocardia sp. were isolated. Most patients were male (297, 61%) with a mean (IQR) age of 60 (51-75) and a median (IQR) Charlson Comorbidity Index of 4 (2-6). Of these, 239 (49%) patients were immunosuppressed. Organisms were most frequently isolated from sputum (174, 36%), and superficial swabs (102, 21%). Patients presented with pulmonary infections (165, 35%) and superficial skin and soft tissue infections (87, 18%) most commonly. One hundred (21%) isolates were deemed pulmonary colonisation and were not treated. Of the speciated organisms, N. nova complex was the most common (93, 19%), followed by N. farcinica complex (79, 16%). Organisms were reliably susceptible to linezolid (240/245, 98%), amikacin (455/470, 97%), and trimethoprim/sulfamethoxazole (459/476, 96%), but less so to imipenem (243/472, 51%) and ceftriaxone (261/448, 58%). This is the largest Australian description of Nocardia sp. to date. Given antimicrobials are often commenced prior to AST results and sometimes even speciation, characterisation of local species and antibiogram data is important to guide empiric choices and local guidelines.
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Affiliation(s)
- B Z Sim
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia. .,Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia. .,University of Queensland, St. Lucia, QLD, 4072, Australia.
| | - L Aaron
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - C Coulter
- Queensland Mycobacterium Reference Laboratory, Herston Road, Herston, QLD, 4029, Australia
| | - J Parkes-Smith
- The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
| | - T Badrick
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - K May
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - M Armstrong
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - S Hendry
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - L Sundac
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - L Dang
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - J Ho
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia
| | - J Hanson
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia.,Kirby Institute, High Street, Kensington, NSW, 2052, Australia
| | - S Smith
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia
| | - K Choong
- Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4575, Australia
| | - A H Henderson
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - E Bursle
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.,University of Queensland, St. Lucia, QLD, 4072, Australia
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Pollok JM, Tinguely P, Berenguer M, Niemann CU, Raptis DA, Spiro M, Dominguez B, Muller E, Rando K, Enoch MA, Tamir N, Healy P, Manser T, Briggs T, Chaudhary A, Humar A, Jafarian A, Soin AS, Eghtesad B, Miller C, Cherqui D, Samuel D, Broering D, Pomfret E, Villamil F, Durand F, Berlakovich G, McCaughan G, Auzinger G, Testa G, Klintmalm G, Belghiti J, Findlay J, Lai J, Fung J, Klinck J, Roberts J, Liu L, Cattral M, Ghobrial M, Selzner M, Ramsay M, Rela M, Ascher N, Man NK, Selzner N, Burra P, Friend P, Busuttil R, Hwang S, McCluskey S, Mas V, Vohra V, Vij V, Merritt W, Tokat Y, Kang Y, Chan A, Mazzola A, Hessheimer A, Rammohan A, Hogan B, Vinaixa C, Nasralla D, Victor D, De Martin E, Alconchel F, Roll G, Kabacam G, Sapisochin G, Campos-Varela I, Liu J, Patel MS, Izzy M, Kalisvaart M, Adams M, Goldaracena N, Tinguely P, Hernandez-Alejandro R, Chadha R, Shaker TM, Klair TS, Pan T, Tanaka T, Yoon U, Kirchner V, Hannon V, Cheah YL, Frola C, Morkane C, Milliken D, Lurje G, Potts J, Fernandez T, Badenoch A, Mukhtar A, Zanetto A, Montano-Loza A, Chieh AKW, Shetty A, DeWolf A, Olmos A, Mrzljak A, Blasi A, Berzigotti A, Malik A, Rajakumar A, Davidson B, O'Farrell B, Kotton C, Imber C, Kwon CHD, Wray C, Ahn CS, Morkane C, Krenn C, Quintini C, Maluf D, Mina DS, Sellers D, Balci D, Patel D, Rudow DL, Monbaliu D, Bezinover D, Krzanicki D, Milliken D, Kim DS, Brombosz E, Blumberg E, Weiss E, Wey E, Kaldas F, Saliba F, Pittau G, Wagener G, Song GW, Biancofiore G, Testa G, Crespo G, Rodríguez G, Palli GM, McKenna G, Petrowsky H, Egawa H, Montasser I, Pirenne J, Eason J, Guarrera J, Pomposelli J, Lerut J, Emond J, Boehly J, Towey J, Hillingsø JG, de Jonge J, Potts J, Caicedo J, Heimbach J, Emamaullee JA, Bartoszko J, Ma KW, Kronish K, Forkin KT, Chok KSH, Olthoff K, Reyntjens K, Lee KW, Suh KS, Denehy L, van der Laan LJ, McCormack L, Gorvin L, Ruffolo L, Bhat M, Ramírez MAM, Londoño MC, Gitman M, Levstik M, Selzner M, de Santibañes M, Lindsay M, Parotto M, Armstrong M, Kasahara M, Schofield N, Rizkalla N, Akamatsu N, Scatton O, Keskin O, Imventarza O, Andacoglu O, Muiesan P, Giorgio P, Northup P, Matins P, Abt P, Newsome PN, Dutkowski P, Bhangui P, Bhangui P, Tandon P, Brustia R, Planinsic R, Brown R, Porte R, Barth R, Ciria R, Florman S, Dharancy S, Pai SL, Yagi S, Nadalin S, Chinnakotla S, Forbes SJ, Rahman S, Hong SK, Liying S, Orloff S, Rubman S, Eguchi S, Ikegami T, Reichman T, Settmacher U, Aluvihare V, Xia V, Yoon YI, Soejima Y, Genyk Y, Jalal A, Borakati A, Gustar A, Mohamed A, Ramirez A, Rothnie A, Scott A, Sharma A, Munro A, Mahay A, Liew B, Hidalgo C, Crouch C, Yan CT, Tschuor C, Shaw C, Schizas D, Fritche D, Huda FF, Wells G, Farrer G, Kwok HT, Kostakis I, Mestre-Costa J, Fan KH, Fan KS, Fraser K, Jeilani L, Pang L, Lenti L, Kathirvel M, Zachiotis M, Vailas M, Milan MM, Elnagar M, Alradhawi M, Dimitrokallis N, Machairas N, Morare N, Yeung O, Khanal P, Satish P, Ghani SA, Makhdoom S, Arulrajan S, Bogan S, Pericleous S, Blakemore T, Otti V, Lam W, Jackson W, Abdi Z. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference. Lancet Gastroenterol Hepatol 2023; 8:81-94. [PMID: 36495912 DOI: 10.1016/s2468-1253(22)00268-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/12/2022]
Abstract
There is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices.
