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Robinson L, Arden MA, Dawson S, Walters SJ, Wildman MJ, Stevenson M. A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions. Health Psychol Rev 2024; 18:1-23. [PMID: 35086431 DOI: 10.1080/17437199.2022.2034516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 12/20/2022]
Abstract
Adherence to medication in long-term conditions is around 50%. The key components of successful interventions to improve medication adherence remain unclear, particularly when examined over prolonged follow-up periods. Behaviour change theories are increasingly interested in the utility of habit formation for the maintenance of health behaviour change, but there is no documentation on how habit has been conceptualised in the medication adherence intervention literature, or what effect the key technique identified in habit formation theory (context dependent repetition) has in these studies. To examine this, a machine-learning assisted review was conducted. Searches of MEDLINE, EMBASE and PSYCInfo and the reference list of a comprehensive systematic review of medication adherence interventions yielded 5973 articles. Machine learning-assisted title and abstract screening identified 15 independent RCTs published between 1976 and 2021, including 18 intervention comparisons of interest. Key findings indicate that conceptualisations of habit in the medication adherence literature are varied and behaviour change technique coding identified only six studies which explicitly described using habit formation. Future work should aim to develop this evidence base, drawing on contemporary habit theory and with explicit demonstration of what techniques have been used to promote habit formation.
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Affiliation(s)
- L Robinson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - S Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - S J Walters
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M J Wildman
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - M Stevenson
- Department of Computer Science, The University of Sheffield, Sheffield, UK
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Chowdhury P, Hemsworth PH, Fisher AD, Rice M, Galea RY, Taylor PS, Stevenson M. Descriptive epidemiology of smothering in Australian commercial free-range layer hen farms. Prev Vet Med 2024; 223:106098. [PMID: 38176152 DOI: 10.1016/j.prevetmed.2023.106098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/06/2024]
Abstract
Since the early 2000 s the practice of free-range egg production has increased in developed countries, partly driven by consumer perception that free-range housing is better for hen welfare. While poultry in free-range systems have more behavioural opportunities compared with poultry in caged systems, free-range systems are associated with greater frequencies of infectious disease, predation and 'smothering', a condition where birds pile on top of one another with death occurring due to suffocation. Although the frequency of smothering deaths in Australian free-range layer poultry is anecdotally high, there is a lack of empirical evidence quantifying smothering cause-specific mortality rates and identifying factors that place birds at higher risk of death from smothering. This was a prospective cohort study of poultry flocks managed by three commercial free-range layer organisations in Eastern Australia. Flocks were enrolled into the study from 1 January 2019 to 29 March 2021 and were followed until the end of lay or until the end of the study on 31 March 2022, whichever occurred first. Throughout the follow-up period flock managers provided production details for each flock and details of smothering events using custom-designed logbooks.A total of 84 flocks were enrolled in the study: 32 from Organisation 1, 35 from Organisation 2 and 17 from Organisation 3. The number of birds per flock ranged from 16,000 to 45,000. The total mortality rate was 1131 deaths per 10,000 bird-years. Smothering mortality rate across the three organisations was 183 (minimum 133, maximum 223) deaths per 10,000 bird-years at risk. Smothering accounted for around 16% (minimum 9%, maximum 22%) of all deaths.We identified no distinctive temporal pattern in daily smothering risk as a function of either the number of days since placement or calendar date. The locations of smothering events in sheds and in the outdoor range were not consistent, with relatively large numbers of smothering events occurring in specific locations for some sheds but not others. To the best of our knowledge, this study is the largest prospective study of smothering mortality in commercial free-range layer flocks conducted to date. Estimates of smothering incidence rate and how that varies within and between flocks and organisations over time provides a critically important benchmark for further investigations into this substantial area of productivity loss.
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Affiliation(s)
- P Chowdhury
- Asia Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia.
| | - P H Hemsworth
- Animal Welfare Science Centre, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia
| | - A D Fisher
- Animal Welfare Science Centre, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia
| | - M Rice
- Animal Welfare Science Centre, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia
| | - R Y Galea
- Animal Welfare Science Centre, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia
| | - P S Taylor
- Animal Welfare Science Centre, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia; School of Environmental and Rural Science, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale 2350, New South Wales, Australia; School of Agriculture, Food and Ecosystem Sciences, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia
| | - M Stevenson
- Asia Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville 3010, Victoria, Australia
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Cooley M, Whiteley P, Thornton G, Stevenson M. Health surveillance representative of koala (Phascolarctos cinereus) distribution in Victoria, Australia. Aust Vet J 2022; 100:605-612. [PMID: 36261878 PMCID: PMC10092863 DOI: 10.1111/avj.13208] [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: 05/11/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022]
Abstract
Health surveillance of wildlife populations is essential for conservation and reduction of the impacts of disease. Population declines and areas of overabundance of koalas (Phascolarctos cinereus) can disrupt the overall survival of the species as well as its habitat. This retrospective study was conducted to describe population distributions, identify areas which need increased surveillance and improve koala health surveillance methodology by Wildlife Health Victoria: Surveillance (WHV:S) at the Veterinary School of The University of Melbourne. Twelve years of Victorian koala observation data from the Atlas of Living Australia combined with surveillance data from WHV:S were used to create choropleth maps, using Quantum Geographic Information Systems of populations and surveillance events, visually representing hot spots. This data was further used to calculate health surveillance efforts between 2008 to the beginning of 2020. Analysis ranked postcodes throughout Victoria from low surveillance efforts to high, using standardised surveillance ratio's 95% confidence interval upper limits which were mapped using a colour gradient. This identified postcodes which need increased surveillance effort, corresponding to areas with high koala observations and low surveillance submissions. This analysis can guide surveillance for postcodes with koalas that were under-represented and inform improved methodology of future surveillance by WHV:S. The specific advice for improvements to WHV:S includes utilisation of citizen science and syndromic surveillance, website improvement, increasing community awareness and more. The limitations of this study were discussed.
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Affiliation(s)
- M Cooley
- School of Veterinary Medicine, Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - P Whiteley
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, 3030, Australia
| | - G Thornton
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, 3030, Australia
| | - M Stevenson
- Melbourne Veterinary School, The University of Melbourne, Melbourne, Victoria, 3010, Australia
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Sticken ET, Wieczorek R, Pour S, Chapman F, Simms L, Stevenson M. P13-11 Comparison of heated tobacco product aerosol to cigarette smoke in human bronchial epithelial tissues using high content screening. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.550] [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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Siciliani EA, Leroux L, Tam M, Arai T, Urban JF, Martin RJ, Geary TG, Stevenson M, Lopes F, Jardim A. A11 ISOLATION OF NON-POLAR METABOLITES IN EXCRETORY/SECRETORY PRODUCTS FROM PARASITIC HELMINTHS AND THEIR POTENTIAL AS IMMUNOTHERAPY IN INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859340 DOI: 10.1093/jcag/gwab049.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Parasitic helminths are known to modulate host immune responses. This is thought to be mediated by their secretome. We are interested in the excretory/secretory products and mechanisms for modulating immune dysfunction in autoinflammatory diseases. Aims This research studies the mechanisms of immune modulation by parasitic helminths in the context of IBD. We aim to describe immunomodulatory helminth-derived metabolites (ESM). Methods Helminth-conditioned media was used to isolate ESM, which were further purified using column chromatography. Bone marrow (BM) derived macrophages (BMDM) from C57BL6 mice, were treated with ESP fractions from Trichuris suis, Ascaris suum, Heligmosomoides polygyrus bakeri or Dirofilaria immitis, stimulated with LPS, and secreted cytokine levels measured. Moreover, BM was cultured with or without ESM throughout differentiation to BMDM. Colitic mice (3% DSS, 5 days) were treated with A. suum ESM or PBS once daily IP. Colon lengths and TNFα mRNA were measured, and histological preparations were scored to assess pathology. Bioactive D. immitis ESM were fractionated using preparatory HPLC and assayed for bioactivity. Active fractions were analysed using MS/MS and fragmentation patterns and molecular weights were obtained. The active fractions are currently being studied by NMR to deduce a structure of an active metabolite. Results BMDM treated with crude ESM decreased TNFα secretion and increased IL-10. BMDM precursors which were treated with A. suum ESM throughout differentiation had reduced proliferation in a dose dependent manner. These BMDM showed remodeling of BMDM metabolic pathways. Intracellular ROS production was inversely proportional to Alamar blue oxidation. We found that ESM from A. suum improved DSS-colitis. Specifically, mice with DSS-induced colitis given IP ESM had longer colons, lower histolopathology score, and lower TNFα mRNA expression in gut tissue. HPLC-fractionated D. immitis ESM used to treat BMDM yielded varying suppression of TNFα with LPS stimulation. MS/MS of TNFα suppressive fractions contained masses with fragmentation patterns which were detected in fractions of several of the above-mentioned parasite species. Preliminary NMR studies will determine if this represents a conserved structure. Conclusions Helminth-derived components can immunologically polarize a response in vitro, as well as favour recovery in DSS colitis. Through multiple purification steps, a nearly pure fraction is found to have bioactivity, suggesting a single, bioactive molecule that is conserved across several parasitic helminths. These data are important in understanding the host-parasite interaction modulated by ESM, as well as provide therapeutic potential in IBD. Funding Agencies NSERC, FRQNT
