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Cullington HE, Jiang D, Broomfield SJ, Chung M, Craddock LC, Driver S, Edwards D, Gallacher JM, Jones LL, Koleva T, Martin J, Meakin H, Nash R, Rocca C, Schramm DR, Willmott NS, Vanat ZH. Cochlear implant services for children, young people and adults. Quality standard. Cochlear Implants Int 2023:1-13. [PMID: 37114384 DOI: 10.1080/14670100.2023.2197344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- H E Cullington
- University of Southampton Auditory Implant Service, SO17 1BJ, UK
| | - D Jiang
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | - S J Broomfield
- West of England Hearing Implant Programme, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - M Chung
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, UK
| | - L C Craddock
- Midlands Hearing Implant Programme (Adult service), University Hospitals Birmingham NHS Foundation Trust, UK
| | - S Driver
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - D Edwards
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - J M Gallacher
- Scottish Cochlear Implant Program, Crosshouse Hospital, Kilmarnock, UK
| | - L Ll Jones
- North Wales Auditory Implant Service, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - T Koleva
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - J Martin
- Cochlear Implant Programme, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - H Meakin
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
| | - R Nash
- Cochlear Implant Programme, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - C Rocca
- Hearing Implant Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - D R Schramm
- University of Ottawa Auditory Implant Centre, Ottawa, Canada
| | - N S Willmott
- Auditory Implant Centre, Belfast Health and Social Care Trust, UK
| | - Z H Vanat
- Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Trust, UK
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Kovaleva M, Nocera JR, Hepburn K, Higgins M, Nash R, Epps F, Brewster G, Bilsborough E, Blumling AA, Griffiths PC. Attention control in a trial of an online psychoeducational intervention for caregivers. Res Nurs Health 2022; 45:337-349. [DOI: 10.1002/nur.22208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Mariya Kovaleva
- Niedfelt Nursing Research Center University of Nebraska (UNMC) College of Nursing ‐ Omaha Division, 985330 Nebraska Medical Center Omaha Nebraska USA
| | - Joe R. Nocera
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation Decatur Georgia USA
- Department of Neurology Emory University School of Medicine, Emory University Atlanta Georgia USA
- Department of Physical Rehabilitation Emory University School of Medicine, Emory University Atlanta Georgia USA
| | - Kenneth Hepburn
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Rachel Nash
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Glenna Brewster
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | | | - Amy A. Blumling
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Division of Human Genetics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Patricia C. Griffiths
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
- Georgia Institute of Technology Center for Assistive Technology Atlanta Georgia USA
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3
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Goatley LC, Nash R, Netherton CL. Primary Macrophage Culture from Porcine Blood and Lungs. Methods Mol Biol 2022; 2503:63-72. [PMID: 35575886 DOI: 10.1007/978-1-0716-2333-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary cultures represent the most reliable method to isolate and propagate field isolates of African swine fever virus (ASFV ). Within the pig ASFV predominantly targets the reticuloendothelial system for replication; therefore, primary macrophage cell cultures are commonly used to isolate, propagate, and study the virus life cycle in the laboratory. In this chapter we will describe methods for the direct isolation of pulmonary alveolar macrophages by lung lavage and the culture of monocyte-derived macrophages from pig blood. We also include a method for the positive selection of CD14+ monocytes as a source for monocyte-derived macrophages from pig blood using microbeads.
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Affiliation(s)
- Lynnette C Goatley
- African Swine Fever Vaccinology Group, The Pirbright Institute, Pirbright, Woking, UK.
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Epps F, Brewster G, Phillips JS, Nash R, Shah RC, Hepburn K. Using a Warm Hand-Off Approach to Enroll African American Caregivers in a Multi-Site Clinical Trial: The Handshake Protocol. J Appl Gerontol 2022; 41:142-147. [PMID: 33567942 PMCID: PMC8353002 DOI: 10.1177/0733464821992920] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
"Testing Tele-Savvy" was a three-arm randomized controlled trial that recruited participants from four National Institute on Aging (NIA)-funded Alzheimer's Disease Centers with Emory University serving as the coordinating center. The enrollment process involved each center providing a list of eligible caregivers to the coordinating center to consent. Initially, the site proposed to recruit primarily African American caregivers generated a significant amount of referrals to the coordinating center, but a gap occurred in translating them into enrolled participants. To increase the enrollment rate, a "Handshake Protocol" was established, which included a warm handoff approach. During preset phone calls each week, the research site coordinator introduced potential participants to a culturally congruent co-investigator from the coordinating center who then completed the consent process. Within the first month of implementation, the team was 97% effective in meeting its goals. This protocol is an example of a successful, innovative approach to enrolling minority participants in multi-site clinical trials.
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Affiliation(s)
| | | | - Judy S Phillips
- Rush Alzheimer's Disease Center, Rush University University Medical Center, Chicago, IL, USA
| | | | - Raj C Shah
- Rush Alzheimer's Disease Center, Rush University University Medical Center, Chicago, IL, USA
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Hepburn K, Nocera J, Higgins M, Epps F, Brewster GS, Lindauer A, Morhardt D, Shah R, Bonds K, Nash R, Griffiths PC. Results of a Randomized Trial Testing the Efficacy of Tele-Savvy, an Online Synchronous/Asynchronous Psychoeducation Program for Family Caregivers of Persons Living with Dementia. Gerontologist 2021; 62:616-628. [PMID: 33640979 PMCID: PMC7989248 DOI: 10.1093/geront/gnab029] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Family caregivers will grow in number as dementia prevalence increases, underscoring the continued importance of equipping these individuals for their new roles and ameliorating the adverse effects of caregiving. RESEARCH DESIGN AND METHODS A three-armed, waitlist, randomized trial design tested Tele-Savvy, an online adaptation of a successful in-person psychoeducation program, the Savvy Caregiver. Tele-Savvy is delivered over 43 days to groups of 6-8 caregivers in 7 weekly synchronous sessions accompanied by 36 brief asynchronous video lessons. We enrolled 23 cohorts of 15 eligible caregivers (N = 261), randomized 2:2:1 to active, attention control, and usual care arms. We assessed caregiver psychological well-being and caregiving mastery at baseline and 3, 6, 9, and 12 months. Multilevel linear models assessed outcomes over the 3 time points examined. The trial was slightly truncated, with Data and Safety Monitoring Board approval, because of the apparent confounding psychological effects of coronavirus disease 2019 restrictions. RESULTS Study findings indicate statistically and clinically significant benefits to Tele-Savvy arm caregivers (with moderate to large effect sizes) in the areas of depression, perceived stress, reaction to care recipients' behaviors, and enhancement of caregiver mastery. Expected benefits for caregiver burden and anxiety were not found. DISCUSSION AND IMPLICATIONS Findings attest to program efficacy and the viability of employing distance means to improve family caregivers' emotional well-being and sense of mastery in the caregiving role over a 6-month period. Next steps entail finding alternate ways to deliver the program to those with connectivity and/or time constraint problems.