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Affiliation(s)
- Joerg M Pollok
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Pascale Tinguely
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, NHS Foundation Trust, London, UK
| | - Marina Berenguer
- Liver Unit, CIBERehd, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe-Universidad de Valencia, Valencia, Spain
| | - Claus U Niemann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA; Department of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, CA, USA
| | - Dimitri A Raptis
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Michael Spiro
- Department of Anaesthesia and Intensive Care Medicine, Royal Free Hospital, NHS Foundation Trust, London, UK; The Royal Free Perioperative Research Group, Royal Free Hospital, NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
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Yoon J, Armstrong M, Cotton C, Mense M, Allaire N. 592 Ribosome profiling reveals distinct translation termination kinetics and efficiency between Fischer rat thyroid and human bronchial epidermal cells. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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9
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Bukis K, Cheng Y, Armstrong M, Conte J, Coote K, Allaire N, Sivachenko A, Mense M, Cotton C, Valley H. 634 Generation of a cystic fibrosis transmembrane conductance regulator R1162X “TAG” model and comparison of readthrough to the naturally occurring R1162X “TGA”. J Cyst Fibros 2022. [PMCID: PMC9527874 DOI: 10.1016/s1569-1993(22)01324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Allaire N, Yoon J, Armstrong M, Valley H, Macadino C, Sivachenko A, Conte J, Tabak B, Bihler H, Cheng Y, Coote K, Cotton C, Mense M. 663 Modulation of cystic fibrosis transmembrane conductance regulator intron 22 alternative polyadenylation use may have therapeutic potential for the treatment of certain 3′ cystic fibrosis transmembrane conductance regulator premature termination codon variants. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01353-4] [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: 11/06/2022]
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11
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Armstrong M, Czechanski A, Chen Q, Swanzey E, O’Connor C, Reinholdt L. LP-65 Interstrain variation of cellular dose response traits in mouse pluripotent stem cells establishes feasibility for population-based studies of genetic susceptibility to triphenyl phosphate exposure. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Gille T, Sivapalan P, Kaltsakas G, Kolekar SB, Armstrong M, Tuffnell R, Evans RA, Vagheggini G, Degani-Costa LH, Vicente C, Das N, Poberezhets V, Rolland-Debord C, Bayat S, Vogiatzis I, Franssen FME, Pinnock H, Vanfleteren LEGW. ERS International Congress 2021: highlights from the Respiratory Clinical Care and Physiology Assembly. ERJ Open Res 2022; 8:00710-2021. [PMID: 35615417 PMCID: PMC9125042 DOI: 10.1183/23120541.00710-2021] [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] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, randomised controlled trials and qualitative research that were presented during the 2021 European Respiratory Society International Congress within the sessions from the five groups of the Assembly 1 - Respiratory clinical care and physiology. Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging.
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Affiliation(s)
- Thomas Gille
- Service de Physiologie et Explorations Fonctionnelles, Centre Hospitalier Universitaire Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm U1272 "Hypoxia and the Lung", UFR Santé - Médecine - Biologie Humaine Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre of Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,1st Respiratory Medicine Dept, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Shailesh B Kolekar
- Dept of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Matthew Armstrong
- Dept of Rehabilitation and Sport Sciences, Bournemouth University, Poole, UK
| | - Rachel Tuffnell
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachael A Evans
- NIHR Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK.,Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Guido Vagheggini
- Dept of Medical Specialties, Chronic Respiratory Failure Care Pathway, Azienda USL Toscana Nordovest, Volterra, Italy.,Fondazione Volterra Ricerche Onlus, Volterra, Italy
| | | | | | - Nilakash Das
- Laboratory of Respiratory Diseases and Thoracic Surgery, Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Vitalii Poberezhets
- Dept of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Camille Rolland-Debord
- Service de Pneumologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sam Bayat
- Service de Pneumologie et de Physiologie, CS10217, CHU Grenoble, Grenoble, France.,Univ. Grenoble Alpes, Inserm UA07 STROBE, Grenoble, France
| | - Ioannis Vogiatzis
- Dept of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Frits M E Franssen
- Dept of Research and Development, Ciro, Horn, the Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Lowie E G W Vanfleteren
- COPD Center, Dept of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Gimblet C, Armstrong M, Nuckols V, Stroud AK, Guerrero M, Pierce G. Aortic Stiffness is Negatively Associated with Microvascular Glycocalyx Thickness and Microvascular Perfusion among Older Adults: Role of Carotid Pressure Pulsatility. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Pincot A, Armstrong M. Novel tensorial Thixo-Visco-Plastic framework for rheological characterization of human blood. Sci Rep 2021; 11:22004. [PMID: 34754014 PMCID: PMC8578634 DOI: 10.1038/s41598-021-01362-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022] Open
Abstract
Characterizing human blood, a complex material with a spectrum of thixo-elasto-visco-plastic properties, through the development of more effective and efficient models has achieved special interest of late. This effort details the development a new approach, the tensorial-enhanced-Thixo-Visco-Plastic model (t-e-TVP), which integrates elements from the proven Bingham and generalized Maxwell systems to create a more robust framework and subsequently cast into a tensorial format. Here, the elastic and viscoelastic stress contributions from the microstructure are superimposed upon the viscoelastic backbone solution for stress offered by the modified TVP frame. The utility of this novel model is tested against the contemporary tensorial-ethixo-mHAWB (t-ethixo-mHAWB) framework, a similar model with a greater number of parameters, using rheological data of human blood collected on an ARESG2 strain-controlled rheometer. The blood samples are parametrically and statistically analyzed, entailing the comparison of the t-e-TVP and t-ethixo-mHAWB models with their capacity to accurately predict small and large amplitude oscillatory shear as well as unidirectional large amplitude oscillatory shear flow in blood.
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Affiliation(s)
- André Pincot
- Department of Chemistry and Life Science, Chemical Engineering Program, United States Military Academy, West Point, NY, 10996, USA
| | - Matthew Armstrong
- Department of Chemistry and Life Science, Chemical Engineering Program, United States Military Academy, West Point, NY, 10996, USA.
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15
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Alexiou C, Ward L, Hume E, Armstrong M, Wilkinson M, Vogiatzis I. Effect of interval compared to continuous exercise training on physiological responses in patients with chronic respiratory diseases: A systematic review and meta-analysis. Chron Respir Dis 2021; 18:14799731211041506. [PMID: 34666528 PMCID: PMC8532221 DOI: 10.1177/14799731211041506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Current evidence suggests that interval exercise training (IET) and continuous exercise training (CET) produce comparable benefits in exercise capacity, cardiorespiratory fitness and symptoms in patients with chronic obstructive pulmonary disease (COPD). However, the effects of these modalities have only been reviewed in patients with COPD. This meta-analysis compares the effectiveness of IET versus CET on exercise capacity, cardiorespiratory fitness and exertional symptoms in patients with chronic respiratory diseases (CRDs). Methods: PubMed, CINHAL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Nursing and Allied health were searched for randomised controlled trials from inception to September 2020. Eligible studies included the comparison between IET and CET, reporting measures of exercise capacity, cardiorespiratory fitness and symptoms in individuals with CRDs. Results: Thirteen randomised control trials (530 patients with CRDs) with fair to good quality on the PEDro scale were included. Eleven studies involved n = 446 patients with COPD, one involved n = 24 patients with cystic fibrosis (CF) and one n = 60 lung transplantation (LT) candidates. IET resulted in greater improvements in peak work rate (WRpeak) (2.40 W, 95% CI: 0.83 to 3.97 W; p = 0.003) and lower exercise-induced dyspnoea (−0.47, 95% CI: −0.86 to 0.09; p = 0.02) compared to CET; however, these improvements did not exceed the minimal important difference for these outcomes. No significant differences in peak values for oxygen uptake (VO2peak), heart rate (HRpeak), minute ventilation (VEpeak), lactate threshold (LAT) and leg discomfort were found between the interventions. Conclusions: IET is superior to CET in improving exercise capacity and exercise-induced dyspnoea sensations in patients with CRDs; however, the extent of the clinical benefit is not considered clinically meaningful.
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Affiliation(s)
- Charikleia Alexiou
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Lesley Ward
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Matthew Armstrong
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Mick Wilkinson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
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16
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McKay SC, Lembach H, Hann A, Okoth K, Anderton J, Nirantharakumar K, Magill L, Torlinska B, Armstrong M, Mascaro J, Inston N, Pinkney T, Ranasinghe A, Borrows R, Ferguson J, Isaac J, Calvert M, Perera T, Hartog H. Health-related quality of life, uncertainty and coping strategies in solid organ transplant recipients during shielding for the COVID-19 pandemic. Transpl Int 2021; 34:2122-2137. [PMID: 34378227 PMCID: PMC8420473 DOI: 10.1111/tri.14010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
Strict isolation of vulnerable individuals has been a strategy implemented by authorities to protect people from COVID‐19. Our objective was to investigate health‐related quality of life (HRQoL), uncertainty and coping behaviours in solid organ transplant (SOT) recipients during the COVID‐19 pandemic. A cross‐sectional survey of adult SOT recipients undergoing follow‐up at our institution was performed. Perceived health status, uncertainty and coping strategies were assessed using the EQ‐5D‐5L, Short‐form Mishel Uncertainty in Illness Scale (SF‐MUIS) and Brief Cope, respectively. Interactions with COVID‐19 risk perception, access to health care, demographic and clinical variables were assessed. The survey was completed by 826 of 3839 (21.5%) invited participants. Overall, low levels of uncertainty in illness were reported, and acceptance was the major coping strategy (92%). Coping by acceptance, feeling protected, self‐perceived susceptibility to COVID‐19 were associated with lower levels of uncertainty. Health status index scores were significantly lower for those with mental health illness, compromised access to health care, a perceived high risk of severe COVID‐19 infection and higher levels of uncertainty. A history of mental health illness, risk perceptions, restricted healthcare access, uncertainty and coping strategies was associated with poorer HRQoL in SOT recipients during strict isolation. These findings may allow identification of strategies to improve HRQoL in SOT recipients during the pandemic.