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Affiliation(s)
- E A Siciliani
- McGill University Institute of Parasitology, Sainte Anne de Bellevue, QC, Canada
| | - L Leroux
- Institut national de la recherche scientifique, Laval, QC, Canada
| | - M Tam
- McGill University Department of Microbiology & Immunology, Montreal, QC, Canada
| | - T Arai
- McGill University Institute of Parasitology, Sainte Anne de Bellevue, QC, Canada
| | - J F Urban
- US Department of Agriculture, Washington
| | - R J Martin
- Iowa State University College of Veterinary Medicine, Ames, IA
| | - T G Geary
- McGill University Institute of Parasitology, Sainte Anne de Bellevue, QC, Canada
| | - M Stevenson
- McGill University Department of Microbiology & Immunology, Montreal, QC, Canada
| | - F Lopes
- McGill University Institute of Parasitology, Sainte Anne de Bellevue, QC, Canada
| | - A Jardim
- McGill University Institute of Parasitology, Sainte Anne de Bellevue, QC, Canada
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Malacco NO, Siciliani EA, Madrigal AG, Cestari I, Jardim A, Stevenson M, Lopes F. A4 HELMINTH-DERIVED METABOLITES INDUCE A TOLEROGENIC PROFILE IN DENDRITIC CELLS AND ALLEVIATE EXPERIMENTAL COLITIS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859128 DOI: 10.1093/jcag/gwab049.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Inflammatory bowel diseases (IBD) are chronic inflammatory diseases characterized by abdominal pain, bloody diarrhea, fatigue, weight loss, and diminished quality of life. The morbidity associated with IBD is a result of loss of tolerance towards the gastrointestinal commensal microbiota. The high incidence of IBD in Western societies is inversely correlated with the low incidence of intestinal helminth parasite infections, potentially due to the ability of the helminth parasite to induce tolerance by inducing tolerogenic dendritic cells (tolDC) polarization. Although macromolecules from helminth such as proteins and polysaccharides have been shown to polarize tolDCs, to characterize a novel pathway, in this study we focused on small molecules such as metabolites in the helminth secretome. We hypothesized that helminth-derived metabolites (HDMs) polarize DCs towards a tolerogenic phenotype, which alleviates colitis. Aims To evaluate and characterize the tolerogenic response induced by HDMs in DCs, and its ability to alleviate colitis. Methods Heligmosomoides polygyrus worms were culture for 24 h and HDMs were isolated from conditioned media by chromatography. Bone marrow dendritic cells (BMDCs) were differentiated with GM-CSF for 8 days and then incubated with HDM for 4 h before LPS stimulation for 20 h. Cytokine secretion was measured by ELISA. The transcriptome of DCs treated with HDMs was assessed by RNAseq. Colitis was induced by giving 3% DSS in drinking water for 5 days followed by 3 days of tap water. The anti-colitic effect of HDMs was assessed by daily treatment with HDM or DCs treated with HDM in the 3 days of tap water. Results Pre-treatment with HDM decreased LPS-induced TNF and increased IL-10 release by BMDCs, compared to control BMDCs. Colitic mice treated with HDM presented lower disease activity scores, less colon shortening, decreased weight loss, and healthier histopathology compared to vehicle-treated colitic mice. Importantly, there was an increased frequency of CD11c+ CD103+ DCs in the colon of HDM-treated mice, suggesting that HDM alleviates colitis by increasing the abundance of tolDCs in the colon. Adoptive transfer of HDM-treated DCs also reduced the severity of colitis compared with vehicle-treated mice or mice that received naïve DCs. These results indicate that HDM induced tolerogenic DCs, which in turn ameliorates DSS colitis. RNAseq showed that HDM upregulated 183 and downregulated 76 genes. These differentially expressed genes may indicate a novel mechanism by which helminths induce a tolerogenic profile in DCs. Conclusions HDMs induce tolerogenic DCs and alleviate DSS-induced colitis. Funding Agencies NSERC and FRQNT
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Affiliation(s)
- N O Malacco
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - E A Siciliani
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - A G Madrigal
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - I Cestari
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - A Jardim
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - M Stevenson
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - F Lopes
- Institute of Parasitology, McGill University, Montreal, QC, Canada
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Abstract
In this paper, the authors: (a) list methods used to diagnose zoonotic diseases in humans and animals; (b) identify between-species differences in diagnostic approaches, providing commentary on the benefits that might arise from simultaneous interpretation of data from human and animal health surveillance systems; and (c) reiterate the importance of using species-specific, validated diagnostic tests for surveillance and disease outbreak investigations. Emerging and endemic zoonotic diseases are likely to provide a continued threat to global health in the short- to medium-term future. A good deal of knowledge about the drivers of infectious disease emergence has been developed based on numerous examples from the recent past. Sharing of diagnostic resources across human and animal health sectors, sharing of human and animal health surveillance data, development of skills in the interpretation of that data and awareness of issues related to the validation and interpretation of diagnostic test data are necessary prerequisites for an effective endemic disease surveillance system. A good understanding of the epidemiological patterns of endemic disease will allow human and animal health professionals be able to more quickly detect the presence of emerging disease threats.
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Lines KE, Stevenson M, Mihai R, Grigorieva IV, Shariq OA, Gaynor KU, Jeyabalan J, Javid M, Thakker RV. Hypoxia stimulates angiogenesis and a metabolic switch in human parathyroid adenoma cells. Endocr Oncol 2021; 1:23-32. [PMID: 37435188 PMCID: PMC10265544 DOI: 10.1530/eo-21-0014] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 07/13/2023]
Abstract
Hypoxia, a primary stimulus for angiogenesis, is important for tumour proliferation and survival. The effects of hypoxia on parathyroid tumour cells, which may also be important for parathyroid autotransplantation in patients, are, however, unknown. We, therefore, assessed the effects of hypoxia on gene expression in parathyroid adenoma (PA) cells from patients with primary hyperparathyroidism. Cell suspensions from human PAs were cultured under normoxic or hypoxic conditions and then subjected to cDNA expression analysis. In total, 549 genes were significantly upregulated and 873 significantly downregulated. The most highly upregulated genes (carbonic anhydrase 9 (CA9), Solute carrier family 2A1 (SLC2A1) and hypoxia-inducible lipid droplet-associated protein (HIG2)) had known involvement in hypoxia responses. Dysregulation of oxidative phosphorylation and glycolysis pathway genes were also observed, consistent with data indicating that cells shift metabolic strategy of ATP production in hypoxic conditions and that tumour cells predominantly utilise anaerobic glycolysis for energy production. Proliferation- and angiogenesis-associated genes linked with growth factor signalling, such as mitogen-activated protein kinase kinase 1 (MAP2K1), Jun proto-oncogene (JUN) and ETS proto-oncogene 1 (ETS1), were increased, however, Ras association domain family member 1 (RASSF1), an inhibitor of proliferation was also upregulated, indicating these pathways are unlikely to be biased towards proliferation. Overall, there appeared to be a shift in growth factor signalling pathways from Jak-Stat and Ras signaling to extracellular signal-regulated kinases (ERKs) and hypoxia-inducible factor (HIF)-1α signalling. Thus, our data demonstrate that PAs, under hypoxic conditions, promote the expression of genes known to stimulate angiogenesis, as well as undergoing a metabolic switch.
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Affiliation(s)
- K E Lines
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - M Stevenson
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - R Mihai
- Department of Endocrine Surgery, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
| | - I V Grigorieva
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - O A Shariq
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - K U Gaynor
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - J Jeyabalan
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - M Javid
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - R V Thakker
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Headington, Oxford, UK
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Thirion P, Dunne M, Parker I, Small C, Shannon A, Clayton-Lea A, Parker M, Collins C, Coffey J, Elbeltagi N, Fitzpatrick D, McArdle O, Stevenson M, Alvarez-Iglesias A, Moriarty M, Salib O, Gillham C, Armstrong J. CTRIAL-IE (ICORG) 07-11: Phase II Trial Evaluating Radiobiological Based Reirradiation Strategy for Patients with Malignant Spinal Cord Compression. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wieczorek R, Phillips G, Czekala L, Trelles Sticken E, O'Connell G, Simms L, Rudd K, Stevenson M, Walele T. A comparative in vitro toxicity assessment of electronic vaping product e-liquids and aerosols with tobacco cigarette smoke. Toxicol In Vitro 2020; 66:104866. [PMID: 32353510 DOI: 10.1016/j.tiv.2020.104866] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022]
Abstract
The use of electronic vaping products (EVPs) continues to increase worldwide among adult smokers in parallel with accumulating information on their potential toxicity and relative safety compared to tobacco smoke. At this time, in vitro assessments of many widely available EVPs are limited. In this study, an in vitro battery of established assays was used to examine the cytotoxic (Neutral red uptake), genotoxic (In vitro micronucleus) and mutagenic (Bacterial reverse mutation) responses of two commercial EVPs (blu GO™ disposable and blu PLUS+™ rechargeable) when compared to smoke from a reference cigarette (3R4F). In total, 12 commercial products were tested as e-liquids and as aerosols. In addition, two experimental base liquids containing 1.2% and 2.4% nicotine were also assessed to determine the effect of flavour and nicotine on all three assays. In the bacterial reverse mutation (Ames) and in vitro micronucleus (IVM) assays, exposures to e-liquids and EVP aerosols, with and without nicotine and in a range of flavourings, showed no mutagenic or genotoxic effects compared to tobacco smoke. The neutral red uptake (NRU) assay showed significantly reduced cytotoxicity (P < .05) for whole undiluted EVP aerosols compared to tobacco smoke, which by contrast was markedly cytotoxic even when diluted. The reduced in vitro toxicological responses of the EVPs add to the increasing body of scientific weight-of-evidence supporting the role of high-quality EVPs as a harm reduction tool for adult smokers.