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Affiliation(s)
- Kenneth Hepburn
- Address correspondence to: Kenneth Hepburn, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA. E-mail:
| | - Joe Nocera
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Allison Lindauer
- Alzheimer’s Disease Research Center, Oregon Health and Sciences University, Portland, USA
| | - Darby Morhardt
- Alzheimer’s Disease Research Center, Northwestern University, Chicago, Illinois, USA
| | - Raj Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Kalisha Bonds
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Rachel Nash
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Nocera JR, Hepburn K, Griffiths P, Higgins M, Epps F, Brewster GS, Bonds K, Nash R. Design and support of an online ‘control’ condition for the Tele‐Savvy randomized control trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.044201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Hepburn K, Griffiths P, Nocera JR, Higgins M, Lindauer A, Morhardt D, Shah RC, Epps F, Brewster GS, Bonds K, Nash R. Intermediate outcomes of a randomized trial of Tele‐Savvy: An online psychoeducation program. Alzheimers Dement 2020. [DOI: 10.1002/alz.039562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Raj C Shah
- Rush Alzheimer's Disease Center Chicago IL USA
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Naumann FL, Nash R, Schumacher U, Taylor J, Cottrell N. Interprofessional education clinical placement program: a qualitative case study approach. J Interprof Care 2020; 35:899-906. [PMID: 33190512 DOI: 10.1080/13561820.2020.1832448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of health professional education programs is to produce competent graduates, with an ability to work collaboratively as effective healthcare team members. We explored the reflections of students and clinical facilitators, in response to participation in a structured interprofessional education (IPE) clinical placement program. In our qualitative study we used an exploratory case study design. In our analysis, we highlight the benefits of interprofessional practice. Key themes identified by students included: limited opportunities to engage in IPE across their course; lack of clarity around IPE; value of IPE for students, practitioners, and patient outcomes; and need for IPE opportunities to be integrated into placements. Key themes identified by the clinical facilitators included: being reminded of the value of IPE for students and patients; preparation for IPE placements need to be embedded in curricula; coordination and communication of IPE learning activities need to be clear for staff and students; and IPE should continue as part of the broader clinical education agenda. Our findings reinforce the notion that students and clinical facilitators value the importance of IPE for student learning within the clinical placement setting. The outcomes offer valuable insights for universities and hospital and health care contexts for setting up and implementing IPE activities, and we provide recommendations for improving ongoing IPE efforts within clinical placement setting.
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Affiliation(s)
- F L Naumann
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - R Nash
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - U Schumacher
- Metro North Hospital and Health Service, Queensland Health, Brisbane, Australia
| | - J Taylor
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - N Cottrell
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
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Bowles PFD, Reading J, Albert D, Nash R. Subglottic cysts: The Great Ormond Street experience in 105 patients. Eur Arch Otorhinolaryngol 2020; 278:2137-2141. [PMID: 32875392 DOI: 10.1007/s00405-020-06321-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the study was to assess the contemporary presentation and management of subglottic cysts and make recommendations on the treatment of these patients. METHODS Retrospective case series of 105 patients between October 1999 and November 2017 from a paediatric teaching hospital. RESULTS Ninety-one percentage (n = 96) had a history of prematurity, with a mean gestation of 27.2 weeks (SD ± 4.1). A history of intubation was found in 99% (n = 104) of cases [median 18 days (range = 1-176)]. Presenting symptoms were: Stridor 57.1%, (n = 60), difficult intubation 14% (n = 15), recurrent croup 11.4% (n = 12), failed extubation 7.6%, (n = 8), hoarseness/weak cry 10.5% (n = 10). Ninety percentage (n = 94) underwent intervention for management of SGCs with 86% (n = 81) treated with cold steel marsupialisation and 14% (n = 13) with CO 2 laser. Recurrent cysts occurred in 56% (n = 53) of cases. Treatment modality did not affect recurrence (p = 0.594 Δ). Sixty-six percentage (n = 69/105) of patients had one or more concurrent airway pathology at MLB. Most frequent was subglottic stenosis 47% (n = 49), with 16% (n = 8) subsequently requiring open reconstructive airway surgery. Mean duration of follow-up was 47.6 months (SD ± 38.3). CONCLUSION SGC are an uncommon, reversible cause of upper airway obstruction and should be considered in the list of differential diagnoses in patients with a history of prematurity and perinatal intubation, presenting with stridor. While concurrent SGS is common, adequate symptom improvement in such cases may be achieved with SGC removal alone. Management is by surgical marsupialisation. Recurrence and additional airway pathologies are common and may necessitate longer-term treatment in centres with paediatric airway expertise.
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Affiliation(s)
- P F D Bowles
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - J Reading
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - D Albert
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - R Nash
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Brewster G, Epps F, Nash R, Griffiths P, Phillips J, Nocera J, Shah R, Hepburn K. RECRUITING FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA FOR PARTICIPATION IN AN ONLINE INTERVENTION. Innov Aging 2019. [PMCID: PMC6846827 DOI: 10.1093/geroni/igz038.2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Responsibilities of caregiving for persons living with dementia make it challenging to participate in in-person research studies. Caregivers may be more willing to participate in studies that are online. This presentation will highlight recruitment strategies of a 4-site telehealth caregiver intervention for caregivers of persons living with dementia. Thus far, we have recruited 596 participants over the period of 2 years: 76, 189, 164 and 167 from each of the sites, respectively. Community partnership strategies such as presentations at churches and events organized by the Alzheimer’s Association, and the Alzheimer’s Disease Research centers, using a handshake protocol, and using social media sites such as Facebook and Twitter have all been effective at recruiting participants. Ongoing communication among the staff at different sites is also an important aspect of successful recruitment. These strategies have enabled recruitment to continue at a consistent rate and enabled the maintenance of relationships within the community.
