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Mullins E, Perry A, Banerjee J, Townson J, Grozeva D, Milton R, Kirby N, Playle R, Bourne T, Lees C. Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study. Eur J Obstet Gynecol Reprod Biol 2022; 276:161-167. [PMID: 35914420 PMCID: PMC9295331 DOI: 10.1016/j.ejogrb.2022.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/14/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. METHODS Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. RESULTS Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. CONCLUSIONS Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection. The proportion affected by pre-eclampsia amongst participants was not higher than would be expected, although we report a higher than expected proportion affected by eclampsia. There appears to be no effect on birthweight or congenital malformations in women affected by SARS-CoV-2 infection in pregnancy and neonatal infection is uncommon. This study reflects a population with a range of infection severity for SARS-COV-2 in pregnancy, generalisable to whole obstetric populations.
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Affiliation(s)
- E Mullins
- Imperial College London and The George Institute for Global Health, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
| | - A Perry
- Lead Research Midwife and Manager, Women's Health Research Centre, Imperial College London, W12 0HS, UK
| | - J Banerjee
- Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, W12 0HS, UK
| | - J Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - D Grozeva
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Milton
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - N Kirby
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Playle
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - T Bourne
- Imperial College London, Consultant Gyanecologist, Queen Charlotte's and Chelsea Hospital, London W12 0HS, UK
| | - C Lees
- Centre for Fetal Care, Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
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Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, Playle R, Perry A, Bourne T, Lees CC. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021; 57:573-581. [PMID: 33620113 PMCID: PMC8014713 DOI: 10.1002/uog.23619] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal-Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. METHODS This was an analysis of data from the PAN-COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP-SONPM National Perinatal COVID-19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP-SONPM). For obstetric outcomes, in PAN-COVID overall and in those with confirmed infection in PAN-COVID and AAP-SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (< 37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.1% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP-SONPM. Extreme preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP-SONPM. Neonatal SARS-CoV-2 infection was reported in 0.9% of all deliveries in PAN-COVID overall, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP-SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a small-for-gestational-age (SGA) neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP-SONPM. Mean gestational-age-adjusted birth-weight Z-scores were -0.03 in PAN-COVID and -0.18 in AAP-SONPM. CONCLUSIONS The findings from the UK and USA registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy. Copyright © 2021 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E. Mullins
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - M. L. Hudak
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Banerjee
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Getzlaff
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Townson
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - K. Barnette
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - R. Playle
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - A. Perry
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Bourne
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - C. C. Lees
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
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Monaghan N, Karki A, Playle R, Johnson I, Morgan M. Measuring oral health impact among care home residents in Wales. Community Dent Health 2017; 34:14-18. [PMID: 28561552 DOI: 10.1922/cdh_3950morgan05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/25/2016] [Indexed: 11/11/2022]
Abstract
Objective To explore inequalities in oral health impact among care home residents using OHIP-14 and ADHS criteria. Basic research design Cross-sectional survey with structured interview and clinical examination using 2009 ADHS criteria including OHIP-14. Comparisons were made between groups of residents and with findings from the ADHS 2009. Participants Care homes and residents were randomly selected. Those without capacity and non-English/Welsh speakers were excluded. 447 residents answered all OHIP-14 questions and had full oral examination. Main Outcome Measure OHIP-14. Results Reporting of OHIP problems was more common among care home residents compared with older people examined in the ADHS 2009 (50% vs 40%). There was no difference in the mean number of impacts between residents who were: dentate/edentate; denture wearing/non-denture wearing; with/without caries. Residents reporting 'problems and pain in your mouth at the moment', or 'occasional or more frequent dry mouth', more often experienced OHIP-14 impacts. Conclusion Compared with peers living in the community, both dentate and edentate care home residents are more likely to live with one or more impacts. Two simple questions related to 'Any problems and pain in your mouth?' and 'Do you have frequent dry mouth?' may help to target care home residents more likely to experience oral health impacts.