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Affiliation(s)
- Siobhan C McKay
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom.,Department of Academic Surgery, University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Hanns Lembach
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Angus Hann
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Kelvin Okoth
- Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Joy Anderton
- Patient Research Partner, Liver & Gastro-Intestinal Patient and Public Involvement Group, Birmingham Biomedical Research Centre, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Laura Magill
- Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Barbara Torlinska
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TH, United Kingdom
| | - Matthew Armstrong
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Jorge Mascaro
- Cardiothoracic Surgery Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Nicholas Inston
- Renal Surgery Unit, Queen Elizabeth Hospital Birmingham Mindelsohn way, Birmingham, United Kingdom
| | - Thomas Pinkney
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TH, United Kingdom
| | - Aaron Ranasinghe
- Cardiothoracic Surgery Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Richard Borrows
- Renal Surgery Unit, Queen Elizabeth Hospital Birmingham Mindelsohn way, Birmingham, United Kingdom
| | - James Ferguson
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - John Isaac
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TH, United Kingdom
| | - Thamara Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Hermien Hartog
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
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17
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Armstrong M, Milner E, Nguyen C, Corrigan T, Lee YF. Visualizing and exploring nonlinear behavior, timescales, and mechanical signatures of human blood. Biorheology 2021; 58:1-26. [PMID: 33867354 DOI: 10.3233/bir-201007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Human blood is a thixo-elasto-visco-plastic (TEVP) material that exhibits unique fluctuations in mechanical properties based on physiology, and shear rate. We demonstrate new visual tools to help visualize and characterize these varied mechanical properties. OBJECTIVE Our objective is to demonstrate contemporary visual and numerical tools to help visualize and characterize the varied mechanical properties of human blood. METHODS Using the ARESG2 strain-controlled rheometer with double wall couette geometry and eight human blood donors, with lab test results, elastic and viscous properties are investigated using Series of Physical Processes (SPP) and MITLaos to both analyze and visualize the mechanical signatures of the blood. RESULTS Variations of mechanical properties are shown via SPP generated Cole-Cole plots and MITLaos analysis. These variations are a function of physiological properties of blood on the day of the blood draw based on hematocrit, fibrinogen, cholesterol, triglycerides, and a host of other proteins and constituents. Each rheological experiment with blood is replicated with an analogous experiments with 0.04 wt% xanthan in glycerol, and water to demonstrate that the mechanical properties of the human blood, and its rheological signatures are unique to human blood. CONCLUSIONS Human blood is proven to be a TEVP material, as shown on a series of Cole-Cole plots for eight different donors, at two different frequency and strain amplitude combinations. Variations in Cole-Cole plots for each donor are shown. MITLaos average mechanical properties are calculated and shown. Aggregated elastic and viscous projections and a Cole-Cole plot is shown for Donors 1-8, along with 95% confidence interval.
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Affiliation(s)
- Matthew Armstrong
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, USA
| | - Erin Milner
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, USA
| | - Chi Nguyen
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, USA
| | - Trevor Corrigan
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY, USA
| | - Yu-Fan Lee
- Department of Chemical and Biomolecular Engineering, Center for Research in Soft Matter & Polymers, University of Delaware, Newark, DE, USA
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18
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Olsen K, Hodson J, Ronca V, Bozward AG, Hayden J, Wootton G, Armstrong M, Adams DH, El-Sherif O, Ferguson J, Knox E, Johnston T, Thompson F, Oo YH. Type 2 Autoimmune Hepatitis and Nonadherence to Medication Correlate With Premature Birth and Risk of Postpartum Flare. Hepatol Commun 2021; 5:1252-1264. [PMID: 34278173 PMCID: PMC8279459 DOI: 10.1002/hep4.1714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/07/2021] [Indexed: 12/19/2022] Open
Abstract
Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that affects all ages, including women of childbearing age. Optimal management during pregnancy is poorly defined. We aimed to explore the clinical and biochemical course of AIH in the antenatal and postpartum periods, and assess factors associated with premature birth and postpartum flares. Pregnant women with AIH reviewed in the autoimmune liver disease clinic at the Queen Elizabeth Hospital Birmingham between 2009 and 2020 were identified retrospectively, and clinical, biochemical, and immunological data 1 year before conception to 1 year postpartum were collected. Analysis was performed to identify trends in blood markers over the antenatal period, with an interrupted time series approach used to assess postpartum trends. Data were available for n = 27 pregnancies (n = 20 women), with median gestation of 38 weeks (30% premature) and most having type 1 AIH (78%) and delivering via caesarean section (63%). Levels of alanine transaminase, aspartate transaminase, and immunoglobulin G all declined significantly during gestation, followed by significant step-change increases after delivery. Postpartum flare developed in 58% of pregnancies. AIH type 2 was associated with a higher rate of premature births (67% vs. 19%, P = 0.044), and a trend toward a higher rate of postpartum flare (100% vs. 48%, P = 0.053). Although not significant, medication nonadherence was associated with almost double the risk of prematurity (40% vs. 24%, P = 0.415) and postpartum flare (80% vs. 44%, P = 0.109). Conclusion: Biochemical and immunological remission of AIH occurs during pregnancy, although subsequent postpartum flare is common. Type 2 AIH is associated with a higher risk of premature birth and postpartum flare, although further research is required to validate and explain this finding.