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Affiliation(s)
- Glenna Brewster
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States
| | - Fayron Epps
- Georgia State University, Atlanta, Georgia, United States
| | - Rachel Nash
- Emory University, Atlanta, Georgia, United States
| | | | | | - Joe Nocera
- Georgia State University, Atlanta, Georgia, United States
| | - Raj Shah
- Rush University, Chicago, Illinois, United States
| | - Kenneth Hepburn
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States
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Srinivasan R, So CW, Amin N, Jaikaransingh D, D'Arco F, Nash R. A review of the safety of MRI in cochlear implant patients with retained magnets. Clin Radiol 2019; 74:972.e9-972.e16. [PMID: 31324337 DOI: 10.1016/j.crad.2019.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
The number of patients with cochlear implants (CIs) is increasing due to expanding indications, and improving CI services. Furthermore, as the use of imaging increases in clinical medicine, it is increasingly likely that patients with CIs will require a magnetic resonance imaging (MRI) examination during their lifetime. Therefore it is important that clinicians are aware of the safety aspects and manufacturer recommendations for CI patients with retained magnets. This article summarises guidelines from all major CI manufacturers and reviews the published literature on the safety of MRI in CI patients with magnets in situ. The most commonly reported complication of MRI in CI patients was pain. Other significant complications included magnet displacement, depolarisation, and polarity reversal. Artefacts caused by the CI remain an issue, but may be reduced by the use of specific sequences. Manufacturer recommendations should be followed to reduce the risk of complications, although complications may occur even when guidelines are followed. For this reason, the indication for imaging these patients should be reviewed, and patients should be appropriately counselled and consented.
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Affiliation(s)
- R Srinivasan
- Department of Radiology, Guy's & St Thomas' Hospital, London, UK
| | - C W So
- Department of Radiology, Northwick Park Hospital, London, UK
| | - N Amin
- Department of ENT, St George's Hospital, London, UK
| | | | - F D'Arco
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - R Nash
- Cochlear Implant Department, Great Ormond Street Hospital, London, UK.
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12
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Abstract
African swine fever virus causes a haemorrhagic fever in domestic pigs and wild boar. The continuing spread in Africa, Europe and Asia threatens the global pig industry. The lack of a vaccine limits disease control. To underpin rational strategies for vaccine development improved knowledge is needed of how the virus interacts with and modulates the host's responses to infection. The virus long double-stranded DNA genome codes for more than 160 proteins of which many are non-essential for replication in cells but can have important roles in evading the host's defences. Here we review knowledge of the pathways targeted by ASFV and the mechanisms by which these are inhibited. The impact of deleting single or multiple ASFV genes on virus replication in cells and infection in pigs is summarised providing information on strategies for rational development of modified live vaccines.
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Affiliation(s)
- L K Dixon
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK.
| | - M Islam
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK
| | - R Nash
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK
| | - A L Reis
- The Pirbright Institute, Ash Road, Pirbright, Woking, Surrey, GU24 0NF, UK
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13
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Abstract
NHS Resolution provides indemnity cover for legal claims against the NHS, assists the NHS with risk management and aims to share lessons from claims in order to improve safety. The study aimed to investigate the financial costs of litigation against English Health Trusts in otolaryngology over a 10-year period, to see if any lessons have been learned and identify trends that may lead to a potential reduction in costs and improve patient safety. A Freedom of Information request was made to NHS Resolution for information regarding claims made to otolaryngology departments over the last 10 years. There was a total of 612 successful claims in the 10-year period between 2008/2009 and 2017/2018 with costs of nearly £87 million. Overall, the costs of litigation have increased dramatically, and the main areas for these successful claims can be identified, but restrictions in the detail of information released allows too little insight for improvements to be made to avoid them in future. This continues to be a major problem for healthcare funding and practice.
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Affiliation(s)
- N Zorlu
- 1 Diabetes & Endocrinology, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - R Nash
- 2 Ear, Nose & Throat Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Srinivasan
- 3 Clinical Radiology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
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14
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Rajput K, Saeed M, Ahmed J, Chung M, Munro C, Patel S, Leal C, Jiang D, Nash R. Findings from aetiological investigation of Auditory Neuropathy Spectrum Disorder in children referred to cochlear implant programs. Int J Pediatr Otorhinolaryngol 2019; 116:79-83. [PMID: 30554714 DOI: 10.1016/j.ijporl.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Auditory neuropathy spectrum disorder (ANSD) is an audiological diagnosis characterised by hearing dysfunction in the presence of intact outer hair cell function in the cochlea. ANSD is thought to account for 7-10% of all childhood permanent hearing impairment, and can result from a range of pathological processes. This paper describes the rationale, methods and findings from the aetiological investigation of ANSD. METHODS Retrospective audit of four cochlear implant programmes. RESULTS 97 patients were identified. 79% of patients were identified before the age of one. Prematurity and jaundice were the most frequently identified aetiological factors. 33 patients had cochlear nerve deficiency on imaging. Genetic diagnoses identified included otoferlin, SX010 gene, connexin 26 and A1FM1 gene mutations. ANSD was seen in conjunction with syndromes including Kallman syndrome, CHARGE syndrome, X-linked deafness, SOTOS syndrome, Brown Vieletto Van Laere syndrome, and CAPOS syndrome. DISCUSSION We present a two-level system of aetiological investigation that is clinically practical. Patients with ANSD sufficiently severe to consider cochlear implantation are generally identified at an early age. Aetiological investigation is important to guide prognosis and identify comorbidity. CONCLUSION Prematurity and jaundice are the most commonly identified aetiological factors in ANSD. Imaging findings identify crucial factors in a significant minority. An important minority may have genetic and syndromic diagnoses that require further management.
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Affiliation(s)
- K Rajput
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom
| | - M Saeed
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom
| | - J Ahmed
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom
| | - M Chung
- Auditory Implant Department, Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - C Munro
- Auditory Implant Department, Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - S Patel
- Auditory Implant Service, St.George's Hospital, London, United Kingdom
| | - C Leal
- Hearing Implant Centre, Guy's Hospital, London, United Kingdom
| | - D Jiang
- Hearing Implant Centre, Guy's Hospital, London, United Kingdom
| | - R Nash
- Cochlear Implant Department, Great Ormond Street Hospital, London, United Kingdom.
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15
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Nash R, Nash DB. Payment Models in the Era of Health Care Reform and Population Health. Surg Innov 2018; 25:97-98. [DOI: 10.1177/1553350618769401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rachel Nash
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - David B. Nash
- Jefferson College of Population Health, Philadelphia, PA, USA
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16
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Mahon AM, O'Connell B, Healy MG, O'Connor I, Officer R, Nash R, Morrison L. Microplastics in Sewage Sludge: Effects of Treatment. Environ Sci Technol 2017; 51:810-818. [PMID: 27936648 DOI: 10.1021/acs.est.6b04048] [Citation(s) in RCA: 433] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Waste water treatment plants (WWTPs) are receptors for the cumulative loading of microplastics (MPs) derived from industry, landfill, domestic wastewater and stormwater. The partitioning of MPs through the settlement processes of wastewater treatment results in the majority becoming entrained in the sewage sludge. This study characterized MPs in sludge samples from seven WWTPs in Ireland which use anaerobic digestion (AD), thermal drying (TD), or lime stabilization (LS) treatment processes. Abundances ranged from 4196 to 15 385 particles kg-1 (dry weight). Results of a general linear mixed model (GLMM) showed significantly higher abundances of MPs in smaller size classes in the LS samples, suggesting that the treatment process of LS shears MP particles. In contrast, lower abundances of MPs found in the AD samples suggests that this process may reduce MP abundances. Surface morphologies examined using scanning electron microscopy (SEM) showed characteristics of melting and blistering of TD MPs and shredding and flaking of LS MPs. This study highlights the potential for sewage sludge treatment processes to affect the risk of MP pollution prior to land spreading and may have implications for legislation governing the application of biosolids to agricultural land.