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Affiliation(s)
- R Wieczorek
- Reemtsma Cigarettenfabriken GmbH - Imperial Brands, Albert-Einstein-Ring 7, 22761 Hamburg, Germany
| | - G Phillips
- Imperial Brands PLC, 121 Winterstoke Road, Bristol BS3 2LL, UK.
| | - L Czekala
- Imperial Brands PLC, 121 Winterstoke Road, Bristol BS3 2LL, UK
| | - E Trelles Sticken
- Reemtsma Cigarettenfabriken GmbH - Imperial Brands, Albert-Einstein-Ring 7, 22761 Hamburg, Germany
| | - G O'Connell
- Imperial Brands PLC, 121 Winterstoke Road, Bristol BS3 2LL, UK
| | - L Simms
- Imperial Brands PLC, 121 Winterstoke Road, Bristol BS3 2LL, UK
| | - K Rudd
- Imperial Brands PLC, 121 Winterstoke Road, Bristol BS3 2LL, UK
| | - M Stevenson
- Imperial Brands PLC, 121 Winterstoke Road, Bristol BS3 2LL, UK
| | - T Walele
- Imperial Brands PLC, 121 Winterstoke Road, Bristol BS3 2LL, UK
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Lines KE, Filippakopoulos P, Stevenson M, Müller S, Lockstone HE, Wright B, Knapp S, Buck D, Bountra C, Thakker RV. Effects of epigenetic pathway inhibitors on corticotroph tumour AtT20 cells. Endocr Relat Cancer 2020; 27:163-174. [PMID: 31935194 PMCID: PMC7040567 DOI: 10.1530/erc-19-0448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
Medical treatments for corticotrophinomas are limited, and we therefore investigated the effects of epigenetic modulators, a new class of anti-tumour drugs, on the murine adrenocorticotropic hormone (ACTH)-secreting corticotrophinoma cell line AtT20. We found that AtT20 cells express members of the bromo and extra-terminal (BET) protein family, which bind acetylated histones, and therefore, studied the anti-proliferative and pro-apoptotic effects of two BET inhibitors, referred to as (+)-JQ1 (JQ1) and PFI-1, using CellTiter Blue and Caspase Glo assays, respectively. JQ1 and PFI-1 significantly decreased proliferation by 95% (P < 0.0005) and 43% (P < 0.0005), respectively, but only JQ1 significantly increased apoptosis by >50-fold (P < 0.0005), when compared to untreated control cells. The anti-proliferative effects of JQ1 and PFI-1 remained for 96 h after removal of the respective compound. JQ1, but not PFI-1, affected the cell cycle, as assessed by propidium iodide staining and flow cytometry, and resulted in a higher number of AtT20 cells in the sub G1 phase. RNA-sequence analysis, which was confirmed by qRT-PCR and Western blot analyses, revealed that JQ1 treatment significantly altered expression of genes involved in apoptosis, such as NFκB, and the somatostatin receptor 2 (SSTR2) anti-proliferative signalling pathway, including SSTR2. JQ1 treatment also significantly reduced transcription and protein expression of the ACTH precursor pro-opiomelanocortin (POMC) and ACTH secretion by AtT20 cells. Thus, JQ1 treatment has anti-proliferative and pro-apoptotic effects on AtT20 cells and reduces ACTH secretion, thereby indicating that BET inhibition may provide a novel approach for treatment of corticotrophinomas.
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Affiliation(s)
- K E Lines
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | | | - M Stevenson
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - S Müller
- Structural Genomics Consortium, Buchmann Institute for Life Sciences, Goethe-University Frankfurt, Frankfurt, Germany
| | - H E Lockstone
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - B Wright
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - S Knapp
- Structural Genomics Consortium, Buchmann Institute for Life Sciences, Goethe-University Frankfurt, Frankfurt, Germany
- Institute of Pharmaceutical Chemistry, Goethe-University Frankfurt, Frankfurt, Germany
| | - D Buck
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - C Bountra
- Structural Genomics Consortium, University of Oxford, Oxford, UK
| | - R V Thakker
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Correspondence should be addressed to R V Thakker:
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Machado V, Sharkey M, Cordeiro T, Barrios L, Henrich T, Stevenson M. Post-ATI viremia in a hyperacute subject comprises macrophage-tropic viral variants. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Davidson M, Hsieh A, Jones R, Hadker N, Suarez S, Stevenson M. How does burden of illness of fcs patients compare to a general population cohort? results of a psm study. ATHEROSCLEROSIS SUPP 2019. [DOI: 10.1016/j.atherosclerosissup.2019.08.022] [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: 10/26/2022]
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Bartlett S, Mackenzie J, Fairbairn I, Stevenson M. Indwelling pleural catheters in Fife: indications and outcomes. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30118-7] [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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15
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Stevenson M, Czekala L, Simms L, Tschierske N, Johansson H, Walele T. The In Vitro assessment of Respiratory Sensitisation Potential of Electronic Cigarette Liquids. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.669] [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: 10/28/2022]
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Mediouni S, Jablonski JA, Tsuda S, Richard A, Kessing C, Andrade MV, Biswas A, Even Y, Tellinghuisen T, Choe H, Cameron M, Stevenson M, Valente ST. Potent suppression of HIV-1 cell attachment by Kudzu root extract. Retrovirology 2018; 15:64. [PMID: 30236131 PMCID: PMC6149077 DOI: 10.1186/s12977-018-0446-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/10/2018] [Indexed: 01/02/2023] Open
Abstract
There is a constant need to improve antiretrovirals against HIV since therapy is limited by cost, side effects and the emergence of drug resistance. Kudzu is a climbing vine from which the root extract (Pueraria lobata), rich in isoflavones and saponins, has long been used in traditional Chinese medicine for a variety of purposes, from weight loss to alcoholism prevention. Here we show that Kudzu root extract significantly inhibits HIV-1 entry into cell lines, primary human CD4+T lymphocytes and macrophages, without cell-associated toxicity. Specifically, Kudzu inhibits the initial attachment of the viral particle to the cell surface, a mechanism that depends on the envelope glycoprotein gp120 but is independent from the HIV-1 cell receptor CD4 and co-receptors CXCR4/CCR5. This activity seems selective to lentiviruses since Kudzu inhibits HIV-2 and simian immunodeficiency virus, but does not interfere with Hepatitis C, Influenza, Zika Brazil and adenovirus infection. Importantly, depending on the dose, Kudzu can act synergistically or additively with the current antiretroviral cocktails against HIV-1 and can block viruses resistant to the fusion inhibitor Enfuvirtide. Together our results highlight Kudzu's root extract value as a supplement to current antiretroviral therapy against HIV.
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Affiliation(s)
- S Mediouni
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA
| | - J A Jablonski
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA
| | - S Tsuda
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA
| | - A Richard
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA
| | - C Kessing
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA
| | - M V Andrade
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - A Biswas
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA
| | - Y Even
- The Botanist's Beach Farm, Jupiter, FL, USA
| | - T Tellinghuisen
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA.,Roche, Basel, Switzerland
| | - H Choe
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA
| | - M Cameron
- Department of Molecular Therapeutics, The Scripps Research Institute, Jupiter, FL, USA
| | - M Stevenson
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - S T Valente
- Department of Immunology and Microbiology, The Scripps Research Institute, 130 Scripps Way, 3C1, Jupiter, FL, 33458, USA.