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Affiliation(s)
- Kathryn Olsen
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom
| | - James Hodson
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| | - Vincenzo Ronca
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom.,National Institute for Health Research Birmingham Biomedical Research CenterEuropean Reference Network Rare-Liver CenterUniversity Hospitals Birmingham National Health Service Foundation Trust and University of BirminghamBirminghamUnited Kingdom
| | - Amber G Bozward
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom
| | - Jennifer Hayden
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| | - Grace Wootton
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom
| | - Matthew Armstrong
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom.,National Institute for Health Research Birmingham Biomedical Research CenterEuropean Reference Network Rare-Liver CenterUniversity Hospitals Birmingham National Health Service Foundation Trust and University of BirminghamBirminghamUnited Kingdom
| | - David H Adams
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom.,National Institute for Health Research Birmingham Biomedical Research CenterEuropean Reference Network Rare-Liver CenterUniversity Hospitals Birmingham National Health Service Foundation Trust and University of BirminghamBirminghamUnited Kingdom
| | - Omar El-Sherif
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| | - James Ferguson
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom.,National Institute for Health Research Birmingham Biomedical Research CenterEuropean Reference Network Rare-Liver CenterUniversity Hospitals Birmingham National Health Service Foundation Trust and University of BirminghamBirminghamUnited Kingdom
| | - Ellen Knox
- Birmingham Women's HospitalBirminghamUnited Kingdom
| | | | - Fiona Thompson
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| | - Ye Htun Oo
- University Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom.,Center for Liver and Gastro ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom.,National Institute for Health Research Birmingham Biomedical Research CenterEuropean Reference Network Rare-Liver CenterUniversity Hospitals Birmingham National Health Service Foundation Trust and University of BirminghamBirminghamUnited Kingdom
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19
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Yaeger MJ, Reece SW, Kilburg-Basnyat B, Hodge MX, Pal A, Dunigan-Russell K, Luo B, You DJ, Bonner JC, Spangenburg EE, Tokarz D, Hannan J, Armstrong M, Manke J, Reisdorph N, Tighe RM, Shaikh SR, Gowdy KM. Sex Differences in Pulmonary Eicosanoids and Specialized Pro-Resolving Mediators in Response to Ozone Exposure. Toxicol Sci 2021; 183:170-183. [PMID: 34175951 DOI: 10.1093/toxsci/kfab081] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ozone (O3) is a criteria air pollutant known to increase the morbidity and mortality of cardiopulmonary diseases. This occurs through a pulmonary inflammatory response characterized by increased recruitment of immune cells into the airspace, pro-inflammatory cytokines, and pro-inflammatory lipid mediators. Recent evidence has demonstrated sex-dependent differences in the O3-induced pulmonary inflammatory response. However, it is unknown if this dimorphic response is evident in pulmonary lipid mediator metabolism. We hypothesized that there are sex-dependent differences in lipid mediator production following acute O3 exposure. Male and female C57BL/6J mice were exposed to 1 part per million O3 for 3 hours and were necropsied at 6 or 24 hours following exposure. Lung lavage was collected for cell differential and total protein analysis, and lung tissue was collected for mRNA analysis, metabololipidomics, and immunohistochemistry. Compared to males, O3-exposed female mice had increases in airspace neutrophilia, neutrophil chemokine mRNA, pro-inflammatory eicosanoids such as prostaglandin E2, and specialized pro-resolving mediators (SPMs) such as resolvin D5 in lung tissue. Likewise, precursor fatty acids (arachidonic and docosahexaenoic acid; DHA) were increased in female lung tissue following O3 exposure compared to males. Experiments with ovariectomized females revealed that loss of ovarian hormones exacerbates pulmonary inflammation and injury. However, eicosanoid and SPM production were not altered by ovariectomy despite depleted pulmonary DHA concentrations. Taken together, these data indicate that O3 drives an increased pulmonary inflammatory and bioactive lipid mediator response in females. Furthermore, ovariectomy increases susceptibility to O3-induced pulmonary inflammation and injury, as well as decreases pulmonary DHA concentrations.
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Affiliation(s)
- M J Yaeger
- Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, Columbus, OH, 43210
| | - S W Reece
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - B Kilburg-Basnyat
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - M X Hodge
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - A Pal
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - K Dunigan-Russell
- Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, Columbus, OH, 43210
| | - B Luo
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - D J You
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27107
| | - J C Bonner
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27107
| | - E E Spangenburg
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - D Tokarz
- Experimental Pathology Laboratories, Inc, Research Triangle Park, NC, 27709
| | - J Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - M Armstrong
- Department of Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, 80045
| | - J Manke
- Department of Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, 80045
| | - N Reisdorph
- Department of Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, 80045
| | - R M Tighe
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710
| | - S R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - K M Gowdy
- Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, Columbus, OH, 43210
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20
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McKeigue PM, McAllister DA, Caldwell D, Gribben C, Bishop J, McGurnaghan S, Armstrong M, Delvaux J, Colville S, Hutchinson S, Robertson C, Lone N, McMenamin J, Goldberg D, Colhoun HM. Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study. BMC Med 2021; 19:149. [PMID: 34158021 PMCID: PMC8219469 DOI: 10.1186/s12916-021-02021-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. METHODS In a matched case-control design, all 178,578 diagnosed cases of COVID-19 in Scotland from 1 March 2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression. RESULTS With those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020. CONCLUSIONS The effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.
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Affiliation(s)
- Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David A McAllister
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - David Caldwell
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Ciara Gribben
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Jen Bishop
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland
| | - Matthew Armstrong
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Joke Delvaux
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sam Colville
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sharon Hutchinson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Chris Robertson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Department of Mathematics and Statistics, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, Scotland
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Jim McMenamin
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David Goldberg
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Helen M Colhoun
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland.
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21
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Manifield J, Winnard A, Hume E, Armstrong M, Baker K, Adams N, Vogiatzis I, Barry G. Inspiratory muscle training for improving inspiratory muscle strength and functional capacity in older adults: a systematic review and meta-analysis. Age Ageing 2021; 50:716-724. [PMID: 33951159 DOI: 10.1093/ageing/afaa221] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The ageing process can result in the decrease of respiratory muscle strength and consequently increased work of breathing and associated breathlessness during activities of daily living in older adults. OBJECTIVE This systematic review and meta-analysis aims to determine the effects of inspiratory muscle training (IMT) in healthy older adults. METHODS A systematic literature search was conducted across four databases (Medline/Pubmed, Web of Science, Cochrane Library CINAHL) using a search strategy consisting of both MeSH and text words including older adults, IMT and functional capacity. The eligibility criteria for selecting studies involved controlled trials investigating IMT via resistive or threshold loading in older adults (>60 years) without a long-term condition. RESULTS Seven studies provided mean change scores for inspiratory muscle pressure and three studies for functional capacity. A significant improvement was found for maximal inspiratory pressure (PImax) following training (n = 7, 3.03 [2.44, 3.61], P = <0.00001) but not for functional capacity (n = 3, 2.42 [-1.28, 6.12], P = 0.20). There was no significant correlation between baseline PImax and post-intervention change in PImax values (n = 7, r = 0.342, P = 0.453). CONCLUSIONS IMT can be beneficial in terms of improving inspiratory muscle strength in older adults regardless of their initial degree of inspiratory muscle weakness. Further research is required to investigate the effect of IMT on functional capacity and quality of life in older adults.
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Affiliation(s)
- James Manifield
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
| | - Andrew Winnard
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
| | - Matthew Armstrong
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
| | - Nicola Adams
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, School Health & Life Sciences, Northumbria University, Newcastle, Upon Tyne, UK
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22
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Rogans-Watson R, Shulman C, Lewer D, Armstrong M, Hudson B. 23 Frailty, Older Age-Associated Conditions, and Multimorbidity Amongst People Experiencing Homelessness in A Hostel in London. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.02] [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] Open
Abstract
Abstract
Introduction
People experiencing homelessness (PEH) face poor health outcomes and extreme health inequity, and evidence suggests earlier onset of older age-associated conditions and signs of premature ageing. This is the first UK study to assess frailty in this population. The objective was to assess frailty, age-associated conditions, and multimorbidity in PEH residing in hostel accommodation, drawing comparisons with population data.
Methods
Participants were drawn from a hostel in London for PEH aged over 30. Age-associated conditions were identified using validated tools and a questionnaire modelled on comprehensive geriatric assessments. Participants’ keyworkers completed questionnaires to provide collateral information. Frailty was defined according to five criteria in Fried’s phenotype model: participants with three or more criteria are classified as frail, one or two criteria as vulnerable, and no criteria as not frail. Multimorbidity was defined as the presence of two or more long-term conditions in one person. Comparisons were made with population data from The English Longitudinal Study of Ageing and Health Survey for England.
Results
Thirty-three people participated (83% of eligible residents), with a mean age of 55.7 years (range 38–74). Frailty was identified in 18/33 participants (55%), with 13/33 (39%) classified as vulnerable, and 2/33 (6%) as not frail. Participants met an average of 2.6/5 frailty phenotype criteria, comparable to 90-year-olds in the general population. The most common age-associated conditions identified were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%), and cognitive impairment (45%). Multimorbidity was present in all thirty-three participants.
Conclusions
A wide range of unmet health needs was identified. The high prevalence of frailty and age-associated conditions support evidence of premature ageing, indicating a need to include holistic older-age assessments in PEH at a younger age. Involvement of health professionals with experience of working with older people could contribute to improving health outcomes for homeless patients.