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Affiliation(s)
- A M Mahon
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - B O'Connell
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - M G Healy
- Civil Engineering, National University of Ireland , Galway, Ireland
| | - I O'Connor
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - R Officer
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - R Nash
- Marine and Freshwater Research Centre (MFRC), Galway-Mayo Institute of Technology , Dublin Road, Galway, Ireland
| | - L Morrison
- Earth and Ocean Sciences, Schools of Natural Sciences and Ryan Institute, National University of Ireland , Galway, Ireland
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Abstract
Encounters with jugular bulb abnormalities during ear surgery are a rare but recognised problem. A high riding jugular bulb is present in 10%-15% of patients and its variable position within the temporal bone can lead to problems as brisk venous haemorrhage can result if the bulb is inadvertently opened. The case of a 52-year-old woman with a central tympanic membrane perforation who underwent elective endaural myringoplasty and experienced brisk bleeding on raising the tympanomeatal flap is presented.
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Affiliation(s)
- R Fox
- Northwick Park Hospital , Harrow , the UK
| | - R Nash
- Northwick Park Hospital , Harrow , the UK
| | - T Tatla
- Northwick Park Hospital , Harrow , the UK
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18
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Krishnamoorthy M, Gerwe B, Heimburg-Molinaro J, Nash R, Arumugham J, Eilertson C, Stice S, Nash R. Ethanol alters cell cycle gene expression in human embryonic stem cells. ACTA ACUST UNITED AC 2016. [DOI: 10.1055/s-0036-1586381] [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: 10/21/2022]
Affiliation(s)
| | - Brian Gerwe
- Department of Biochemistry, The University of Georgia, Athens, GA, USA
| | | | | | | | - Carmen Eilertson
- Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Steven Stice
- Regenerative Bioscience Center, The University of Georgia, Athens, GA, USA
| | - Rodney Nash
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
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Taylor DL, Nash R, Fellows LE, Kang MS, Tyms AS. Naturally Occurring Pyrrolizidines: Inhibition of α-Glucosidase 1 and Anti-HIV Activity of One Stereoisomer. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/095632029200300504] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alexine, a naturally occurring pyrrolizidine alkaloid, isolated from Alexa leiopetala, and four stereoisomers, isolated from Castanospermum australe, were investigated for inhibitory activity against the growth of HIV-1. Only treatment with the 7,7a-diepialexine restricted virus growth (IC50 0.38 mm) although it was less active than the indolizidine alkaloid castanospermine (IC50 0.02 mm). The antiviral effects of 7,7a-diepialexine, like castanospermine, correlated with the inhibitory activity against purified pig kidney α-glucosidase 1 of the glycoprotein processing enzymes and the reduced cleavage of the precursor HIV-1 glycoprotein gp160.
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Affiliation(s)
- D. L. Taylor
- MRC Collaborative Centre, 1-3 Burtonhole Lane, Mill Hill, London NW7 1AD, UK
| | - R. Nash
- Royal Botanic Gardens, Kew, Surrey TW9 3DS, UK
| | | | - M. S. Kang
- Marion Merrell Dow Research Institute, Cincinnati, OH, USA
| | - A. S. Tyms
- MRC Collaborative Centre, 1-3 Burtonhole Lane, Mill Hill, London NW7 1AD, UK
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20
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Nash R, Hughes J, Kuchai R, Sandison A, Sandhu G. Assessment and management of laryngeal mucous membrane pemphigoid: our experience in six patients and a proposed severity scale. Clin Otolaryngol 2016; 42:752-756. [DOI: 10.1111/coa.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R. Nash
- Department of ENT; Charing Cross Hospital; London UK
| | - J. Hughes
- Department of ENT; Charing Cross Hospital; London UK
| | - R. Kuchai
- Department of ENT; Charing Cross Hospital; London UK
| | - A. Sandison
- Department of Histopathology; Charing Cross Hospital; London UK
| | - G. Sandhu
- Department of ENT; Charing Cross Hospital; London UK
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21
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Ramessur KT, Greenwell P, Nash R, Dwek MV. Breast cancer invasion is mediated by β-N-acetylglucosaminidase (β-NAG) and associated with a dysregulation in the secretory pathway of cancer cells. Br J Biomed Sci 2016; 67:189-96. [DOI: 10.1080/09674845.2010.11730318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K. T. Ramessur
- Departments of Molecular and Applied Biosciences, University of Westminster, London, W1W 6UW
| | - P. Greenwell
- Biomedical Sciences, University of Westminster, London, W1W 6UW
| | - R. Nash
- Summit (Wales), IBERS, Plas Gogerddan, Aberystwyth, Ceredigion SY23 3EB
| | - M. V. Dwek
- Departments of Molecular and Applied Biosciences, University of Westminster, London, W1W 6UW
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22
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Nash R, Kalan A, Lingam R, Singh A. The role of diffusion-weighted magnetic resonance imaging in assessing residual/recurrent cholesteatoma after canal wall down mastoidectomy. Clin Otolaryngol 2016; 41:307-9. [DOI: 10.1111/coa.12612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- R. Nash
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - A. Kalan
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - R.K. Lingam
- Department of Radiology; Northwick Park Hospital; Middlesex UK
| | - A. Singh
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
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23
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Rogers CA, Bryan AJ, Nash R, Suleiman MS, Baos S, Plummer Z, Hillier J, Davies I, Downes R, Nicholson E, Reeves BC, Angelini GD. Propofol cardioplegia: A single-center, placebo-controlled, randomized controlled trial. J Thorac Cardiovasc Surg 2015; 150:1610-9.e13. [DOI: 10.1016/j.jtcvs.2015.06.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/28/2015] [Accepted: 06/20/2015] [Indexed: 12/09/2022]
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24
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Ramani P, Nash R, Sowa-Avugrah E, Rogers C. High levels of polo-like kinase 1 and phosphorylated translationally controlled tumor protein indicate poor prognosis in neuroblastomas. J Neurooncol 2015; 125:103-11. [PMID: 26318737 DOI: 10.1007/s11060-015-1900-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/24/2015] [Indexed: 01/15/2023]
Abstract
Despite multimodality treatment, the long-term survival of high-risk patients with neuroblastomas is below 50%. New anti-mitotic drugs against targets, such as polo-like kinase 1 (PLK1), are being evaluated in early phase clinical trials. PLK1 phosphorylates the translationally controlled tumor protein (TCTP). We investigated the expression of PLK1 and the phosphorylated substrate, pTCTP, by immunostaining eighty-eight neuroblastomas. Digitally scanned slides were scored using image analysis software. The median PLK1 and pTCTP proliferation indices (PIs) were 4.6 and 1% respectively. There was moderate positive correlation between PLK1 and pTCTP (ρ = 0.65). The PIs for both markers were significantly higher in neuroblastomas from patients with adverse clinical (advanced-stage, high-risk group, primary abdominal compared to extra-abdominal sites), biological (MYCN amplification, 1p deletion, 17q gain) and pathological (undifferentiated or poorly differentiated status, high mitosis-karyorrhexis index, [MKI], unfavorable histology) factors. Using Cox regression models, higher-than-median PLK1 and pTCTP PIs were associated with a shorter overall survival (OS) and event-free survival (EFS) in the univariate analyses. In the multivariate analyses, a high PLK1 PI count was associated with significantly shorter OS and EFS, independent of MYCN amplification and MKI; in addition, the significantly shorter EFS was independent of the risk-group. After adjustment for MKI and MYCN amplification, and for risk-group, high pTCTP PI was also associated with significantly shorter OS. Our study shows that PLK1 provides valuable prognostic information in patients with neuroblastomas.