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Affiliation(s)
| | - A Karki
- Public Health Wales, Cardiff, UK
| | - R Playle
- Dental Public Health Unit, Applied Clinical Research and Public Health, College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Wales, UK
| | - I Johnson
- Dental Public Health Unit, Applied Clinical Research and Public Health, College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Wales, UK
| | - M Morgan
- Dental Public Health Unit, Applied Clinical Research and Public Health, College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Wales, UK
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Chestnutt IG, Playle R, Hutchings S, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, Hood K, Humphreys I, Kirby N, Lau TMM, Lisles C, Morgan MZ, Murphy S, Nuttall J, Onishchenko K, Phillips C, Pickles T, Scoble C, Townson J, Withers B, Chadwick BL. Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness. J Dent Res 2017; 96:754-761. [PMID: 28394709 DOI: 10.1177/0022034517702094] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).
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Affiliation(s)
- I G Chestnutt
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - R Playle
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK.,2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Hutchings
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Morgan-Trimmer
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - D Fitzsimmons
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Aawar
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - L Angel
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Derrick
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - C Drew
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Hoddell
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - K Hood
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - I Humphreys
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Kirby
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - T M M Lau
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Lisles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - M Z Morgan
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - S Murphy
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - J Nuttall
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - K Onishchenko
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - C Phillips
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - T Pickles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Scoble
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - J Townson
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - B Withers
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - B L Chadwick
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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Dawes H, Collett J, Debono K, Quinn L, Jones K, Kelson MJ, Simpson SA, Playle R, Backx K, Wasley D, Nemeth AH, Rosser A, Izardi H, Busse M. Exercise testing and training in people with Huntington's disease. Clin Rehabil 2014; 29:196-206. [PMID: 25142278 DOI: 10.1177/0269215514540921] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore exercise response in people with Huntington's disease (HD). DESIGN Experimental observational study with a randomly allocated subgroup before/after interventional study. SETTING Community. SUBJECTS People with HD (n=30) and a healthy comparator group (n=20). Thirteen people from the HD group were randomly allocated to an exercise training program. MAIN MEASURES Heart rate (HR) and perceived exertion on the Borg-CR10 scale (RPE) during a submaximal cycle ergometer exercise test (three minute unloaded and nine minute 65%-75%HRmaximum phase). Expired air and lactate measures were available for 8 people with HD during the exercise. INTERVENTION A 12 week gym and home walking exercise programme (n=13). RESULTS People with HD achieved a lower work rate at nine minutes (82±42(0-195) v 107±35(50 -185) Watts (p<0.05)), but higher RPE at both three (3±2(0-7) v 1±1(0-4)) and nine minutes (7±3(1-10) v 5± 2(2-9)) both p<0.01, compared to the healthy group and did not achieve a steady state HR during unloaded cycling. People with HD also demonstrated higher than expected lactate at three 2.5±2.5(1.1-8)mmo.L-1 and nine 3.8±1.9(1.2-6.6)mmo.L-1 minutes and respiratory exchange ratio at three 0.78±0.03 (0.74-0.81) and nine minutes 0.94±0.11(0.81-1.15). After exercise training there were no changes observed in HR or RPE responses during the exercise test. CONCLUSIONS There was a large variability in the observed metabolic and physiological responses to exercise in people with HD. The observed exercise responses suggest that altered exercise prescription parameters may be required for people with HD and that exercise response and factors' affecting this requires further investigation.