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Affiliation(s)
- R Rogans-Watson
- Dept of Elderly Care, Croydon University Hospital, London
- Pathway: UK's leading homeless healthcare charity, London
| | - C Shulman
- Pathway: UK's leading homeless healthcare charity, London
- Marie Curie Research Department, Division of Psychiatry, UCL
| | - D Lewer
- Department of Epidemiology & Public Health, UCL, London
| | - M Armstrong
- Pathway: UK's leading homeless healthcare charity, London
- Marie Curie Research Department, Division of Psychiatry, UCL
| | - B Hudson
- Pathway: UK's leading homeless healthcare charity, London
- Marie Curie Research Department, Division of Psychiatry, UCL
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23
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Armstrong M, Hume E, McNeillie L, Chambers F, Wakenshaw L, Burns G, Marshall KH, Vogiatzis I. Behavioural modification interventions alongside pulmonary rehabilitation improve COPD patients' experiences of physical activity. Respir Med 2021; 180:106353. [PMID: 33735798 DOI: 10.1016/j.rmed.2021.106353] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES The Clinical PROactive Physical Activity in COPD (C-PPAC) instrument, combines a questionnaire assessing the domains of amount and difficulty of physical activity (PA) with activity monitor data (steps/day and vector magnitude units) to assess patients' experiences of PA. The C-PPAC instrument is responsive to pharmacological and non-pharmacological interventions and to changes in clinically relevant variables. We compared the effect of PA behavioural modification interventions alongside pulmonary rehabilitation (PR) to PR alone on the C-PPAC scores in COPD patients with low baseline PA levels. METHODS In this randomised controlled trial, 48 patients (means ± SD: FEV1: 50 ± 19%, baseline steps/day: 3450 ± 2342) were assigned 1:1 to receive PR alone, twice weekly for 8 weeks, or PA behavioural modification interventions (comprising motivational interviews, monitoring and feedback using a pedometer and goal setting) alongside PR (PR + PA). The C-PPAC instrument was used to assess PA experience, including a perspective of the amount and difficulty of PA. RESULTS There were clinically important improvements in favour of the PR + PA interventions compared to PR alone in: 1) the C-PPAC total score (mean [95% CI] difference: 8 [4 to 12] points, p = 0.001), the difficulty (mean [95% CI] difference: 8 [3 to 13] points, p = 0.002) and the amount (mean [95% CI] difference 8 [3 to 16] points, p = 0.005) domains and 2) the CAT score (mean [95% CI] difference: -2.1 [-3.8 to -0.3] points, p = 0.025). CONCLUSION PA behavioural modification interventions alongside PR improve the experiences of PA in patients with advanced COPD and low baseline PA levels. (NCT03749655).
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Affiliation(s)
- Matthew Armstrong
- Department of Sport, Exercise and Rehabilitation, School of Health & Life Sciences, Northumbria University, Newcastle, UK.
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, School of Health & Life Sciences, Northumbria University, Newcastle, UK.
| | - Laura McNeillie
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Francesca Chambers
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Lynsey Wakenshaw
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Graham Burns
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Karen Heslop Marshall
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne & Wear, NE1 4LP, UK.
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health & Life Sciences, Northumbria University, Newcastle, UK.
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24
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Dhaliwal A, Chauhan A, Aggarwal D, Davda P, David M, Amel-Kashipaz R, Brown R, Dedicoat M, Clark F, Shah T, Elsharkawy AM, Ushiro-Lumb I, Chiodini P, El-Sherif O, Armstrong M, Ferguson JW. Donor acquired visceral leishmaniasis following liver transplantation. Frontline Gastroenterol 2021; 12:690-694. [PMID: 34917328 PMCID: PMC8640386 DOI: 10.1136/flgastro-2020-101659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/03/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023] Open
Abstract
Patients who undergo solid organ transplantation are at risk of opportunistic infection associated with immunosuppression. We report a case of confirmed donor derived visceral leishmaniasis (VL), in a patient following liver transplantation causing fever and pancytopenia. The diagnosis was confirmed by bone marrow biopsy, with confirmed positive donor serology, with no other route of transmission. To our knowledge, this is the first case report in the United Kingdom and Europe, of confirmed organ donor transmission of VL. This case report highlights an important consideration of donor derived infections, in the context of solid organ transplantation.
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Affiliation(s)
- Amritpal Dhaliwal
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK,National Institute for Health Research (NIHR) Biomedical Research Centre Birmingham, University of Birmingham, Birmingham, UK
| | - Abhishek Chauhan
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK,National Institute for Health Research (NIHR) Biomedical Research Centre Birmingham, University of Birmingham, Birmingham, UK
| | - Dinesh Aggarwal
- Hospital for Tropical Disease, University College London, London, UK
| | - Pretin Davda
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Miruna David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rasoul Amel-Kashipaz
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachel Brown
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Dedicoat
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fiona Clark
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tahir Shah
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Ines Ushiro-Lumb
- Department of Haematology, NHS Blood and Transplant, Watford, UK
| | - Peter Chiodini
- Hospital for Tropical Disease, University College London, London, UK
| | - Omar El-Sherif
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Matthew Armstrong
- National Institute for Health Research (NIHR) Biomedical Research Centre Birmingham, University of Birmingham, Birmingham, UK,Liver Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - James W Ferguson
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK,National Institute for Health Research (NIHR), Biomedical Research Centre, University of Birmingham, Birmingham, UK
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25
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Hume E, Armstrong M, Manifield J, McNeillie L, Chambers F, Wakenshaw L, Burns G, Heslop Marshall K, Vogiatzis I. Impact of COVID-19 shielding on physical activity and quality of life in patients with COPD. Breathe (Sheff) 2020; 16:200231. [PMID: 33447283 PMCID: PMC7792782 DOI: 10.1183/20734735.0231-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is a highly infectious disease that can cause severe respiratory illness, particularly in patients with pre-existing lung conditions such as COPD [1]. To prevent infection during the peak of the pandemic, patients considered to be clinically extremely vulnerable were instructed to “shield” at home, resulting in significant restrictions to usual daily activities and social interaction. In the absence of a preventative vaccine, these public health measures are imperative to reduce transmission of the virus. However, despite this positive aspect, there are likely to be harmful repercussions on people's physical and mental health. In response to #COVID19, healthcare professionals should scale up virtual consultations for assessing core patient-reported outcomes and providing home-based rehabilitation programmes #COPDhttps://bit.ly/30gQEpG
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Affiliation(s)
- Emily Hume
- Dept of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Matthew Armstrong
- Dept of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - James Manifield
- Dept of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Laura McNeillie
- Physiotherapy Dept, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Francesca Chambers
- Physiotherapy Dept, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Lynsey Wakenshaw
- Physiotherapy Dept, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Graham Burns
- Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Ioannis Vogiatzis
- Dept of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University Newcastle, Newcastle, UK
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26
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Reed S, Getahun D, Gatz J, Armstrong M, Raine-Bennett T, Zhou X, Fassett M, Peipert J, Saltus C, Im T, Alabaster A, Hunter S, Takhar H, Chillemi G, Xie F, Wang J, Chiu V, Frenz A, Shi J, Lynen R, Asiimwe A, Anthony M. 78 Postpartum timing of IUD insertion is associated with risk of uterine perforation: Results from APEX IUD. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Robertson BF, Campbell EJ, Armstrong M, Malyon A. Reconstructive trends following mastectomies in Scotland: A comparison with England. Surgeon 2020; 19:212-218. [PMID: 32839117 DOI: 10.1016/j.surge.2020.07.008] [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: 03/10/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In England there has been a substantial increase in the use of immediate implant-based reconstruction, accounting for over half of all immediate reconstructions (IR). Less than one third of patients in England undergo autologous reconstruction IR. Our aim was to examine IR trends in Scotland. METHODS Data was extracted from the Scottish Morbidity Record held at the Information Services Division of the NHS National Services Scotland. All patients discharged from Scottish hospitals between 2011 and 2016 who had a diagnosis of breast cancer including DCIS and underwent mastectomy were identified. Patients undergoing IR were identified by coding at the time of mastectomy to identify who had IR and what method was used. RESULTS Between 2011 and 2016, 7358 patients underwent a mastectomy for breast cancer. 1845 patients (25%) had an IR. The percentage of patients undergoing IR increased from 22% in 2011 to 26% in 2016. The dominant annual procedure type was autologous reconstruction (free flap and pedicled flaps), accounting for 58% in 2011 and 54% in 2016. Pedicled flaps alone decreased from 40% in 2011 to 28% in 2016 and free flaps increased from 18% in 2011 to 26% in 2016. Implant based reconstruction rates were broadly consistent, 37% in both 2011 and 2016. Pedicled flaps with implant reconstruction decreased from 13% in 2011 to 5% in 2016. CONCLUSIONS Autologous reconstruction (with increasing trend for free flaps procedures) remains a constant preferred technique for IR in Scotland, accounting for over half of IR performed.