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Lines KE, Newey PJ, Yates CJ, Stevenson M, Dyar R, Walls GV, Bowl MR, Thakker RV. MiR-15a/miR-16-1 expression inversely correlates with cyclin D1 levels in Men1 pituitary NETs. J Endocrinol 2018; 240:JOE-18-0278.R2. [PMID: 30389902 PMCID: PMC6347280 DOI: 10.1530/joe-18-0278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
Multiple Endocrine Neoplasia type 1 (MEN1) is an autosomal dominant disorder characterised by the combined occurrence of parathyroid, pituitary and pancreatic islet tumours, and is due to mutations of the MEN1 gene, which encodes the tumour suppressor protein menin. Menin has multiple roles in genome stability, transcription, cell division and proliferation, but its mechanistic roles in tumourigenesis remain to be fully elucidated. MicroRNAs (miRNA) are non-coding single stranded RNAs that post-transcriptionally regulate gene expression and have been associated with tumour development, although the contribution of miRNAs to MEN1-associated tumourigenesis and their relationship with menin expression are not fully understood. Alterations in miRNA expression, including downregulation of three putative 'tumour suppressor' miRNAs, miR-15a, miR-16-1 and let-7a, have been reported in several tumour types including non-MEN1 pituitary adenomas. We have therefore investigated the expression of miR-15a, miR-16-1 and let-7a in pituitary tumours that developed after 12 months of age in female mice with heterozygous knock out of the Men1 gene (Men1+/- mice). The miRNAs miR-15a, miR-16-1 and let-7a were significantly downregulated in pituitary tumours (by 2.3-fold, p<0.05; 2.1-fold p<0.01 and 1.6-fold p<0.05, respectively) of Men1+/- mice, compared to normal wild type pituitaries. MiR-15a and miR-16-1 expression inversely correlated with expression of cyclin D1, a known pro-tumourigenic target of these miRNAs, and knock down of menin in a human cancer cell line (HeLa), and AtT20 mouse pituitary cell line resulted in significantly decreased expression of miR-15a (p<0.05), indicating that the decrease in miR-15a may be a direct result of lost menin expression.
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Affiliation(s)
- K E Lines
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
| | - P J Newey
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
- Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - C J Yates
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
| | - M Stevenson
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
| | - R Dyar
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
| | - G V Walls
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
| | - M R Bowl
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK
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Arca M, Soran H, Digenio A, Hsieh A, Rosenblit P, Stevenson M. Assessing the disease burden among patients with familial chylomicronemia syndrome (FCS) on volanesorsen: Results of the re-focus study. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Background Occupational health nurses (OHNs) play a pivotal role in the delivery of occupational health (OH) services. Specific competency guidance has been developed in a number of countries, including the UK. While it is acknowledged that UK OHN practice has evolved in recent years, there has been no formal research to capture these developments to ensure that training and curricula remain up-to-date and reflect current practice. Aims To identify current priorities among UK OHNs of the competencies required for OH practice. Methods A modified Delphi study undertaken among representative OHN networks in the UK. This formed part of a larger study including UK and international occupational physicians. The study was conducted in two rounds using a questionnaire based on available guidance on training competencies for OH practice, the published literature, expert panel reviews and conference discussions. Results Consensus among OHNs was high with 7 out of the 12 domains scoring 100% in rating. 'Good clinical care' was the principal domain ranked most important, followed by 'general principles of assessment & management of occupational hazards to health'. 'Research methods' and 'teaching & educational supervision' were considered least important. Conclusions This study has established UK OHNs' current priorities on the competencies required for OH practice. The timing of this paper is opportune with the formal launch of the Faculty of Occupational Health Nursing planned in 2018 and should inform the development of competency requirements as part of the Faculty's goals for standard setting in OHN education and training.
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Affiliation(s)
- D Lalloo
- Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8RZ, UK
| | - E Demou
- Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8RZ, UK.,MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G2 3QB, UK
| | - S Kiran
- Department of Occupational Health and Medicine, Institute of Public Health, Hacettepe University, Sihhiye-Ankara 06100, Turkey
| | - M Gaffney
- Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8RZ, UK
| | - M Stevenson
- Specialist Community Public Health Nursing (Occupational Health), University of the West Of Scotland, Paisley Campus, Glasgow PA1 2BE, UK
| | - E B Macdonald
- Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8RZ, UK
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20
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Plitnik T, Stevenson M, Sharkey M. Intrinsic resistance of HIV-1 to SAMHD1 restriction permits efficient macrophage infection. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Machado V, Alvarado T, Barrios L, Morales A, Sharkey M, Mavian C, Salemi M, Stevenson M. Identification of macrophage reservoirs through tropism of HIV-1 envelope. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30574-4] [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: 11/28/2022] Open
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22
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Davidson M, Stevenson M, Hsieh A, Jones R, Issa B, Romeo S, Witztum J. Results of the Investigation of Findings and Observations Captured in Burden of Illness Survey in FCS Patients (IN-FOCUS) study: European Respondents. ATHEROSCLEROSIS SUPP 2017. [DOI: 10.1016/j.atherosclerosissup.2017.08.018] [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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23
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Hardefeldt LY, Holloway S, Trott DJ, Shipstone M, Barrs VR, Malik R, Burrows M, Armstrong S, Browning GF, Stevenson M. Antimicrobial Prescribing in Dogs and Cats in Australia: Results of the Australasian Infectious Disease Advisory Panel Survey. J Vet Intern Med 2017; 31:1100-1107. [PMID: 28514013 PMCID: PMC5508328 DOI: 10.1111/jvim.14733] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/15/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background Investigations of antimicrobial use in companion animals are limited. With the growing recognition of the need for improved antimicrobial stewardship, there is urgent need for more detailed understanding of the patterns of antimicrobial use in this sector. Objectives To investigate antimicrobial use for medical and surgical conditions in dogs and cats by Australian veterinarians. Methods A cross‐sectional study was performed over 4 months in 2011. Respondents were asked about their choices of antimicrobials for empirical therapy of diseases in dogs and cats, duration of therapy, and selection based on culture and susceptibility testing, for common conditions framed as case scenarios: 11 medical, 2 surgical, and 8 dermatological. Results A total of 892 of the 1,029 members of the Australian veterinary profession that completed the survey satisfied the selection criteria. Empirical antimicrobial therapy was more common for acute conditions (76%) than chronic conditions (24%). Overall, the most common antimicrobial classes were potentiated aminopenicillins (36%), fluoroquinolones (15%), first‐ and second‐generation cephalosporins (14%), and tetracyclines (11%). Third‐generation cephalosporins were more frequently used in cats (16%) compared to dogs (2%). Agreement with Australasian Infectious Disease Advisory Panel (AIDAP) guidelines (generated subsequently) was variable ranging from 0 to 69% between conditions. Conclusions and Clinical Importance Choice of antimicrobials by Australian veterinary practitioners was generally appropriate, with relatively low use of drugs of high importance, except for the empirical use of fluoroquinolones in dogs, particularly for otitis externa and 3rd‐generation cephalosporins in cats. Future surveys will determine whether introduction of the 2013 AIDAP therapeutic guidelines has influenced prescribing habits.
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Affiliation(s)
- L Y Hardefeldt
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
| | - S Holloway
- Advanced Vetcare, Kensington, Vic., Australia
| | - D J Trott
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, SA, Australia
| | - M Shipstone
- School of Veterinary Sciences, University of Queensland, Gatton, Qld, Australia
| | - V R Barrs
- Faculty of Veterinary Science, University of Sydney, Sydney, NSW, Australia
| | - R Malik
- Faculty of Veterinary Science, University of Sydney, Sydney, NSW, Australia
| | - M Burrows
- Animal Dermatology, Perth, WA, Australia
| | - S Armstrong
- Zoetis Animal Health, Rhodes, NSW, Australia
| | - G F Browning
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
| | - M Stevenson
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
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Lines KE, Stevenson M, Filippakopoulos P, Müller S, Lockstone HE, Wright B, Grozinsky-Glasberg S, Grossman AB, Knapp S, Buck D, Bountra C, Thakker RV. Epigenetic pathway inhibitors represent potential drugs for treating pancreatic and bronchial neuroendocrine tumors. Oncogenesis 2017; 6:e332. [PMID: 28504695 PMCID: PMC5523063 DOI: 10.1038/oncsis.2017.30] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 02/06/2023] Open
Abstract
Cancer is associated with alterations in epigenetic mechanisms such as histone modifications and methylation of DNA, and inhibitors targeting epigenetic mechanisms represent a novel class of anti-cancer drugs. Neuroendocrine tumors (NETs) of the pancreas (PNETs) and bronchus (BNETs), which may have 5-year survivals of <50% and as low as 5%, respectively, represent targets for such drugs, as >40% of PNETs and ~35% of BNETs have mutations of the multiple endocrine neoplasia type 1 (MEN1) gene, which encodes menin that modifies histones by interacting with histone methyltransferases. We assessed 9 inhibitors of epigenetic pathways, for their effects on proliferation, by CellTiter Blue assay, and apoptosis, by CaspaseGlo assay, using 1 PNET and 2 BNET cell lines. Two inhibitors, referred to as (+)-JQ1 (JQ1) and PFI-1, targeting the bromo and extra terminal (BET) protein family which bind acetylated histone residues, were most effective in decreasing proliferation (by 40-85%, P<0.001) and increasing apoptosis (by 2-3.6 fold, P<0.001) in all 3 NET cell lines. The anti-proliferative effects of JQ1 and PFI-1 remained present for at least 48 hours after removal of the compound. JQ1, but not PFI-1, had cell cycle effects, assessed by propidium iodide staining and flow cytometry, resulting in increased and decreased proportions of NET cells in G1, and S and G2 phases, respectively. RNA Sequencing analysis revealed that these JQ1 effects were associated with increased histone 2B expression, and likely mediated through altered activity of bromodomain-containing (Brd) proteins. Assessment of JQ1 in vivo, using a pancreatic beta cell-specific conditional Men1 knockout mouse model that develops PNETs, revealed that JQ1 significantly reduced proliferation (by ~50%, P<0.0005), assessed by bromodeoxyuridine incorporation, and increased apoptosis (by ~3 fold, P<0.0005), assessed by terminal deoxynucleotidyl transferase dUTP nick end labelling, of PNETs. Thus, our studies demonstrate that BET protein inhibitors may provide new treatments for NETs.