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Affiliation(s)
- H Dawes
- Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, UK Department of Clinical Neurology University of Oxford, UK
| | - J Collett
- Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - K Debono
- School of Healthcare Sciences, Cardiff University, UK
| | - L Quinn
- School of Healthcare Sciences, Cardiff University, UK
| | - K Jones
- School of Healthcare Sciences, Cardiff University, UK
| | - M J Kelson
- Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University School of Medicine, UK
| | - S A Simpson
- Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University School of Medicine, UK
| | - R Playle
- Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University School of Medicine, UK
| | - K Backx
- Cardiff Metropolitan University, Cardiff School of Sport, UK
| | - D Wasley
- Cardiff Metropolitan University, Cardiff School of Sport, UK
| | - A H Nemeth
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - A Rosser
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK Cardiff Brain Repair Group, School of BioSciences, Cardiff University, UK
| | - H Izardi
- School of Technology, Oxford Brookes University, UK
| | - M Busse
- School of Healthcare Sciences, Cardiff University, UK
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Popat H, Corns S, Richmond S, Playle R. Preparing for practice – calibration of dental undergraduate students in the Index of Orthodontic Treatment Need. Br Dent J 2013; 215:469-71. [PMID: 24201623 DOI: 10.1038/sj.bdj.2013.1043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/09/2022]
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Busse M, Quinn L, DeBono K, Jones K, Collett J, Playle R, Kelly M, Backx K, Dawes H, Rosser A, Backx K, Busse M, Collett J, Dawes H, DeBono K, Hunt S, Jones K, Kelly M, Nemeth A, Playle R, Quinn L, Rosser A, Simpson S, Wasley) D. Q12 A randomised feasibility study of a 12-week exercise programme in Huntington's disease (HD). J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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DeBono K, Wasley D, Riley J, Enright S, Collett J, Dawes H, Quinn L, Rosser A, Busse M, Busse M, Collett J, Dawes H, DeBono K, Hunt S, Jones K, Kelly M, Nemeth A, Playle R, Quinn L, Rosser A, Simpson S, Wasley) D. Q13 Perspectives of participating in a 12-week exercise programme for people with early -mid stage Huntington's disease. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Khalil H, Quinn L, van Dursen R, Dawes H, Playle R, Rosser A, Busse M. Q15 A pilot study of an exercise intervention to improve motor function in people with Huntington's disease (HD). J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McAndrew R, Ban J, Playle R. A comparison of computer- and hand-generated clinical dental notes with statutory regulations in record keeping. Eur J Dent Educ 2012; 16:e117-e121. [PMID: 22251334 DOI: 10.1111/j.1600-0579.2011.00684.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Dental patient records should be of high quality, contain information to allow for good continuity of care and clinical defence (should the need ever arise) and, ideally, facilitate clinical audit. Handwritten dental records have been assessed for their compliance to statutory regulations, but the same cannot be levelled at computer-generated notes. This study aimed to compare and analyse the compliance of both methods of data recording with statutory regulations. METHOD Fifty consecutive sets of handwritten notes and 50 sets of computer-generated notes were audited for compliance with a number of legal requirements and desirable characteristics for dental records and the results compared. The standard set for compliance with all characteristics was 100%. RESULTS The computer-generated notes satisfied the set standard for 8 of the 11 legal requirements and three of six desirable characteristics. The handwritten notes satisfied the set standard for 1 of 11 legal requirements and none of the desirable characteristics. A statistical difference (using a 95% confidence interval) between the two methods was observed in 5 of 11 legal characteristics and three of six desirable characteristics, all of which were in favour of computer-generated notes. CONCLUSIONS Within the limitations of this study, computer-generated notes achieved a much higher compliance rate with the set parameters, making defence in cases of litigation, continuity of care and clinical audit easier and more efficient.
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Affiliation(s)
- R McAndrew
- Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Heath Park, Cardiff, UK.