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Affiliation(s)
| | | | - Matthew Armstrong
- Information Services Department, National Services for Scotland (NHS), United Kingdom
| | - Andrew Malyon
- Canniesburn Plastic Surgery Department, Glasgow Royal Infirmary, United Kingdom
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28
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Karatuna O, Dance DAB, Matuschek E, Åhman J, Turner P, Hopkins J, Amornchai P, Wuthiekanun V, Cusack TP, Baird R, Hennessy J, Norton R, Armstrong M, Zange S, Zoeller L, Wahab T, Jacob D, Grunow R, Kahlmeter G. Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off values. Clin Microbiol Infect 2020; 27:S1198-743X(20)30384-0. [PMID: 32653660 DOI: 10.1016/j.cmi.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Melioidosis, caused by Burkholderia pseudomallei, requires intensive antimicrobial treatment. However, standardized antimicrobial susceptibility testing (AST) methodology based on modern principles for determining breakpoints and ascertaining performance of methods are lacking for B. pseudomallei. This study aimed to establish MIC and zone diameter distributions on which to set epidemiological cut-off (ECOFF) values for B. pseudomallei using standard EUCAST methodology for non-fastidious organisms. METHODS Non-consecutive, non-duplicate clinical B. pseudomallei isolates (9-70 per centre) were tested at eight study centres against eight antimicrobials by broth microdilution (BMD) and the EUCAST disc diffusion method. Isolates without and with suspected resistance mechanisms were deliberately selected. The EUCAST Development Laboratory ensured the quality of study materials, and provided guidance on performance of the tests and interpretation of results. Aggregated results were analysed according to EUCAST recommendations to determine ECOFFs. RESULTS MIC and zone diameter distributions were generated using BMD and disc diffusion results obtained for 361 B. pseudomallei isolates. MIC and zone diameter ECOFFs (mg/L; mm) were determined for amoxicillin-clavulanic acid (8; 22), ceftazidime (8; 22), imipenem (2; 29), meropenem (2; 26), doxycycline (2; none), tetracycline (8; 23), chloramphenicol (8; 22) and trimethoprim-sulfamethoxazole (4; 28). CONCLUSIONS We have validated the use of standard BMD and disc diffusion methodology for AST of B. pseudomallei. The MIC and zone diameter distributions generated in this study allowed us to establish MIC and zone diameter ECOFFs for the antimicrobials studied. These ECOFFs served as background data for EUCAST to set clinical MIC and zone diameter breakpoints for B. pseudomallei.
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Affiliation(s)
- O Karatuna
- EUCAST Development Laboratory, Växjö, Sweden.
| | - D A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - E Matuschek
- EUCAST Development Laboratory, Växjö, Sweden
| | - J Åhman
- EUCAST Development Laboratory, Växjö, Sweden
| | - P Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - J Hopkins
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - P Amornchai
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - V Wuthiekanun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - T-P Cusack
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; National Infection Service, Public Health England, London, UK
| | - R Baird
- Royal Darwin Hospital, Darwin, NT, Australia
| | - J Hennessy
- Royal Darwin Hospital, Darwin, NT, Australia
| | - R Norton
- Townsville Hospital, Townsville, QLD, Australia
| | - M Armstrong
- Townsville Hospital, Townsville, QLD, Australia
| | - S Zange
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - L Zoeller
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - T Wahab
- Public Health Agency of Sweden, Stockholm, Sweden
| | - D Jacob
- Robert Koch Institute, Berlin, Germany
| | - R Grunow
- Robert Koch Institute, Berlin, Germany
| | - G Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden
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Gao A, Armstrong M, Liu C, Liu L, Yang J, Lou W, Li P, Evans C. Inhibition steroid sulfatase suppresses androgen signaling and improves response to enzalutamide. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.
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Affiliation(s)
- I Gassiep
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - M Armstrong
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
| | - R Norton
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Schultz M, Picone D, Armstrong M, Black A, Dwyer N, Roberts-Thomson P, Sharman J. P63 Accuracy (Validation) of Central Blood Pressure Measurement Using the Sphygmocor Xcel-cuff Device. Artery Res 2020. [DOI: 10.2991/artres.k.191224.094] [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: 11/01/2022] Open
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Morris L, Picone D, Armstrong M, Schultz M, Sharman J. P19 Upper Arm Cuff Inflation Induces Reactive Changes in Systolic Blood Pressure that Could Influence Diagnosis in Some Individuals. Artery Res 2020. [DOI: 10.2991/artres.k.191224.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Picone D, Schultz M, Armstrong M, Dwyer N, Roberts-Thomson P, Weber T, Sharman J. P113 The Forgotten Black Box of Blood Pressure: Error in Oscillometric Mean Arterial Pressure is Associated with Cuff Measurement Inaccuracy. Artery Res 2020. [DOI: 10.2991/artres.k.191224.139] [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: 11/01/2022] Open
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Stoneman E, Picone D, Schultz M, Armstrong M, Bos W, Dwyer N, Lacy P, Laugesen E, Omboni S, Pucci G, Roberts-Thomson P, Stouffer G, Takazawa K, Weber T, Westerhof B, Sharman J. P109 The Influence of Sex on Cuff Blood Pressure Accuracy. Artery Res 2020. [DOI: 10.2991/artres.k.191224.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Picone D, Schultz M, Armstrong M, Bos W, Dwyer N, Lacy P, Laugesen E, Omboni S, Pucci G, Roberts-Thomson P, Stouffer G, Takazawa K, Weber T, Westerhof B, Sharman J. P112 Influence of Cuff Blood Pressure Accuracy on Identification of Isolated Systolic Hypertension. Artery Res 2020. [DOI: 10.2991/artres.k.191224.138] [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: 11/01/2022] Open
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Armstrong M, Winnard A, Chynkiamis N, Boyle S, Burtin C, Vogiatzis I. Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis. Eur Respir Rev 2019; 28:28/154/190039. [DOI: 10.1183/16000617.0039-2019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/11/2019] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to examine the use of pedometers as a tool to promote daily physical activity levels in patients with COPD.A systematic review meta-analysis of pedometer physical activity promotion in patients with COPD was conducted. Medline/PubMed, Cochrane Library, Web of Science and CINAHL were searched from inception to January 2019. The search strategy included the following keywords: physical activity promotion, pulmonary rehabilitation and daily physical activity. The eligibility criteria for selecting studies were randomised controlled trials reporting pedometer physical activity promotion in patients with COPD.Improvements in steps per day were found with pedometer physical activity promotion either standalone (n=12, mean 0.53 (95% CI 0.29–0.77); p=0.00001) or alongside pulmonary rehabilitation (n=7, 0.51 (0.13–0.88); p=0.006). A subgroup analysis reported significant differences in the promotion of physical activity based on baseline physical activity levels and the type of instrument used to assess levels of physical activity.Future trials should consider the way in which pedometers are used to promote physical activity to inform clinical practice in the setting of pulmonary rehabilitation.