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Affiliation(s)
- K E Lines
- Academic Endocrine Unit, OCDEM, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - M Stevenson
- Academic Endocrine Unit, OCDEM, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - P Filippakopoulos
- Structural Genomics Consortium, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - S Müller
- Structural Genomics Consortium, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - H E Lockstone
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, UK
| | - B Wright
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, UK
| | - S Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology & Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A B Grossman
- Academic Endocrine Unit, OCDEM, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - S Knapp
- Structural Genomics Consortium, University of Oxford, Old Road Campus, Headington, Oxford, UK
- Institute for Pharmaceutical Chemistry, Johann Wolfgang Goethe-University and Buchmann Institute for Molecular Life Sciences, Max-von-Laue-Strasse 9, Frankfurt am Main, Jerusalem, Germany
| | - D Buck
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, UK
| | - C Bountra
- Structural Genomics Consortium, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - R V Thakker
- Academic Endocrine Unit, OCDEM, University of Oxford, Churchill Hospital, Headington, Oxford, UK
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25
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McKinley A, Stevenson M, Steele K. Widening Participation To The Medical Course At Queens University Belfast. Ulster Med J 2017. [PMID: 29535485 PMCID: PMC5845993] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The United Kingdom Clinical Aptitude Test (UKCAT) was introduced to assist in identification of applicants from all levels of society with the appropriate characteristics to become good doctors. Evidence that the UKCAT has achieved such widened participation (WP) in applicants to medical school remains elusive. One of the limitations to WP investigation has been that data on socioeconomic status of applicants to medical schools has been obtained through voluntary submission on application to UKCAT and up to 30% of applications offered either none or only limited information. In this study of local applicants (451 from Northern Ireland) to Queens University Belfast (QUB) for 2012, socioeconomic data was ascertained through post code analysis. These data were utilized to investigate the relationship between affluence, application to the medical school and UKCAT score. Our study has shown that for NI applicants to QUB medical school, postcode /socioeconomic back ground accounts for only 3 percent of UK CAT score variation. We have also shown that our admissions process is largely independent of socioeconomic background. However we have demonstrated that the socioeconomic profile of applicants from Northern Ireland to QUB medical school is such that even if every applicant to QUB in 2012 were offered a place in the medical school the number of applicants from least affluent areas would increase by only 9. In conclusion efforts to achieve meaningful WP must be directed at raising aspirations for a career in Medicine within the community.
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Affiliation(s)
- A McKinley
- Centre for Medical Education, QUB,Corresponding Author: Dr Andrew McKinley
| | | | - K Steele
- Centre for Medical Education, QUB
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26
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Lines KE, Vas Nunes RP, Frost M, Yates CJ, Stevenson M, Thakker RV. A MEN1 pancreatic neuroendocrine tumour mouse model under temporal control. Endocr Connect 2017; 6:232-242. [PMID: 28420716 PMCID: PMC5632719 DOI: 10.1530/ec-17-0040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 12/28/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterised by occurrence of parathyroid tumours and neuroendocrine tumours (NETs) of the pancreatic islets and anterior pituitary. The MEN1 gene, encoding menin, is a tumour suppressor, but its precise role in initiating in vivo tumourigenesis remains to be elucidated. The availability of a temporally controlled conditional MEN1 mouse model would greatly facilitate the study of such early tumourigenic events, and overcome the limitations of other MEN1 knockout models, in which menin is lost from conception or tumour development occurs asynchronously. To generate a temporally controlled conditional mouse model, we crossbred mice with the MEN1 gene floxed by LoxP sites (Men1L/L ), and mice expressing tamoxifen-inducible Cre recombinase under the control of the rat insulin promoter (RIP2-CreER), to establish a pancreatic β-cell-specific NET model under temporal control (Men1L/L /RIP2-CreER). Men1L/L /RIP2-CreER mice aged ~3 months were given tamoxifen in the diet for 5 days, and pancreata harvested 2-2.5, 2.9-3.5 and 4.5-5.5 months later. Control mice did not express Cre and did not receive tamoxifen. Immunostaining of pancreata from tamoxifen-treated Men1L/L /RIP2-CreER mice, compared to control mice, showed at all ages: loss of menin in all islets; increased islet area (>4.2-fold); increased proliferation of insulin immunostaining β-cells (>2.3-fold) and decreased proliferation of glucagon immunostaining α-cells (>1.7-fold). There were no gender and apoptotic or proliferation differences, and extra-pancreatic tumours were not detected. Thus, we have established a mouse model (Men1L/L /RIP2-CreER) to study early events in the development of pancreatic β-cell NETs.
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Affiliation(s)
| | | | - M Frost
- Academic Endocrine UnitOCDEM, University of Oxford, Churchill Hospital, Oxford, UK
| | - C J Yates
- Academic Endocrine UnitOCDEM, University of Oxford, Churchill Hospital, Oxford, UK
| | - M Stevenson
- Academic Endocrine UnitOCDEM, University of Oxford, Churchill Hospital, Oxford, UK
| | - R V Thakker
- Academic Endocrine UnitOCDEM, University of Oxford, Churchill Hospital, Oxford, UK
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27
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Schmalz L, Chaput K, Lagadin C, Stevenson M, Adeleye A. 1204 RESOURCE UTILIZATION OF POLYSOMNOGRAPHY AT THE ALBERTA CHILDREN’S HOSPITAL. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1203] [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: 11/12/2022] Open
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28
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Stevenson M, Achille M, Liben S, Proulx MC, Humbert N, Petti A, Macdonald ME, Cohen SR. Understanding How Bereaved Parents Cope With Their Grief to Inform the Services Provided to Them. Qual Health Res 2017; 27:649-664. [PMID: 26848080 DOI: 10.1177/1049732315622189] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Our objective was to develop a rich description of how parents experience their grief in the first year after the death of their child, and how various bereavement follow-up and support services helped them during this time, with the aim of informing follow-up and support services offered to bereaved parents. Our findings situated parents' individual experiences of coping within the social and institutional contexts in which they grieved. In the first year after the death of their child, parents regulated their intense feelings of grief through loss-oriented, restoration-oriented, and/or meaning reconstruction strategies. Often, parents' relationships with others and many of the bereavement follow-up and support services helped them in this regard. This article also explores how the results may aid service providers in accompanying parents in a way that optimizes outcomes for these parents.