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Gregory J, Robling M, Bennert K, Channon S, Cohen D, Crowne E, Hambly H, Hawthorne K, Hood K, Longo M, Lowes L, McNamara R, Pickles T, Playle R, Rollnick S, Thomas-Jones E. Development and evaluation by a cluster randomised trial of a psychosocial intervention in children and teenagers experiencing diabetes: the DEPICTED study. Health Technol Assess 2011; 15:1-202. [PMID: 21851764 DOI: 10.3310/hta15290] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To develop and evaluate a health-care communication training programme to help diabetes health-care professionals (HCPs) counsel their patients more skilfully, particularly in relation to behaviour change. DESIGN The HCP training was assessed using a pragmatic, cluster randomised controlled trial. The primary and secondary analyses were intention-to-treat comparisons of outcomes using multilevel modelling to allow for cluster (service) and individual effects, and involved two-level linear models. SETTING Twenty-six UK paediatric diabetes services. PARTICIPANTS The training was delivered to HCPs (doctors, nurses, dietitians and psychologists) working in paediatric diabetes services and the effectiveness of this training was measured in 693 children aged 4-15 years and families after 1 year (95.3% follow-up). INTERVENTIONS A blended learning programme was informed by a systematic review of the literature, telephone and questionnaire surveys of professional practice, focus groups with children and parents, experimental consultations and three developmental workshops involving a stakeholder group. The programme focused on agenda-setting, flexible styles of communication (particularly guiding) and a menu of strategies using web-based training and practical workshops. MAIN OUTCOME MEASURES The primary trial outcome was a change in glycosylated haemoglobin (HbA1c) levels between the start and finish of a 12-month study period. Secondary trial outcomes included change in quality of life, other clinical [including body mass index (BMI)] and psychosocial measures (assessed at participant level as listed above) and cost (assessed at service level). In addition, patient details (HbA1c levels, height, weight, BMI, insulin regimen), health service contacts and patient-borne costs were recorded at each clinic visit, along with details of who patients consulted with, for how long, and whether or not patients consulted on their own at each visit. Patients and carers were also asked to complete an interim questionnaire assessing patient enablement (or feelings towards clinic visit for younger patients aged 7-10 years) at their first clinic visit following the start of the trial. The cost of the intervention included the cost of training intervention teams. RESULTS Trained staff showed better skills than control subjects in agenda-setting and consultation strategies, which waned from 4 to 12 months. There was no effect on HbA1c levels (p = 0.5). Patients in intervention clinics experienced a loss of confidence in their ability to manage diabetes, whereas controls showed surprisingly reduced barriers (p = 0.03) and improved adherence (p = 0.05). Patients in intervention clinics reported short-term increased ability (p = 0.04) to cope with diabetes. Parents in the intervention arm experienced greater excitement (p = 0.03) about clinic visits and improved continuity of care (p = 0.01) without the adverse effects seen in their offspring. The mean cost of training was £13,145 per site or £2163 per trainee. There was no significant difference in total NHS costs (including training) between groups (p = 0.1). CONCLUSIONS Diabetes HCPs can be trained to improve consultation skills, but these skills need reinforcing. Over 1 year, no benefits were seen in children, unlike parents, who may be better placed to support their offspring. Further modification of this training is required to improve outcomes that may need to be measured over a longer time to see effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN61568050. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 15, No. 29. See the HTA programme website for further project information.
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Affiliation(s)
- Jw Gregory
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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Affiliation(s)
- S. Malic
- Tissue Engineering and Reparative Dentistry, School of Dentistry, Cardiff University, UK
| | - K.E. Hill
- Tissue Engineering and Reparative Dentistry, School of Dentistry, Cardiff University, UK
| | - R. Playle
- Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, UK
| | - D.W. Thomas
- Tissue Engineering and Reparative Dentistry, School of Dentistry, Cardiff University, UK
| | - D.W. Williams
- Tissue Engineering and Reparative Dentistry, School of Dentistry, Cardiff University, UK