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Dhaliwal A, Towey J, Lord JM, Armstrong M, Elsharkawy AM. Nutrition in liver cirrhosis: a case-based overview. Frontline Gastroenterol 2019; 11:155-161. [PMID: 32133115 PMCID: PMC7043081 DOI: 10.1136/flgastro-2018-101121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/10/2019] [Accepted: 08/27/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Amritpal Dhaliwal
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, Birmingham, UK,Institute of Inflammation and Ageing, NIHR Biomedical Research Centre, University of Birmingham, Birmingham, Birmingham, UK
| | - Jennifer Towey
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, Birmingham, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, NIHR Biomedical Research Centre, University of Birmingham, Birmingham, Birmingham, UK
| | - Matthew Armstrong
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, Birmingham, UK
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Harris KL, Armstrong M, Swain R, Erzinclioglu S, Das T, Burgess N, Barker RA, Mason SL. Huntington's disease patients display progressive deficits in hippocampal-dependent cognition during a task of spatial memory. Cortex 2019; 119:417-427. [PMID: 31499434 DOI: 10.1016/j.cortex.2019.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/24/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cognitive disturbances occur early in Huntington's disease (HD) and place a significant burden on the lives of patients and family members. Whilst these impairments are typically attributed to deterioration of the frontal-striatal pathways, accumulating evidence suggests that hippocampal dysfunction may also contribute to such impairments. Here, we employ a novel spatial memory task that has previously been shown to elicit impairments in individuals with focal hippocampal lesions, as a means to further investigate the role of hippocampal dysfunction in HD. METHOD Sixty-four individuals participated in the study, including 32 healthy controls, 11 patients with diagnosed HD and 16 premanifest HD gene carriers. We also included an additional control group of 5 individuals with focal unilateral basal ganglia lesions. Participants undertook a task that measured perception and short-term spatial memory using computer-generated visual scenes. RESULTS HD patients experienced significant impairments in spatial perception and memory, which strongly correlated with disease burden score (DBS). Premanifest gene carriers performed at a similar level to healthy controls throughout all aspects of the task indicating that the effects seen in the HD patients represent a deterioration in function. Interestingly, basal ganglia lesion patients were not impaired in any aspects of the task. CONCLUSION There is evidence of significant deficits in hippocampal-dependent spatial cognition in HD that cannot be explained as a function of degeneration to the basal ganglia. The impairments were greatest in individuals with higher DBSs, suggesting that deficits relate to the disease process in HD.
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Affiliation(s)
- Kate L Harris
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
| | - Matthew Armstrong
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Rachel Swain
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Sharon Erzinclioglu
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tilak Das
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Neil Burgess
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK; Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, MRC-WT Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Sarah L Mason
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
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Armstrong M, Vogiatzis I. Personalized exercise training in chronic lung diseases. Respirology 2019; 24:854-862. [PMID: 31270909 DOI: 10.1111/resp.13639] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
Abstract
Chronic respiratory diseases (CRD) are characterized by exertional dyspnoea, exercise limitation and reduced health-related quality of life (QoL). Exercise training is essential for improving symptoms, physical function and QoL. Current research available supports the effectiveness of exercise training in patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis and interstitial lung disease (ILD). However, recent studies have also shown safety and effectiveness of exercise training in patients with pulmonary arterial hypertension (PAH) and asthma. Despite the lack of clinical guidelines for exercise training in PAH, a recent Cochrane review has reported improvements in functional capacity and effective reductions in mean pulmonary arterial pressure. In the other CRD, a number of Cochrane reviews, supported by numerous randomized controlled trials, have been published outlining the benefits of different types of exercise training. The aim of this review is to establish the principles and modalities of personalized exercise training and the effects of exercise training across a number of CRD. In addition, this review provides information on personalized exercise prescription for CRD patients with co-morbidities.
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Affiliation(s)
- Matthew Armstrong
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
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Kang A, Armstrong M, Parry J. 48. CD30 expression in a small bowel follicular lymphoma transforming to diffuse large B cell lymphoma; should CD30 be part of the standard workup of all follicular lymphomas? Pathology 2019. [DOI: 10.1016/j.pathol.2018.09.047] [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: 10/27/2022]
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Candy B, Armstrong M, Amey R, Booth J, Flemming K, Kupeli N, Maclean V, Preston J, Stone P, Wilkinson S. 9 Using what people value to develop new interventions in palliative care: a multilevel level review approach. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionComplex interventions are common in palliative care (PC) but are difficult to evaluate. Complementary therapies (CT) are one type of widely-used complex intervention for which there is inconclusive evidence. No systematic review has been conducted in PC of trials or of qualitative studies of patients’ views of CTs. There are novel approaches with established exemplars of using both types of reviews to help develop more clinically appropriate interventions. These approaches are in their infancy in PC research and have much to offer the specialism.AimsUsing our on-going review on CT we present as an exemplar in PC an approach to draw together the findings of trials and qualitative studies in a data table (matrix) to contrast what patients value and want with how the intervention is tested.MethodsWe sought trials on the effectiveness of CT and qualitative studies on patients’ perspectives about these therapies. Our primary outcomes for trials included anxiety. Eight databases were searched in 2017. Citations and full-text papers were reviewed to identify relevant studies. Meta-analyses pooled trial data where appropriate and a thematic synthesis is being undertaken to understand patient experience. These findings will be combined in a matrix to explore similarities and differences.Results19 trials and five qualitative studies were included. Data analysis and development of the matrix which includes intervention content and patients’ needs is currently underway. We will present the final matrix framework.ConclusionsOur approach demonstrates a potential way in PC to enhance development of practice appropriate complex interventions.
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Wadman R, Armstrong M, Clarke D, Harroe C, Majumder P, Sayal K, Vostanis P, Townsend E. Experience of Self-Harm and Its Treatment in Looked-After Young People: An Interpretative Phenomenological Analysis. Arch Suicide Res 2018; 22:365-379. [PMID: 28786765 DOI: 10.1080/13811118.2017.1355286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Qualitative interviews with 24 looked-after young people were completed. Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronized, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation, and increasing support during placement changes.
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Armstrong M, Schultz M, Picone D, Sharman J, Dwyer N, Roberts-Thomson P, Black A. P20 BRACHIAL AND RADIAL SYSTOLIC BLOOD PRESSURE ARE NOT THE SAME: POTENTIAL IMPLICATIONS FOR VALIDATION PROTOCOLS INCLUDING BRACHIAL CUFF DEVICES AND WRIST-BASED WEARABLES. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.073] [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: 10/27/2022] Open
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Quinn KD, Schedel M, Nkrumah-Elie Y, Joetham A, Armstrong M, Cruickshank-Quinn C, Reisdorph R, Gelfand EW, Reisdorph N. Dysregulation of metabolic pathways in a mouse model of allergic asthma. Allergy 2017; 72:1327-1337. [PMID: 28213886 DOI: 10.1111/all.13144] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Asthma is a complex lung disease resulting from the interplay of genetic and environmental factors. To understand the molecular changes that occur during the development of allergic asthma without genetic and environmental confounders, an experimental model of allergic asthma in mice was used. Our goals were to (1) identify changes at the small molecule level due to allergen exposure, (2) determine perturbed pathways due to disease, and (3) determine whether small molecule changes correlate with lung function. METHODS In this experimental model of allergic asthma, matched bronchoalveolar lavage (BAL) fluid and plasma were collected from three groups of C57BL6 mice (control vs sensitized and/or challenged with ovalbumin, n=3-5/group) 6 hour, 24 hour, and 48 hour after the last challenge. Samples were analyzed using liquid chromatography-mass spectrometry-based metabolomics. Airway hyper-responsiveness (AHR) measurements and differential cell counts were performed. RESULTS In total, 398 and 368 dysregulated metabolites in the BAL fluid and plasma of sensitized and challenged mice were identified, respectively. These belonged to four, interconnected pathways relevant to asthma pathogenesis: sphingolipid metabolism (P=6.6×10-5 ), arginine and proline metabolism (P=1.12×10-7 ), glycerophospholipid metabolism (P=1.3×10-10 ), and the neurotrophin signaling pathway (P=7.0×10-6 ). Furthermore, within the arginine and proline metabolism pathway, a positive correlation between urea-1-carboxylate and AHR was observed in plasma metabolites, while ornithine revealed a reciprocal effect. In addition, agmatine positively correlated with lung eosinophilia. CONCLUSION These findings point to potential targets and pathways that may be central to asthma pathogenesis and can serve as novel therapeutic targets.