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Affiliation(s)
- Pramila Ramani
- School of Cellular and Molecular Medicine, University of Bristol, School of Medical Sciences, University Walk, Bristol, BS8 1TD, UK.
- Department of Histopathology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
| | - Rachel Nash
- Clinical Trials and Evaluation Unit, University of Bristol, School of Clinical Sciences, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Emile Sowa-Avugrah
- Department of Histopathology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Chris Rogers
- Clinical Trials and Evaluation Unit, University of Bristol, School of Clinical Sciences, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
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25
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Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, Sammut S. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disord 2015; 173:90-6. [PMID: 25462401 DOI: 10.1016/j.jad.2014.10.054] [Citation(s) in RCA: 600] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/15/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the past four years, the Franciscan University Counseling Center has reported a 231% increase in yearly visits, as well as a 173% increase in total yearly clients. This trend has been observed at many universities as mental health issues pose significant problems for many college students. The objective of this study was to investigate potential correlates of depression, anxiety, and stress in a sample of college students. METHODS The final analyzed sample consisted of 374 undergraduate students between the ages of 18 and 24 attending Franciscan University, Steubenville, Ohio. Subjects completed a survey consisting of demographic questions, a section instructing participants to rate the level of concern associated with challenges pertinent to daily life (e.g. academics, family, sleep), and the 21 question version of the Depression Anxiety Stress Scale (DASS21). RESULTS The results indicated that the top three concerns were academic performance, pressure to succeed, and post-graduation plans. Demographically, the most stressed, anxious, and depressed students were transfers, upperclassmen, and those living off-campus. CONCLUSIONS With the propensity for mental health issues to hinder the success of college students, it is vital that colleges continually evaluate the mental health of their students and tailor treatment programs to specifically target their needs.
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Affiliation(s)
- R Beiter
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - R Nash
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - M McCrady
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - D Rhoades
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - M Linscomb
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - M Clarahan
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA
| | - S Sammut
- Department of Psychology, Sociology, and Social Work, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH 43952, USA.
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26
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Mendoza-Lattes S, Besomi J, O'Sullivan C, Ries Z, Gnanapradeep G, Nash R, Gao Y, Weinstein S. Pediatric Spine Trauma in the United States--Analysis of the HCUP Kid'S Inpatient Database (KID) 1997-2009. Iowa Orthop J 2015; 35:135-9. [PMID: 26361456 PMCID: PMC4492135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Few references are available describing the epidemiology of pediatric spine injuries. The purpose of this study is to examine the prevalence, risk factors and trends during the period from 1997 to 2009 of pediatric spine injuries in the United States using a large national database. METHODS Data was obtained from the Kid's Inpatient Database (KID) developed by the Healthcare Cost and Utilization Project (HCUP), for the years 1997-2009. This data includes >3 million discharges from 44 states and 4121 hospitals on children younger than 20 years. Weighted variables are provided which allow for the calculation of national prevalence rates. The Nationwide Emergency Department Sample (NEDS), HCUP. net, and National Highway Traffic Safety Administration (NHTSA) data were used for verification and comparison. RESULTS A prevalence of 107.96 pmp (per million population) spine injuries in children and adolescents was found in 2009, which is increased from the 77.07 pmp observed in 1997. The group 15 to 19 years old had the highest prevalence of all age groups in (345.44 pmp). Neurological injury was present in 14.6% of the cases, for a prevalence of 15.82 pmp. The majority (86.7%) of these injuries occurred in children >15 years. Motor vehicle collisions accounted for 52.9% of all spine injuries, particularly in children >15 years. Between 1997 and 2009 the hospital length of stay decreased, but hospital charges demonstrated a significant increase. CONCLUSIONS Pediatric Spine Injuries continue to be a relevant problem, with rates exceeding those of other industrialized nations. Teenagers >15 years of age were at greatest risk, and motor vehicle collisions accounted for the most common mechanism. An increase in prevalence was observed between 1997 and 2009, and this was matched by a similar increase in hospital charges. LEVEL OF EVIDENCE III.
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27
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Ramani P, Nash R, Rogers CA. Aurora kinase A is superior to Ki67 as a prognostic indicator of survival in neuroblastoma. Histopathology 2014; 66:370-9. [PMID: 25297850 DOI: 10.1111/his.12520] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 06/11/2014] [Accepted: 07/31/2014] [Indexed: 01/09/2023]
Abstract
AIMS To compare the expression and prognostic value of the cell cycle markers Aurora kinase A (AURKA) and Ki67 in neuroblastoma, because AURKA expression levels have greater prognostic significance than those of Ki67 in some cancers. METHODS AND RESULTS Eighty-eight neuroblastomas were immunostained with anti-AURKA and Ki67 antibodies. Digitally scanned slides were scored using imaging analysis software. Median AURKA and Ki67 proliferation indices (PIs) were 1.5% and 26%, respectively. Higher than median AURKA and Ki67 levels were detected in the neuroblastomas from patients belonging to the high-risk group, those with MYCN amplification, and those with unfavourable pathology, including a high mitosis-karyorrhexis index (MKI). High AURKA and Ki67 levels were significantly associated with shorter overall survival (OS) and event-free survival (EFS) in univariate analyses. In multivariate analyses, high AURKA level was associated with significantly shorter OS and EFS, independently of risk group, and of MYCN amplification and MKI. High Ki67 level was not associated with shorter OS or EFS after adjustment for risk group or MYCN amplification and MKI. CONCLUSIONS High AURKA and Ki67 levels were associated with adverse prognostic factors and shorter survival, but AURKA provides more valuable prognostic information than Ki67 in neuroblastoma.