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Affiliation(s)
- Moire Stevenson
- 1 MAB-Mackay Rehabilitation Centre, Montreal, Québec, Canada
- 2 Université de Montréal, Québec, Canada
| | | | | | | | | | - Antoinette Petti
- 4 Centre hospitalier universitaire Sainte-Justine, Montreal, Québec, Canada
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Moore AS, Morton J, Guymer T, Bazin N, Bentley C, Stevenson M, Kline JL, Keiter P, Taccetti M, Mussack K, Peterson B, Schmidt DW, Hamilton C, Lanier N, Workman J. Developing High-Temperature Laser-Driven Half Hohlraums for High-Energy-Density Physics Experiments at the National Ignition Facility. Fusion Science and Technology 2017. [DOI: 10.13182/fst13-a16323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. S. Moore
- AWE Aldermaston, Reading, Berkshire RG7 4PR United Kingdom
| | - J. Morton
- AWE Aldermaston, Reading, Berkshire RG7 4PR United Kingdom
| | - T. Guymer
- AWE Aldermaston, Reading, Berkshire RG7 4PR United Kingdom
| | - N. Bazin
- AWE Aldermaston, Reading, Berkshire RG7 4PR United Kingdom
| | - C. Bentley
- AWE Aldermaston, Reading, Berkshire RG7 4PR United Kingdom
| | - M. Stevenson
- AWE Aldermaston, Reading, Berkshire RG7 4PR United Kingdom
| | - J. L. Kline
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - P. Keiter
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - M. Taccetti
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - K. Mussack
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - B. Peterson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - D. W. Schmidt
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - C. Hamilton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - N. Lanier
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - J. Workman
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
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Walls GV, Stevenson M, Lines KE, Newey PJ, Reed AAC, Bowl MR, Jeyabalan J, Harding B, Bradley KJ, Manek S, Chen J, Wang P, Williams BO, Teh BT, Thakker RV. Mice deleted for cell division cycle 73 gene develop parathyroid and uterine tumours: model for the hyperparathyroidism-jaw tumour syndrome. Oncogene 2017; 36:4025-4036. [PMID: 28288139 PMCID: PMC5472200 DOI: 10.1038/onc.2017.43] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 08/18/2016] [Revised: 12/22/2016] [Accepted: 01/24/2017] [Indexed: 02/06/2023]
Abstract
The hyperparathyroidism-jaw tumour (HPT-JT) syndrome is an autosomal dominant disorder characterized by occurrence of parathyroid tumours, often atypical adenomas and carcinomas, ossifying jaw fibromas, renal tumours and uterine benign and malignant neoplasms. HPT-JT is caused by mutations of the cell division cycle 73 (CDC73) gene, located on chromosome 1q31.2 and encodes a 531 amino acid protein, parafibromin. To facilitate in vivo studies of Cdc73 in tumourigenesis we generated conventional (Cdc73+/-) and conditional parathyroid-specific (Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre) mouse models. Mice were aged to 18-21 months and studied for survival, tumour development and proliferation, and serum biochemistry, and compared to age-matched wild-type (Cdc73+/+ and Cdc73+/+/PTH-Cre) littermates. Survival of Cdc73+/- mice, when compared to Cdc73+/+ mice was reduced (Cdc73+/-=80%; Cdc73+/+=90% at 18 months of age, P<0.05). Cdc73+/-, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice developed parathyroid tumours, which had nuclear pleomorphism, fibrous septation and increased galectin-3 expression, consistent with atypical parathyroid adenomas, from 9 months of age. Parathyroid tumours in Cdc73+/-, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice had significantly increased proliferation, with rates >fourfold higher than that in parathyroid glands of wild-type littermates (P<0.0001). Cdc73+/-, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice had higher mean serum calcium concentrations than wild-type littermates, and Cdc73+/- mice also had increased mean serum parathyroid hormone (PTH) concentrations. Parathyroid tumour development, and elevations in serum calcium and PTH, were similar in males and females. Cdc73+/- mice did not develop bone or renal tumours but female Cdc73+/- mice, at 18 months of age, had uterine neoplasms comprising squamous metaplasia, adenofibroma and adenomyoma. Uterine neoplasms, myometria and jaw bones of Cdc73+/- mice had increased proliferation rates that were 2-fold higher than in Cdc73+/+ mice (P<0.05). Thus, our studies, which have established mouse models for parathyroid tumours and uterine neoplasms that develop in the HPT-JT syndrome, provide in vivo models for future studies of these tumours.
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Affiliation(s)
- G V Walls
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - M Stevenson
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - K E Lines
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - P J Newey
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - A A C Reed
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - M R Bowl
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - J Jeyabalan
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - B Harding
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - K J Bradley
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - S Manek
- Department of Pathology, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - J Chen
- Laboratory of Cancer Genetics, Van Andel Research Institute, Grand Rapids, MI, USA
| | - P Wang
- Laboratory of Cancer Genetics, Van Andel Research Institute, Grand Rapids, MI, USA
| | - B O Williams
- Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, MI, USA
| | - B T Teh
- Laboratory of Cancer Genetics, Van Andel Research Institute, Grand Rapids, MI, USA
| | - R V Thakker
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
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Kurscheid J, Stevenson M, Durr PA, Toribio JALML, Kurscheid S, Ambarawati IGAA, Abdurrahman M, Fenwick S. Social network analysis of the movement of poultry to and from live bird markets in Bali and Lombok, Indonesia. Transbound Emerg Dis 2017; 64:2023-2033. [PMID: 28160424 DOI: 10.1111/tbed.12613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 11/29/2022]
Abstract
Highly pathogenic avian influenza H5N1 has resulted in large losses to the Indonesian poultry sector. Evidence suggests that live bird markets (LBMs) play an important role in the epidemiology of the disease. Knowledge of the frequency and type of contact between the various poultry market players should allow animal health authorities to develop a better understanding of factors influencing virus transmission between Indonesian villages. A questionnaire-based cross-sectional survey was conducted in 17 LBMs on the neighbouring Indonesian islands of Bali and Lombok to investigate the movement patterns of poultry to and from markets. Using social network analyses, a network of contacts was created for each island from a total of 413 live poultry traders and 134 customers. Individual nodes with high degree and/or betweenness were identified in each network. The Lombok network was more dense and connected than the Bali network indicating that disease transmission would be more efficient in the Lombok network. Our findings indicate that whilst live poultry are typically transported over relatively short distances of approximately 10 km, it is not uncommon for traders and customers to travel in excess of 100 km to buy or sell poultry, which may facilitate the spread of disease over a large geographical area. This study highlights the different roles markets play in poultry movement networks and their potential for disease dissemination. The identification of highly influential market nodes allows authorities to target HPAI surveillance activities to locations where disease is more likely to be present, which is crucial in low-resource settings.
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Affiliation(s)
- J Kurscheid
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, Australia.,Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - M Stevenson
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic., Australia
| | - P A Durr
- Australian Animal Health Laboratory, Commonwealth Science and Industry Organisation, Geelong, Vic., Australia
| | - J-A L M L Toribio
- Faculty of Veterinary Science, Camden Campus, School of Life and Environmental Sciences, The University of Sydney, Camden, NSW, Australia
| | - S Kurscheid
- John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - I G A A Ambarawati
- Agribusiness Study Program, Faculty of Agriculture, Udayana University, Denpasar, Bali, Indonesia
| | - M Abdurrahman
- Research Center for Rural Development, Mataram University, Mataram, Lombok, Indonesia
| | - S Fenwick
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, Boston, MA, USA
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Graham LE, Leggett P, Steele K, Gilliland A, O'reilly D, Stevenson M, Wootton R, Taggart AJ. Do all outpatients need a face-to-face consultation in rheumatology? J Telemed Telecare 2016. [DOI: 10.1258/1357633001934681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- L E Graham
- Rheumatology Department, Belfast City Hospital, Belfast
| | - P Leggett
- Department of General Practice, Queen's University Belfast
| | - K Steele
- Department of General Practice, Queen's University Belfast
| | - A Gilliland
- Department of General Practice, Queen's University Belfast
| | - D O'reilly
- Department of Epidemiology and Statistics, Royal Group of Hospitals, Belfast
| | - M Stevenson
- Department of Epidemiology and Statistics, Royal Group of Hospitals, Belfast
| | - R Wootton
- Institute of Telemedicine and Telecare, Royal Group of Hospitals, Belfast, UK
| | - A J Taggart
- Rheumatology Department, Belfast City Hospital, Belfast
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Marquetoux N, Heuer C, Wilson P, Ridler A, Stevenson M. Merging DNA typing and network analysis to assess the transmission of paratuberculosis between farms. Prev Vet Med 2016; 134:113-121. [PMID: 27836032 DOI: 10.1016/j.prevetmed.2016.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/04/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022]
Abstract
Paratuberculosis, a chronic enteric infection caused by Mycobacterium subsp. paratuberculosis (MAP), is endemic in all farmed ruminant species in New Zealand. The use of genotyping in combination with network analysis of livestock movement events from one farm location to another has the potential to contribute to our understanding of between-farm transmission events. We studied a population of 122 farms from a corporate commercial livestock enterprise in New Zealand, trading with each other in near isolation from other commercial farms. The data consisted of longitudinal movements to and from these farms between 2006 and 2010, as well as the results of cross-sectional MAP screening and genotyping performed in 2010. We explored associations between past livestock movements and current strain type distribution in this population of farms using quadratic assignment procedure. Our results show that measures of farm clustering within the movement network were significantly associated with sharing of MAP strains. For example, farms closely related by trade were twice as likely to share the same strains of MAP (p=0.033). Other covariates were also associated with the probability of sharing the same strains of MAP, such as being located on the same island (OR=5.8 to 8.7, p<0.01), farming the same livestock species and Euclidian distance between farms. The novel approach we used supports the hypothesis that livestock movement is indeed a significant contributor to farm-to-farm transmission of MAP.