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Toma AM, Zhurov A, Playle R, Ong E, Richmond S. Reproducibility of facial soft tissue landmarks on 3D laser-scanned facial images. Orthod Craniofac Res 2009; 12:33-42. [DOI: 10.1111/j.1601-6343.2008.01435.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [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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Popat H, Richmond S, Playle R, Marshall D, Rosin PL, Cosker D. Three-dimensional motion analysis - an exploratory study. Part 2: Reproducibility of facial movement. Orthod Craniofac Res 2008; 11:224-8. [DOI: 10.1111/j.1601-6343.2008.00435.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Popat H, Richmond S, Playle R, Marshall D, Rosin PL, Cosker D. Three-dimensional motion analysis - an exploratory study. Part 1: Assessment of facial movement. Orthod Craniofac Res 2008; 11:216-23. [DOI: 10.1111/j.1601-6343.2008.00433.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Toma AM, Zhurov A, Playle R, Richmond S. A three-dimensional look for facial differences between males and females in a British-Caucasian sample aged 151/2 years old. Orthod Craniofac Res 2008; 11:180-5. [PMID: 18713155 DOI: 10.1111/j.1601-6343.2008.00428.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Optical surface scanning accurately records the three-dimension (3D) shape of the face non-invasively. Many software programs have been developed to process and analyze the 3D data, enabling the clinicians to create average templates for groups of subjects to provide a comparison of facial shape. OBJECTIVE Differences in facial morphology of males and females were identified using a laser scan imaging technology. SUBJECTS AND METHODS This study was undertaken on 380 British-Caucasian children aged 15 and a half year old, recruited from the Avon Longitudinal Study of Parents and Children (ALSPAC). 3D facial images were obtained for each individual using two high resolution Konica/Minolta laser scanners. The scan quality was assessed and any unsuitable scans were excluded from the study. Average facial templates were created for males and females, and a registration technique was used to superimpose the facial shells of males and females so that facial differences can be quantified. RESULTS Thirty unsuitable scans were excluded from the study. The final sample consisted of 350 subjects (166 females, 184 males). Females tend to have more prominent eyes and cheeks in relation to males with a maximum difference of 2.4 mm. Males tend to have more prominent noses and mouths with a maximum difference of 2.7 mm. About 31% of the facial shells match exactly (no difference), mainly in the forehead and chin regions of the face. CONCLUSIONS Differences in facial morphology can be accurately quantified and visualized using 3D imaging technology. This method of facial assessment can be recommended and applied for future research studies to assess facial soft tissue changes because of growth or healthcare intervention.
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Affiliation(s)
- A M Toma
- Department of Applied Clinical Research & Public Health (Orthodontic Department), Dental School, Cardiff University, Cardiff, Wales, UK.
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Abstract
OBJECTIVES To compare the colour of incisors depicted in teenage magazines with a sample of Welsh teenagers. MATERIALS AND METHODS A representative one month sample of magazines aimed at 9- to 16-year-old girls was obtained from a retail outlet. All images containing photographs of anterior teeth were identified and the colour of the incisor teeth measured using two commercial shade guides. An additional category of 'whiter than shade guide' was introduced. Images were viewed under standardised conditions by the same examiner; 10% were repeated. Clinical measurements under standard conditions were taken, by the same examiner, of 9- to 16-year-old children presenting to the department over a one month period, using the same shade guides; 47% of readings were repeated. Data were entered into SPSS and comparison of proportions used to compare the two groups. RESULTS Nineteen magazines containing 268 images and 53 patients were used. Intra-examiner agreement with the two shade guides was 80% or 92% for patients and 93% or 96% for images. 0/53 (0%) clinical compared with 202/268 (75.4%) photographs were found to be whiter than the shade guide. CONCLUSIONS Teenage magazines do not give an accurate representation of the colour of teenager's teeth. The impact of this on children's self esteem is unknown.
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Affiliation(s)
- B Chadwick
- Dental Health & Biological Sciences, School of Dentistry, Cardiff University, Heath Park, Cardiff, UK.
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Hovorka R, Albarrak A, Chassin L, Luzio SD, Playle R, Owens DR. Relationship between beta-cell responsiveness and fasting plasma glucose in Caucasian subjects with newly presenting type 2 diabetes. Diabet Med 2001; 18:797-802. [PMID: 11678969 DOI: 10.1046/j.0742-3071.2001.00567.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS beta-cell responsiveness was related to fasting plasma glucose to gain further understanding of pathophysiology of Type 2 diabetes. METHODS An insulin secretion model gave fasting beta-cell responsiveness M0 (ability of fasting glucose to stimulate beta-cell) and postprandial beta-cell responsiveness MI (ability of postprandial glucose to stimulate beta-cell) by analysing glucose and C-peptide time-concentration curves sampled every 10-30 min over 240 min during a meal tolerance test (MTT; 75 g CHO, 500 kcal). Caucasian subjects with newly presenting Type 2 diabetes according to WHO criteria (N = 83, male/female: 65 : 18, age: 54 +/- 10 years, body mass index (BMI): 30.9 +/- 5.2 kg/m2, fasting plasma glucose (FPG): 11.0 +/- 3.2 mmol/L; mean +/- SD) and Caucasian healthy subjects (N = 54, m/f: 21 : 33, age: 48 +/- 9 years, BMI: 26.1 +/- 3.7 kg/m2, FPG: 5.1 +/- 0.4 mmol/L) were studied. RESULTS A continuum inverse relationship between MI and FPG was observed. In the diabetes group, MI was closely related to FPG (rs = -0.74, P < 0.0001) and explained 60% intersubject FPG variability with the use of an exponential regression model. CONCLUSIONS In newly presenting Type 2 diabetes in Caucasian subjects a close inverse association exists between postprandial beta-cell responsiveness and FPG.