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Affiliation(s)
- Pramila Ramani
- School of Cellular and Molecular Medicine, School of Medical Sciences, University of Bristol, Bristol, UK; Department of Histopathology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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28
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Nash R, Bunce C, Freemantle N, Doré CJ, Rogers CA. Ophthalmic Statistics Note 4: analysing data from randomised controlled trials with baseline and follow-up measurements. Br J Ophthalmol 2014; 98:1467-9. [PMID: 25107901 PMCID: PMC4215292 DOI: 10.1136/bjophthalmol-2014-305614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Rachel Nash
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Catey Bunce
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline J Doré
- UCL Clinical Trials Unit, University College London, London, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
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29
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Mcintyre C, Allen J, Jones S, Nash R, Clarke P. Quality of Life after Orbital Exenteration. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Nash R. Book Review: The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System. Am J Med Qual 2014. [DOI: 10.1177/1062860613502521] [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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31
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Alberry M, Hassan WA, Goodburn S, Brockelsby J, Wladimiroff J, Nash R, Lees C. The impact of national guidance for anomaly screening and invasive testing: unintended consequences. Arch Dis Child Fetal Neonatal Ed 2014; 99:F83-6. [PMID: 23833074 DOI: 10.1136/archdischild-2013-303914] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Recent guidance from the UK National Screening Committee (NSC) and the Fetal Anomaly Screening Programme (FASP) has led to important changes in prenatal ultrasound diagnosis and invasive testing. These relate to prenatal ultrasound investigation of what were previously known as 'soft markers' for Down's syndrome at the time of the detailed anomaly scan and as to whether full karyotype or FISH (fluorescent in situ hybridisation)/QFPCR (quantitative fluorescence PCR) testing for trisomies should be carried out when an invasive test is performed. Neither recommendation is directly related to the other but both in combination could have profound implications for the detection of chromosomal abnormalities other than trisomy 21 (Down's syndrome). In the light of two cases recently managed in one regional fetal medicine unit, we retrospectively reviewed cases where, with correct application of the NSC and FASP recommendations, non-lethal and clinically important chromosomal abnormalities would most likely not have been detected.
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Affiliation(s)
- M Alberry
- Department of Fetal Medicine, Rosie Hospital, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, , Cambridge, UK
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Nash R, Scott L, Chakravarthy U, Harding SP, Reeves BC, Rogers CA. Modelling of longitudinal outcomes with highly skewed distributions: applications in the IVAN trial. Trials 2013. [PMCID: PMC3981619 DOI: 10.1186/1745-6215-14-s1-o39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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33
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Rogers CA, Mazza G, Paramasivan S, Smith N, Nash R, Blazeby JM, Donovan J. Integrating qualitative research in a multi-centre trial - the clinical trials unit perspective. Trials 2013. [PMCID: PMC3980820 DOI: 10.1186/1745-6215-14-s1-p67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jacques T, Nash R, Kenway B, Vlastarakos P. Pitfalls of operative management of secondary post-tonsillectomy haemorrhage--a case report. B-ENT 2013; 9:335-337. [PMID: 24597111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION The authors present a potential complication associated with the surgical management of post-tonsillectomy haemorrhage using absorbable cellulose haemostatic dressings. The article discusses the deficiencies of our current understanding of how best to manage this common and potentially life-threatening ENT emergency. CASE REPORT A 40-year-old man presented to Accident-and-Emergency with a post-tonsillectomy haemorrhage on the 7th postoperative day. The bleeding was managed surgically, with suturing of the faucial pillars incorporating a piece of Surgicel into the closure. Two days later the patient experienced an episode of partial airway obstruction, due to a piece of dislodged haemostatic material, owing to failure of the closure. The techniques used in the operative management of post-tonsillectomy bleeding are not formally evaluated or discussed in the current literature, and in some cases are unreliable or even potentially hazardous. Further discussion, research, and formulation of a more stepwise approach would be of considerable benefit.
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Affiliation(s)
| | - R Nash
- Lister Hospital, Stevenage
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35
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Majithia A, Lingam R, Nash R, Khemani S, Kalan A, Singh A. Staging primary middle ear cholesteatoma with non-echoplanar (half-Fourier-acquisition single-shot turbo-spin-echo) diffusion-weighted magnetic resonance imaging helps plan surgery in 22 patients: Our experience. Clin Otolaryngol 2012; 37:325-30. [DOI: 10.1111/j.1749-4486.2012.02502.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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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Abstract
AIMS More than 50% of neuroblastomas (NBs) present with haematogenous and/or lymphatic metastasis; however, little is known about the clinicopathological significance in NBs of the key lymphangiogenesis growth factors vascular endothelial growth factor (VEGF)-C and VEGF-D and the receptor VEGFR-3. METHODS AND RESULTS Ninety-three NBs and nine ganglioneuromas (GNs) were immunostained for VEGF-C, VEGF-D and VEGFR-3. VEGF-C and VEGF-D were present in 76% and 82% of the NBs, respectively. There was no significant difference in VEGF-C expression between NBs and GNs. VEGF-D expression was significantly higher in NBs compared with GNs and in MYCN-amplified NBs. VEGFR-3 tumoral cell expression (VEGFR-3c), present in 48% of the NBs, was significantly higher in NBs from children ≥ 18 months at presentation and those belonging to a high-risk group. VEGFR-3 lymphovascular density was increased significantly in NBs compared with GNs and in NBs associated with adverse clinicopathological and biological factors. Lymphovascular invasion, assessed in VEGFR-3-stained vessels, was present in ∼50% of NBs. Cox regression analyses demonstrated that VEGFR-3c expression was associated with a significantly shorter event-free survival and that its effect was independent of the important pathological variable, mitosis-karyorrhexis index. CONCLUSIONS VEGF-D and VEGFR-3 up-regulation support tumour progression in NB and VEGFR-3c may provide a useful prognostic marker in NBs.
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Affiliation(s)
- Pramila Ramani
- School of Cellular and Molecular Medicine, University of Bristol, School of Medical Sciences, University Walk, Bristol, UK.