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Affiliation(s)
- N Marquetoux
- EpiCentre, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand.
| | - C Heuer
- EpiCentre, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - P Wilson
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, New Zealand
| | - A Ridler
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, New Zealand
| | - M Stevenson
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, Australia
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Ogonda L, Hill J, Doran E, Dennison J, Stevenson M, Beverland D. Aspirin for thromboprophylaxis after primary lower limb arthroplasty: early thromboembolic events and 90 day mortality in 11,459 patients. Bone Joint J 2016; 98-B:341-8. [PMID: 26920959 DOI: 10.1302/0301-620x.98b3.36511] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to present data on 11 459 patients who underwent total hip (THA), total knee (TKA) or unicompartmental knee arthroplasty (UKA) between November 2002 and April 2014 with aspirin as the primary agent for pharmacological thromboprophylaxis. PATIENTS AND METHODS We analysed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) then compared the 90-day all-cause mortality with the corresponding data in the National Joint Registry for England and Wales (NJR). RESULTS The incidence of PE was 0.6% after THA, 1.47% after TKA and 1.2% after UKA. The 90-day mortality was 0.39% after THA and 0.44% after TKA. No deaths occurred after UKA. The main causes of death were ischaemic heart disease and respiratory failure. PE was responsible for only 18% of deaths. There was a decline in 90-day mortality, from 0.64% between 2002 and 2007, to 0.21% between 2008 and 2013 after THA, and from 0.47% to 0.39% after TKA for the corresponding period. The standardised mortality ratio (SMR) declined from 86.5 (confidence interval (CI) 63.0 to 137.7) to 39.7 (CI 31.2 to 54.3) p = 0.024. The incidence of proximal DVT was 0.3%. TAKE HOME MESSAGE With individualised risk assessment and as part of a multimodal approach, Aspirin is safe to use as the main thromboprophylactic agent in primary arthroplasty. It is not associated with an increased incidence of symptomatic DVT, PE or death.
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Affiliation(s)
- L Ogonda
- Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, UK
| | - J Hill
- Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK
| | - E Doran
- Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK
| | - J Dennison
- Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK
| | - M Stevenson
- Queens University, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - D Beverland
- Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK
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Abstract
AIMS To determine whether the application of lime or nitrogen to pasture affected the spore counts of Pithomyces chartarum. MATERIALS AND METHODS The lime application studies were undertaken on a spring-calving, pasture-based, commercial dairy farm near Te Awamutu, New Zealand. On 6 November 2012, five randomly selected paddocks were split into three equal sections. In two of the sections, lime was applied at either 1.5 or 2.5 t/ha, and the central section was left as an untreated control. Each section was sampled for spore counting weekly from 16 January to 15 May 2013. Starting in January 2013, five other randomly selected paddocks were monitored for spore counts. On 20 March 2013 the average spore counts in three paddocks were >100,000 spores/g of pasture. These paddocks were then divided into three equal sections and lime was applied as described above. Spore counting in each section continued weekly until 15 May 2013. The nitrogen application study was carried out on three commercial dairy farms near Te Awamutu, New Zealand. Two randomly selected paddocks on each farm were divided into three equal sections and, on 20 December 2012, nitrogen in the form of urea was applied at either 50 or 80 kg urea/ha to two of the sections; the central section remained as an untreated control. Each section was sampled for spore counting weekly from 16 January to 15 May 2013. RESULTS Following pre-summer lime application, treatment at 1.5 or 2.5 t/ha did not affect spore counts over time compared with the control section (p>0.26). Similarly following autumn lime application, treatment at 1.5 or 2.5 t/ha did not affect spore counts over time compared with the control section (p>0.11). Following nitrogen application median spore counts remained <20,000 spores/g pasture throughout the trial period and there was no effect of treatment on spore counts over time (p>0.49). CONCLUSION This study found that application of lime before the risk period for facial eczema, in November, application of lime after a spore count rise, in March, or urea application in December did not affect changes in number of spores produced by P. chartarum. CLINICAL RELEVANCE This study does not support previous suggestions that fertilising pasture with lime or urea could alter the spore counts of P. chartarum. Fertiliser use does not provide an alternative to, or support, conventional methods of facial eczema control such as zinc prophylaxis or treatment of pasture with fungicides.
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Affiliation(s)
- E L Cuttance
- a VetEnt , 49 Benson Road, Te Awamutu 3840 , New Zealand
| | - R A Laven
- b Institute of Veterinary, Animal and Biomedical Sciences , Massey University , Palmerston North , New Zealand
| | - W A Mason
- a VetEnt , 49 Benson Road, Te Awamutu 3840 , New Zealand
| | - M Stevenson
- c Veterinary Faculty , University of Melbourne , Melbourne , Australia
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Abstract
Pituitary neoplasias can occur as part of a complex inherited disorder, or more commonly as sporadic (non-familial) disease. Studies of the molecular and genetic mechanisms causing such pituitary tumours have identified dysregulation of >35 genes, with many revealed by studies in mice, rats and zebrafish. Strategies used to generate these animal models have included gene knockout, gene knockin and transgenic over-expression, as well as chemical mutagenesis and drug induction. These animal models provide an important resource for investigation of tissue-specific tumourigenic mechanisms, and evaluations of novel therapies, illustrated by studies into multiple endocrine neoplasia type 1 (MEN1), a hereditary syndrome in which ∼ 30% of patients develop pituitary adenomas. This review describes animal models of pituitary neoplasia that have been generated, together with some recent advances in gene editing technologies, and an illustration of the use of the Men1 mouse as a pre clinical model for evaluating novel therapies.
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Affiliation(s)
- K E Lines
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford OX3 7LJ, UK
| | - M Stevenson
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford OX3 7LJ, UK
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford OX3 7LJ, UK.
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Wada M, Stevenson M, Cogger N, Carpenter T. Evaluation of the Control Strategy for the 2010 Foot-and-Mouth Disease Outbreak in Japan Using Disease Simulation. Transbound Emerg Dis 2016; 64:978-989. [PMID: 26748445 DOI: 10.1111/tbed.12467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Indexed: 11/27/2022]
Abstract
In 2010, Japan experienced a foot-and-mouth disease (FMD) epidemic where 292 premises were infected over a period of 75 days. The epidemic was controlled by stamping-out and vaccination, applied 5 weeks after the first confirmation of disease within a 10 km radius of identified infected places. This study aimed at identifying the role of emergency vaccination to epidemic control while adjusting for the dynamic pattern of local spread, and assessing alternative vaccination strategies, using a disease simulation model. Our results indicate that the overall hazard of local spread remained high throughout the silent spread phase and the first two weeks post-detection, with significant reduction occurring from week 3 onwards. The estimated effectiveness of emergency vaccination quantified as reduction in the hazard of infection was at most 81% and 44% for cattle and pig farms, respectively. The vaccination strategy reduced the simulated median number of IPs by 22%, epidemic duration by 64% and culling duration by 52%, but increased the total number of infected or vaccinated premises subject to culling by 144% compared with no vaccination. The simulation indicated that vaccination starting 2 weeks earlier (3 weeks post-first detection) with a smaller vaccination radius (3 km) was more effective for eradication of the epidemic compared with the actually implemented strategy.
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Affiliation(s)
- M Wada
- EpiCentre, Institute of Veterinary Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - M Stevenson
- EpiCentre, Institute of Veterinary Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand.,Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - N Cogger
- EpiCentre, Institute of Veterinary Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - T Carpenter
- EpiCentre, Institute of Veterinary Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
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Kuczawski M, Mason S, Teare M, Stevenson M, Goodacre S, Holmes M, Harper R, Ramlakhan S, Morris F. DELAYED BLEEDING IN ANTICOAGULATED PATIENTS AFTER BLUNT HEAD TRAUMA. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.7] [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: 11/04/2022]
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Jeffries MA, Donica M, Annan A, Stevenson M, Humphrey MB, James JA, Sawalha AH. A4.24 Global transcriptome analysis in osteoarthritic cartilage reveals significant differential gene expression and associations with histologic disease progression. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.106] [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: 11/04/2022]
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Abstract
Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8o (28o to 63o), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 μg/L (0.24 μg/L to 27.56 μg/L) and 0.78 μg/L (0.21 μg/L to 8.84 μg/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly. Cite this article: Bone Joint J 2015;97-B:300–5.
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Affiliation(s)
- J. C. Hill
- Musgrave Park Hospital, Stockman’s
Lane, Belfast, BT9 7JB, UK
| | - O. J. Diamond
- Musgrave Park Hospital, Stockman’s
Lane, Belfast, BT9 7JB, UK
| | - S. O’Brien
- Musgrave Park Hospital, Stockman’s
Lane, Belfast, BT9 7JB, UK
| | - J. G. Boldt
- Private Hospital Worbstrasse, 324
CH 3073 Guemligen, Switzerland
| | - M. Stevenson
- Institute of Clinical Science 'B' , Grosvenor
Road, Belfast BT12 6BJ, UK
| | - D. E. Beverland
- Musgrave Park Hospital, Stockman’s
Lane, Belfast, BT9 7JB, UK
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Baker RC, Spence RAJ, Boohan M, Dorman A, Stevenson M, Kirk SJ, McGlade K. A novel approach to improve undergraduate surgical teaching. Ulster Med J 2015; 84:30-6. [PMID: 25964701 PMCID: PMC4330803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 10/28/2022]
Abstract
BACKGROUND Undergraduate surgery is at an important crossroads. Many departments report significant difficulties delivering effective teaching. Our student feedback indicated a dated surgical curriculum lacking structure, quality and uniformity. We report on a new "blended" approach employing a combination of professional DVDs, case based discussions, online material and traditional bedside teaching designed to provide structure, standardization, and equality of learning . METHODS Year 4 students who had undertaken the new course and year 5 students who had participated in the traditional teaching programme were compared. Students completed a 20 item questionnaire about their experiences of the surgical teaching programme. RESULTS One hundred and seventy-one year 4 (70%) and 148 year 5 students (66%) responded. Domains relating to "Overall Satisfaction with the course", "Approval of innovative teaching methods and interactivity" and "Satisfaction with the clarity of course information" showed improvements when comparing the new and old programmes. However bedside teaching was not rated as highly in the new programme (p<0.05). CONCLUSION This blended approach has resulted in improved student understanding and engagement. The apparent compromise of bedside teaching may be a reflection of higher expectations. We believe that a similar blended approach has the potential to re-invigorate surgical teaching elsewhere.