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Affiliation(s)
- R Hovorka
- Metabolic Modelling Group, Centre for Measurement and Information in Medicine, City University, Northampton Square, London, UK.
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Abstract
OBJECTIVE To determine the day-to-day intraindividual variability of fasting plasma glucose (FPG) in newly diagnosed Caucasian type 2 diabetic subjects. RESEARCH DESIGN AND METHODS A total of 193 newly diagnosed, previously untreated, Caucasian type 2 diabetic subjects (135 men, 58 women) had FPG measured on two consecutive days (FPG1, FPG2). Ethical approval and subjects' full informed consent were obtained. Subjects fasted for 12 h before each study day and rested for at least 30 min before blood was taken. Plasma glucose was analyzed by a glucose oxidase method with intra- and interassay coefficients of variation (CVs) < 2%. Variability of FPG was assessed by comparison of percentage differences (PDs): PD = 100 (FPG2 - FPG1)/FPG1, with averaged FPG (FPGaver = [FPG1 + FPG2]/2). Biological and analytical variability were determined by use of SD2total = SD2biological + SD2analytical, where SD2analytical approximately equal to 2 x (CVglucose measurement)2. Given normally distributed data with zero mean, 95% of daily percentage differences will be expected to fall within a range of +/- 2 SDtotal. RESULTS Subjects were age 54 +/- 10 years (mean +/- SD) and had BMI of 29.3 +/- 5.3 kg/m2. FPG values for both days were 12.2 +/- 3.4 mmol/l (FPG1) and 12.1 +/- 3.3 mmol/l (FPG2), with a mean paired difference (95% CI) of 0.1 (0.0 to 0.3) mmol/l. The variance of these differences increased with increasing FPGaver. The PDs did not exhibit this effect and were normally distributed (mean -0.6% [-1.7 to 0.4]; SD 7.4% [6.8 to 8.3]), giving a 95% variability (2 SD) of 14.8%. Biological variability (2 SDbiological) was 13.7%. No significant difference in PD was found between men and women (mean difference 1.3% [-1.0 to 3.6]; SDmale 7.4%, SDfemale 7.3%; P = 0.62). CONCLUSIONS A total of 95% of the FPG values for this group of newly diagnosed type 2 diabetic subjects varied within approximately +/- 15% on a daily basis, with approximately 14% caused by biological variability. As these results are expressed in percentage terms, subjects in the group with higher FPG values are likely to experience larger changes in FPG values measured from day to day. This variability should be considered when using FPG for the diagnosis and/or monitoring of response to treatment in patients with type 2 diabetes.
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Affiliation(s)
- R L Ollerton
- Diabetes Research Unit, Llandough Hospital, Cardiff, Wales, U.K.