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Affiliation(s)
- K. D. Quinn
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
- Immunology & Microbiology Department School of Medicine; University of Colorado Denver; Aurora CO USA
| | - M. Schedel
- Division of Cell Biology; Department of Pediatrics; National Jewish Health; Denver CO USA
| | - Y. Nkrumah-Elie
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - A. Joetham
- Division of Cell Biology; Department of Pediatrics; National Jewish Health; Denver CO USA
| | - M. Armstrong
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - C. Cruickshank-Quinn
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - R. Reisdorph
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - E. W. Gelfand
- Division of Cell Biology; Department of Pediatrics; National Jewish Health; Denver CO USA
| | - N. Reisdorph
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
- Immunology & Microbiology Department School of Medicine; University of Colorado Denver; Aurora CO USA
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Armstrong M, Ladwa R, Lockyer A. Dental radiography: Cherry picking evidence. Br Dent J 2017; 223:4. [DOI: 10.1038/sj.bdj.2017.562] [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: 11/09/2022]
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Joshi N, Rolheiser TM, Fisk JD, McKelvey JR, Schoffer K, Phillips G, Armstrong M, Khan MN, Leslie RA, Rusak B, Robertson HA, Good KP. Lateralized microstructural changes in early-stage Parkinson's disease in anterior olfactory structures, but not in substantia nigra. J Neurol 2017; 264:1497-1505. [PMID: 28653210 DOI: 10.1007/s00415-017-8555-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
Parkinson's disease (PD) is a progressive neurological disorder characterized by motor symptoms as well as severe deficits in olfactory function and microstructural changes in olfactory brain regions. Because of the evidence of asymmetric neuropathological features in early-stage PD, we examined whether lateralized microstructural changes occur in olfactory brain regions and the substantia nigra in a group of early-stage PD patients. Using diffusion tensor imaging (DTI) and the University of Pennsylvania Smell Identification Test (UPSIT), we assessed 24 early-stage PD patients (Hoehn and Yahr stage 1 or 2) and 26 healthy controls (HC). We used DTI and a region of interest (ROI) approach to study the microstructure of the left and right anterior olfactory structures (AOS; comprising the olfactory bulbs and anterior end of the olfactory tracts) and the substantia nigra (SN). PD patients had reduced UPSIT scores relative to HC and showed increased mean diffusivity (MD) in the SN, with no lateralized differences. Significant group differences in fractional anisotropy (FA) and MD were seen in the AOS, but these differences were restricted to the right side and were not associated with the primary side of motor symptoms amongst PD patients. No associations were observed between lateralized motor impairment and lateralized microstructural changes in AOS. Impaired olfaction and microstructural changes in AOS are useful for early identification of PD but asymmetries in AOS microstructure seem unrelated to the laterality of PD motor symptoms.
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Affiliation(s)
- N Joshi
- Department of Psychiatry, IWK Hospital, Halifax, NS, Canada
| | - T M Rolheiser
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada
| | - J D Fisk
- Department of Psychology, Nova Scotia Health Authority, Central Zone, Halifax, NS, Canada
| | - J R McKelvey
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - K Schoffer
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - G Phillips
- Division of Respirology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - M Armstrong
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - M N Khan
- Department of Radiology, IWK Hospital, Halifax, NS, Canada
| | - R A Leslie
- Department of Medical Neurosciences, Dalhousie University, Halifax, NS, Canada
| | - B Rusak
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - H A Robertson
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada.,Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - K P Good
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada. .,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
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Van Veggel N, Armstrong M. In Dogs with Periodontal Disease Is Feeding a Complete Raw Meat Diet More Effective Than a Complete Kibble 'Dental' Diet at Reducing Periodontal Disease? VE 2017. [DOI: 10.18849/ve.v2i2.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<p>In light of the absence of evidence, vets and vet nurses should be cautious when recommending raw diets to support periodontal health and advise clients accordingly by relying on their clinical experience rather than the literature until more evidence is generated.</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />
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Walsh P, Pong S, Armstrong M, Christie AE, Dickinson PS. Characterization of the Receptors Associated with the Differing Responses to the Neuropeptide, AST‐C, by the Cardiac Ganglion of the American Lobster,
Homarus americanus. FASEB J 2017. [DOI: 10.1096/fasebj.31.1_supplement.874.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Townsend E, Wadman R, Sayal K, Armstrong M, Harroe C, Majumder P, Vostanis P, Clarke D. Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS). J Affect Disord 2016; 206:161-168. [PMID: 27475886 PMCID: PMC5082440 DOI: 10.1016/j.jad.2016.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. METHODS Forty-five young people (aged 13-21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). RESULTS A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. LIMITATIONS Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. CONCLUSIONS The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions.
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Affiliation(s)
- E. Townsend
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK,Corresponding author.
| | - R. Wadman
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK
| | - K. Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - M. Armstrong
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Thorneywood CAMHS, Porchester Rd, Nottingham NG3 6LF, UK
| | - C. Harroe
- Harmless, 7 Mansfield Road, Nottingham NG1 3FB, UK
| | - P. Majumder
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Thorneywood CAMHS, Porchester Rd, Nottingham NG3 6LF, UK
| | - P. Vostanis
- School of Neurosciences, Psychology and Behaviour, University of Leicester, Westcotes Drive, Leicester LE3 0QU, UK
| | - D. Clarke
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK
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Pakhale S, Baron J, Armstrong M, Tasca G, Gaudet E, Aaron SD, Cameron W, Balfour L. Lost in translation? How adults living with Cystic Fibrosis understand treatment recommendations from their healthcare providers, and the impact on adherence to therapy. Patient Educ Couns 2016; 99:1319-1324. [PMID: 27036082 DOI: 10.1016/j.pec.2016.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study builds on the limited research documenting Cystic Fibrosis (CF) patients' understanding of treatment recommendations and how this may impact adherence to therapy. METHODS We surveyed adults with CF and their healthcare professional (HCP) to capture treatment recommendations provided by the HCP, and patients' knowledge, and frequency of performance, of these recommendations. We classified CF participants' understanding of treatment recommendations (correct/incorrect) as compared to the actual recommendations made by the HCP. We computed CF participants' adherence in relation to HCP treatment recommendations and to their own understanding of treatment recommendations (adherent/non-adherent). RESULTS Complete HCP and patient data were available for 42 participants. The recommended treatment frequency was correctly understood by 0%-87.8% of CF participants. Adherence to HCP treatment recommendations ranged from 0 to 68.3% (mean 45.4%±21.5), and rates were low (<33%) for acapella, percussion/postural drainage, tobramycin nebulization and insulin. Participants' adherence was greater when calculated in relation to participants' understanding of treatment recommendations (62.4%±25.1) than when calculated in relation to actual HCP treatment recommendations (45.4%±21.5%) (p=0.009). CONCLUSION AND PRACTICE IMPLICATIONS Adults with CF misunderstand treatment recommendations; this likely affects treatment adherence. Interventions to ensure HCPs use effective communication strategies are needed.
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Affiliation(s)
- S Pakhale
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada; Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Canada.
| | - J Baron
- Ottawa Hospital Research Institute, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - M Armstrong
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - G Tasca
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - E Gaudet
- The Ottawa Hospital, Ottawa, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada; Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Canada
| | - W Cameron
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - L Balfour
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
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