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37
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Saccardi R, Freedman MS, Sormani MP, Atkins H, Farge D, Griffith LM, Kraft G, Mancardi GL, Nash R, Pasquini M, Martin R, Muraro PA. A prospective, randomized, controlled trial of autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: a position paper. Mult Scler 2012; 18:825-34. [PMID: 22383228 PMCID: PMC3389500 DOI: 10.1177/1352458512438454] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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] [Indexed: 12/29/2022]
Abstract
Background: Haematopoietic stem cell transplantation (HSCT) has been tried in the last 15 years as a therapeutic option in patients with poor-prognosis autoimmune disease who do not respond to conventional treatments. Worldwide, more than 600 patients with multiple sclerosis (MS) have been treated with HSCT, most of them having been recruited in small, single-centre, phase 1–2 uncontrolled trials. Clinical and magnetic resonance imaging outcomes from case series reports or Registry-based analyses suggest that a major response is achieved in most patients; quality and duration of response are better in patients transplanted during the relapsing–remitting phase than in those in the secondary progressive stage. Objectives: An interdisciplinary group of neurologists and haematologists has been formed, following two international meetings supported by the European and American Blood and Marrow Transplantation Societies, for the purpose of discussing a controlled clinical trial, to be designed within the new scenarios of evolving MS treatments. Conclusions: Objectives of the trial, patient selection, transplant technology and outcome assessment were extensively discussed. The outcome of this process is summarized in the present paper, with the goal of establishing the background and advancing the development of a prospective, randomized, controlled multicentre trial to assess the clinical efficacy of HSCT for the treatment of highly active MS.
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Affiliation(s)
- R Saccardi
- Hematology Department, Careggi University Hospital, Florence, Italy.
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38
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Sullivan K, Froshaug D, Furst D, Nash R, Mayes M, Crofford L, McSweeney P, Goldmuntz E, Keyes-Elstein L, Khanna D, Sullivan K, Woolson R, Wallace P, Sempowski G, McSweeney P, Mayes M, Crofford L, Nash R, Furst D, Storek J, Quirici N, Corti L, Scavullo C, Ferri C, Manfredi A, Giuggioli D, Lambertenghi Deliliers G, Del Papa N, Foeldvari I, Wierk A, Fargue D. S.1.1 Organ function and quality of life correlates at randomization on the SCOT (Scleroderma: Cyclophosphamide Or Transplantion) Trial. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker456] [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: 11/13/2022] Open
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39
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Abstract
STUDY OBJECTIVES To examine sleep health knowledge and beliefs and their relationship to sleep practices in a community sample of caregivers of young children. METHODS A convenience sample of caregivers visiting a museum on one of 2 consecutive weekend days completed a brief parent-report survey on child sleep habits and parental basic sleep knowledge and beliefs and attitudes regarding sleep as a health behavior. RESULTS Of the 253 analyzable surveys (response rate 80%; mean age of index child 3.4 ± 2.0 years), 23% of children did not have a consistent bedtime, 25% had a bedtime later than 9 pm, 23% had at least one electronic device in the bedroom, and 56% frequently fell asleep with an adult present. Both positive and negative sleep habits tended to cluster together. Children who had irregular and late bedtimes were more than twice as likely to obtain insufficient sleep that those with regular and early bedtimes (OR 2.30, 2.45). While 25% of children were getting less than the recommended sleep amount for age, just 13% of parents believed that their child was getting insufficient sleep. Lack of knowledge regarding the potential negative impact of specific sleep practices was associated with an increased likelihood of engaging in those practices. CONCLUSIONS The results of this survey study of a generally well-educated sample of caregivers suggest that there are clear parental knowledge gaps regarding healthy sleep in young children and supports the need for increased sleep health education.
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Affiliation(s)
- Judith A Owens
- Division of Ambulatory Pediatrics, Department of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA.
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Crosby RA, DiClemente RJ, Salazar LF, Nash R, Younge S, Head S. Human papillomavirus vaccine intention among college men: what's oral sex got to do with it? J Am Coll Health 2012; 60:8-12. [PMID: 22171724 DOI: 10.1080/07448481.2011.552538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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
OBJECTIVE To identify associations between engaging in oral sex and perceived risk of oral cancer among college men. Also, to identify associations, and their moderating factors, between oral sex and human papillomavirus (HPV) vaccine acceptance. METHODS Young men were recruited from 2 university campuses in the South (N = 150). Men completed an audio computer-assisted self-administered interview. RESULTS With the exception of receiving fellatio, each measure of oral sex behavior was significantly associated with greater perceived risk of oral cancer. Four oral sex behaviors evidenced significant associations with vaccine acceptance. Men engaging in recent oral sex or reporting oral sex behaviors with more than 2 partners were more likely to indicate vaccine intent. African American/black race, communication with parents about sex-related topics, and HPV-related stigma/shame were identified as moderating factors. CONCLUSION Young college men giving or receiving oral sex with multiple partners may be predisposed to HPV vaccination.
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Affiliation(s)
- Richard A Crosby
- College of Public Health and the Rural Cancer Prevention Center, University of Kentucky, Lexington, Kentucky, USA.
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Abstract
We aimed to determine whether the type of outcome expectation, stemming from HPV vaccination, would have any effect on young men's HPV vaccine intent. We recruited young men (18-24 years of age) from two university campuses (n = 150). After answering a series of questions they were randomly assigned to one of three information conditions (all delivered by computer): (1) how women may benefit from men's HPV vaccination, (2) preventing genital warts and (3) preventing head and neck cancers. Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition. A repeated-measures t-test indicated that a significant increase in young men's intent to be vaccinated after they received the assigned information (t = 9.48, [147], P = 0.0001). However, the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups (F = 0.59, [2/144], P = 0.56). Information that promotes the outcome expectations of protecting women from cervical cancer, preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men.
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Affiliation(s)
- R J DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, GA, USA
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Crosby RA, DiClemente RJ, Salazar LF, Nash R, Younge S. Gardasil for guys: correlates of intent to be vaccinated. Journal of Men's Health 2011. [DOI: 10.1016/j.jomh.2011.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Carotid body tumours cause characteristic splaying of the internal and external carotid arteries, known as ‘Lyre Sign’. Vagal paragangliomas are rare tumours that arise from glomus cells along the length of the vagus nerve. We present a case in which a vagal paraganglioma has arisen from the vagus nerve at the carotid bifurcation, and has mimicked the ‘Lyre Sign’ of a carotid body tumour.