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Playle R, Ollerton RL, Dunstan FD, Evans WD, Burch A, Luzio SD, Owens DR. Determining true glomerular filtration status in newly presenting type 2 diabetic subjects using age and sex adjustment. Diabetes Care 1998; 21:1893-6. [PMID: 9802739 DOI: 10.2337/diacare.21.11.1893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine age- and sex-adjusted reference ranges (ASARRs) for glomerular filtration status using data from nondiabetic subjects and to apply these to newly presenting type 2 diabetic subjects. RESEARCH DESIGN AND METHODS Glomerular filtration rate corrected for body surface area (cGFR) was determined using a radionuclide (51Cr-EDTA) method in 75 non-diabetic subjects (37 men, 38 women) and 219 type 2 diabetic subjects (157 men, 62 women). The 95% constant reference ranges (CRRs) were calculated as mean nondiabetic cGFR+/-1.96 SD. The 95% ASARRs were calculated by Altman's method from the nondiabetic cGFR versus age regression residuals for both male and female subjects. RESULTS Using Altman's method, the intercepts, but not the gradients, of the cGFR versus age regressions were significantly different between male and female subjects (intercept difference [95% CI] 8.2 [1.3-15.1], gradient difference -0.4 [-1.1 to 0.3]). Fitting a common gradient, 95% ASARRs for normofiltration were found to be from 123.9 - (0.89 X age) to 181.7 - (0.89 x age) for male subjects, and from 116.0 - (0.89 X age) to 173.2 - (0.89 X age) for female subjects. The 95% CRR for normofiltration was 70.2-138.1 ml x min(-1) x (1.73 m)(-2). When applied to the diabetic cGFRs, the CRRs and ASARRs gave, respectively, 17% (37/219) versus 21% (46/219) hyperfiltrators and 83% (181/219) versus 79% (172/219) normofiltrators. Using the ASARRs, 14 normofiltrators (6 men, 8 women) were reclassified as hyperfiltrators (change [n/total n] [95% CI] 8% [14/181] [4-12]), and 5 hyperfiltrators (5 men, 0 women) were reclassified as normofiltrators (change 14% [5/37] [5-30]). CONCLUSIONS We conclude that age and sex adjustment are essential to assess glomerular filtration status.
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Affiliation(s)
- R Playle
- Diabetes Research Unit, Llandough Hospital, Cardiff, Wales, UK.
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Hovorka R, Chassin L, Luzio SD, Playle R, Owens DR. Pancreatic beta-cell responsiveness during meal tolerance test: model assessment in normal subjects and subjects with newly diagnosed noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1998; 83:744-50. [PMID: 9506719 DOI: 10.1210/jcem.83.3.4646] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A model-based method was developed to quantify pancreatic beta-cell responsiveness during a meal tolerance test (MTT). C peptide secretion was related in a linear fashion to glucose concentration, whereas the standard population model was used to derive transfer rate constants of the two compartmental model of C peptide kinetics. Two indexes of pancreatic beta-cell responsiveness were defined: 1) postprandial sensitivity M(I) (ability of postprandial glucose to stimulate beta-cell), and 2) basal sensitivity M0 (ability of fasting glucose to stimulate beta-cell). The method was evaluated using plasma glucose and C peptide measured over 180 min with a 10- to 30-min sampling interval during a MTT (75 g carbohydrates; 500 Cal) performed in 16 normal subjects (7 men and 9 women; age, 50 +/- 10 yr; body mass index, 29.2 +/- 3.6 kg/m2; fasting plasma glucose, 5.1 +/- 0.5 mmol/L; mean +/- SD) and 16 body mass index-matched subjects with newly diagnosed noninsulin-dependent diabetes mellitus (NIDDM; 15 men and 1 woman; age, 50 +/- 9 yr; body mass index, 29.3 +/- 3.7 kg/m2; fasting plasma glucose, 12.6 +/- 3.2 mmol/L). M(I) and M0 indexes were estimated with very good precision (coefficient of variation, < 15%). Subjects with NIDDM demonstrated lower postprandial sensitivity M(I) (17.7 +/- 11.4 vs. 90.0 +/- 43.3 x 10(-9)/min; NIDDM vs. normal, P < 0.001) and basal sensitivity M0 (5.4 +/- 2.2 vs. 10.3 +/- 4.9 x 10(-9)/min; P < 0.005). Deconvolution analysis documented that the relationship between C peptide secretion and glucose concentration is approximately linear during MTT in both normal subjects (plasma glucose range, 5-8 mmol/L) and subjects with NIDDM (12-17 mmol/L). We conclude that pancreatic responsiveness during glucose stimulation (M(I)) and under basal conditions (M0) can be obtained from this novel method during MTT in healthy and disease states.
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Affiliation(s)
- R Hovorka
- Metabolic Modelling Group, Center for Measurement and Information in Medicine, City University, London, United Kingdom.
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Playle R, Gleed J, Jonasson R, Kramer J. Comparison of atomic absorption spectrometric, spectrophotometric, and fluorimetric methods for determination of aluminum in water. Anal Chim Acta 1982. [DOI: 10.1016/s0003-2670(01)84210-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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