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McKavanagh P, Lusk L, Ball PA, Verghis RM, Agus AM, Trinick TR, Duly E, Walls GM, Stevenson M, James B, Hamilton A, Harbinson MT, Donnelly PM. A comparison of cardiac computerized tomography and exercise stress electrocardiogram test for the investigation of stable chest pain: the clinical results of the CAPP randomized prospective trial. Eur Heart J Cardiovasc Imaging 2014; 16:441-8. [DOI: 10.1093/ehjci/jeu284] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lathlean T, Gastin P, Finch C, Stevenson M. Incidence and severity of injury in elite junior Australian football players over the preseason. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.380] [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: 10/24/2022]
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Wailoo AJ, Stevenson M, Tosh J, Hernández M, Stevens JW, Archer R, Simpson E, Everson HE, Scott D, Young A, Paisley S, Williams K. The Cost-Effectiveness of Biologic Dmards in Patients With Severe or Mild-To-Severe Rheumatoid Arthritis After Conventional Dmards. Value Health 2014; 17:A380. [PMID: 27200840 DOI: 10.1016/j.jval.2014.08.2611] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A J Wailoo
- NICE Decision Support Uni, Sheffield, UK
| | | | - J Tosh
- University of Sheffield, Sheffield, UK
| | | | | | - R Archer
- University of Sheffield, Sheffield, UK
| | - E Simpson
- University of Sheffield, Sheffield, UK
| | | | | | - A Young
- adam. young@nhs. net, Heertford, UK
| | - S Paisley
- The University of Sheffield, Sheffield, UK
| | - K Williams
- The University of Sheffield, Sheffield, UK
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Stevenson M, Rawdin A, Uttley L, Sutton A. The Cost Effectiveness of Group Art Therapy for Patients with Non-Psychotic Mental Health Disorders in England And Wales. Value Health 2014; 17:A458-A459. [PMID: 27201276 DOI: 10.1016/j.jval.2014.08.1263] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - A Rawdin
- University of Sheffield, Sheffield, UK
| | - L Uttley
- University of Sheffield, Sheffield, UK
| | - A Sutton
- University of Sheffield, Sheffield, UK
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Tosh J, Stevenson M, Strong M, Akehurst R. A Framework for the Economic Evaluation of Sequential Therapies for Chronic Conditions. Value Health 2014; 17:A584. [PMID: 27201978 DOI: 10.1016/j.jval.2014.08.1986] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Tosh
- University of Sheffield, Sheffield, UK
| | | | - M Strong
- University of Sheffield, Sheffield, UK
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Savage EM, McCormick D, McDonald S, Moore O, Stevenson M, Cairns AP. Does rheumatoid arthritis disease activity correlate with weather conditions? Rheumatol Int 2014; 35:887-90. [PMID: 25342437 DOI: 10.1007/s00296-014-3161-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
Abstract
To determine whether rheumatoid arthritis disease activity correlates with changing weather conditions. A longitudinal analysis of 133 patients attending the Department of Rheumatology, Musgrave Park Hospital, Belfast was performed. Participants had a diagnosis of rheumatoid arthritis and were receiving subcutaneous anti-TNF therapy (Adalimumab or Etanercept) for a period of >6 months. Data were collected at five time points. This included tender joint count, swollen joint count, patient visual analogue score (VAS), erythrocyte sedimentation rate, C-reactive protein, VAS, and DAS-28 (Disease Activity Score). Each weather factor (maximum, minimum temperature, pressure, rainfall, sunshine, humidity, and wind-speed) was analysed against each patients' DAS-28 score at five time points, using an analysis of covariance. A significant correlation was noted between low DAS-28 and increased hours of sunshine (p < 0.001). Sunny conditions were associated with a DAS-28 reduction of 0.037 (95 % CI -0.059, -0.016) p < 0.001. A significant correlation between humidity and DAS-28 was also noted (p = 0.016). Increased humidity was associated with an increased DAS-28 of 0.007 (95 % CI 0.001, 0.013) p = 0.016. Higher temperatures were associated with a non-significant decrease in DAS-28 (p = 0.16). In this study, rheumatoid arthritis disease activity (as measured by DAS-28) was significantly lower in both more sunny and less humid conditions.
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Affiliation(s)
- E M Savage
- Department of Rheumatology, Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, Northern Ireland, UK,
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Petrasiunas MJ, Hussain MI, Canning J, Stevenson M, Kielpinski D. Picosecond 554 nm yellow-green fiber laser source with average power over 1 W. Opt Express 2014; 22:17716-17722. [PMID: 25089391 DOI: 10.1364/oe.22.017716] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We demonstrate a source of 554 nm pulses with 2.7 ps pulse duration and 1.41 W average power, at a repetition rate of 300 MHz. The yellow-green pulse train is generated from the second harmonic of a 1.11 μm fiber laser source in periodically-poled stoichiometric LiTaO3. A total fundamental power of 2.52 W was used, giving a conversion efficiency of 56%.
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Esfahani D, Stevenson M, Moss H, Amin-Hanjani S, Aletich V, Charbel F, Alaraj A. O-011 Quantitative MRA is Correlated with Intravascular Pressures Before and After Venous Sinus Stenting: Implications for Treatment and Monitoring. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Everson-Hock E, Cantrell A, Stevenson M, Michaels J. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess 2014; 17:i-xvi, 1-141. [PMID: 24176098 DOI: 10.3310/hta17480] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. Uncomplicated varicose veins can cause major discomfort and some complications. They are part of chronic venous disease (CVD), which is reported to have a substantial negative impact on health-related quality of life (HRQoL). Traditional treatments for varicose veins involve surgical stripping and ligation and liquid sclerotherapy (LS), but can be invasive and painful. New minimally invasive treatments offer an alternative. These treatments typically involve use of laser, radiofrequency or foam sclerosant. They are increasingly widely used and offer potential benefits such as reduced complications, faster recovery, fewer physical limitations and improved quality of life. OBJECTIVE The aim of this report is to evaluate the clinical effectiveness, safety and cost-effectiveness of the minimally invasive techniques of foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in comparison with other techniques, including traditional surgical techniques, LS and conservative management, in the management of varicose veins. DATA SOURCES A systematic search was made of 11 bibliographic databases of published and unpublished literature from their inception to July 2011: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library; Biological Abstracts; Science Citation Index (SCI); Social Sciences Citation Index; Conference Proceedings Citation Index-Science; UK Clinical Research Network; Current Controlled Trials; and ClinicalTrials.gov. REVIEW METHODS A systematic review of randomised controlled trials (RCTs) to assess the clinical effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, retreatment and clinical symptoms, as measured by the Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS The literature search identified 1453 unique citations, of which 34 RCTs (54 papers) satisfied the criteria for the clinical effectiveness review. The minimally invasive techniques reported clinical outcomes similar to surgery. Rates of recurrence were slightly lower for EVLA, RFA and FS, especially for longer follow-up periods; VCSS score was lower for EVLA and FS than for stripping, but slightly higher for RFA; short-term pain was less for FS and RFA but higher for EVLA; higher quality-of-life scores were reported for all evaluated interventions than for stripping. Differences between treatments were therefore negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Our central estimate is that total FS costs were lowest and FS is marginally more effective than stripping. However, this result was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs are equivalent to stripping. These findings are subject to uncertainty on account of the risk of bias present in the evidence base and the variation in costs. LIMITATIONS The relative clinical effectiveness and cost-effectiveness of the techniques are principally based on rates of post-operative technical recurrence rather than symptomatic recurrence, as this was the reported outcome in all trials. The true proportion of treated individuals who are likely to present with symptoms of recurrence requiring retreatment is therefore not certain. A figure reflecting the likely proportion of treated individuals who would experience symptomatic recurrence requiring retreatment (with its associated costs), therefore, had to be calculated by the authors based on a small number of studies. The findings of this report also need to be verified by data from future trials with longer follow-up and using more standardised outcome measures. CONCLUSIONS This assessment of the currently available evidence suggests there is little to choose between the minimally invasive techniques in terms of efficacy or cost, and each offers a viable, clinically effective alternative to stripping. FS might offer the most cost-effective alternative to stripping, within certain time parameters. High-quality RCT evidence is needed. Future trials should aim to measure and report outcomes in a standardised manner, which would permit more efficient pooling of their results. STUDY REGISTRATION PROSPERO number CRD42011001355. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Carroll
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
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