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Affiliation(s)
- R Nash
- Northwick Park Hospital, London, UK
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44
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Abdurahman E, Houghton P, Nash R, Mahmood N. Irvingia gabonensis : inhibition of glycosidase activity and blockage of growth of Juman Immunodeficiency Virus (HIV) in vitro. ACTA ACUST UNITED AC 2010. [DOI: 10.4314/wajpdr.v11i1.53381] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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45
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Tyreman M, Abbott KM, Willatt LR, Nash R, Lees C, Whittaker J, Simonic I. High resolution array analysis: diagnosing pregnancies with abnormal ultrasound findings. J Med Genet 2009; 46:531-41. [PMID: 19451135 DOI: 10.1136/jmg.2008.065482] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M Tyreman
- Medical Genetics Department, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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46
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Hirschman JE, Engel S, Hong E, Balakrishnan R, Christie K, Costanzo M, Dwight S, Fisk D, Nash R, Park J, Skrzypek M, Dolinski K, Livstone M, Oughtred R, Andrada R, Binkley G, Dong Q, Hitz B, Miyasoto S, Schroeder M, Weng S, Wong E, Botstein D, Cherry JM. The
Saccharomyces
Genome Database provides comprehensive information about the biology of
S. cerevisiae
and tools for studies in comparative genomics. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a264-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jodi Ellen Hirschman
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - S. Engel
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - E. Hong
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - R. Balakrishnan
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - K. Christie
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - M. Costanzo
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - S. Dwight
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - D. Fisk
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - R. Nash
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - J. Park
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - M. Skrzypek
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - K. Dolinski
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - M. Livstone
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - R. Oughtred
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - R. Andrada
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - G. Binkley
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - Q. Dong
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - B. Hitz
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - S. Miyasoto
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - M. Schroeder
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - S. Weng
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - E. Wong
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
| | - D. Botstein
- Lewis‐Sigler Institute for Integrative Genomics, Princeton UniversityCarl Icahn Lab Room 134, Washington RoadPrincetonNJ08544
| | - J. M. Cherry
- Department of GeneticsStanford University, Stanford University School of MedicineStanfordMA94305‐5120
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Mcsweeney P, Pasquini M, Kukreja M, Bredeson C, Nash R, Horowitz M, Atkins H. 86: Hematopoietic stem cell transplantation (HCT) for autoimmune diseases (AI). Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.090] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This article outlines the chaotic proliferation of multicultural micro-literacies over the decades since the Canadian government first brought the concept of multiculturalism to the national stage in the mid-1960s. The authors define multicultural literacy in terms of patterned and sustained orientations to multiculturalism discourse — orientations that manifest themselves by way of recurrent social and textual practices. In the years prior to 1988 and the official enactment of multiculturalism in Canada, the discourse lent itself to naïve and largely optimistic renderings in a phase of literacy development described in the essay as protoliteracy. Subsequent efforts by the Canadian government to mute the discourse, even as it made multiculturalism into official policy, cleared the way for a post-literate multiplication of multicultural literacies in this country, which severely fragmented and undermined the discourse in the process.
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Affiliation(s)
| | - Rachel Nash
- Department of English, University of Waterloo
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49
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Ellis IO, Coleman D, Wells C, Kodikara S, Paish EM, Moss S, Al-Sam S, Anderson N, Bobrow L, Buley I, Connolly CE, Dallimore NS, Hales S, Hanby A, Humphreys S, Knox F, Lowe J, Macartney J, Nash R, Parham D, Patnick J, Pinder SE, Quinn CM, Robertson AJ, Shrimankar J, Walker RA, Winder R. Impact of a national external quality assessment scheme for breast pathology in the UK. J Clin Pathol 2006; 59:138-45. [PMID: 16443727 PMCID: PMC1860326 DOI: 10.1136/jcp.2004.025551] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This article presents the results and observed effects of the UK National Health Service Breast Screening Programme (NHSBSP) external quality assurance scheme in breast histopathology. AIMS/METHODS The major objectives were to monitor and improve the consistency of diagnoses made by pathologists and the quality of prognostic information in pathology reports. The scheme is based on a twice yearly circulation of 12 cases to over 600 registered participants. The level of agreement was generally measured using kappa statistics. RESULTS Four main situations were encountered with respect to diagnostic consistency, namely: (1) where consistency is naturally very high-this included diagnosing in situ and invasive carcinomas (and certain distinctive subtypes) and uncomplicated benign lesions; (2) where the level of consistency was low but could be improved by making guidelines more detailed and explicit-this included histological grading; (3) where consistency could be improved but only by changing the system of classification-this included classification of ductal carcinoma in situ; and (4) where no improvement in consistency could be achieved-this included diagnosing atypical hyperplasia and reporting vascular invasion. Size measurements were more consistent for invasive than in situ carcinomas. Even in cases where there is a high level of agreement on tumour size, a few widely outlying measurements were encountered, for which no explanation is readily forthcoming. CONCLUSIONS These results broadly confirm the robustness of the systems of breast disease diagnosis and classification adopted by the NHSBSP, and also identify areas where improvement or new approaches are required.
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Affiliation(s)
- I O Ellis
- Department of Histopathology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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50
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Parham DM, Coleman D, Kodikara S, Moss S, Ellis IO, Al-Sam S, Anderson N, Bobrow L, Buley I, Connolly CE, Dallimore NS, Hales S, Hanby A, Humphreys S, Knox F, Lowe J, Macartney J, Nash R, Patnick J, Pinder SE, Quinn CM, Robertson AJ, Shrimankar J, Walker RA, Wells C, Winder R, Patel N. The NHS breast screening programme (pathology) EQA: experience in recent years relating to issues involved in individual performance appraisal. J Clin Pathol 2006; 59:130-7. [PMID: 16443726 PMCID: PMC1860311 DOI: 10.1136/jcp.2004.025619] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The original role of the National Health Service breast screening programme (pathology) external quality assessment (EQA) scheme was educational; it aimed to raise standards, reinforce use of common terminology, and assess the consistency of pathology reporting of breast disease in the UK. AIMS/METHODS To examine the performance (scores) of pathologists participating in the scheme in recent years. The scheme has evolved to help identify poor performers, reliant upon setting an acceptable cutpoint. Therefore, the effects of different cutpoint strategies were evaluated and implications discussed. RESULTS/CONCLUSIONS Pathologists who joined the scheme improved over time, particularly those who did less well initially. There was no obvious association between performance and the number of breast cancer cases reported each year. This is not unexpected because the EQA does not measure expertise, but was established to demonstrate a common level of performance (conformity to consensus) for routine cases, rather than the ability to diagnose unusual/difficult cases. A new method of establishing cutpoints using interquartile ranges is proposed. The findings also suggest that EQA can alter a pathologist's practice: those who leave the scheme (for whatever reason) have, on average, marginally lower scores. Consequently, with the cutpoint methodology currently used (which is common to several EQA schemes) there is the potential for the cutpoint to drift upwards. In future, individuals previously deemed competent could subsequently be erroneously labelled as poor performers. Due consideration should be given to this issue with future development of schemes.
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Affiliation(s)
- D M Parham
- Department of Pathology, Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, UK.
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